BackgroundNigeria has an estimated 3.6 million people with HIV/AIDS and is home to one out of every 11 people with HIV/AIDS worldwide. This study is the first population-based assessment of discrimination against people living with HIV/AIDS in the health sector of a country. The purpose of this study was to characterize the nature and extent of discriminatory practices and attitudes in the health sector and indicate possible contributing factors and intervention strategies. The study involved a cross-sectional survey of 1,021 Nigerian health-care professionals (including 324 physicians, 541 nurses, and 133 midwives identified by profession) in 111 health-care facilities in four Nigerian states.Methods and FindingsFifty-four percent of the health-care professionals (550/1,021) were sampled from public tertiary care facilities. Nine percent of professionals reported refusing to care for an HIV/AIDS patient, and 9% indicated that they had refused an HIV/AIDS patient admission to a hospital. Fifty-nine percent agreed that people with HIV/AIDS should be on a separate ward, and 40% believed a person's HIV status could be determined by his or her appearance. Ninety-one percent agreed that staff and health-care professionals should be informed when a patient is HIV-positive so they can protect themselves. Forty percent believed that health-care professionals with HIV/AIDS should not be allowed to work in any area of health-care that requires patient contact. Twenty percent agreed that many with HIV/AIDS behaved immorally and deserve the disease. Basic materials needed for treatment and prevention of HIV were not adequately available. Twelve percent agreed that treatment of opportunistic infections in HIV/AIDS patients wastes resources, and 8% indicated that treating someone with HIV/AIDS is a waste of precious resources. Providers who reported working in facilities that did not always practice universal precautions were more likely to favor restrictive policies toward people with HIV/AIDS. Providers who reported less adequate training in HIV treatment and ethics were also more likely to report negative attitudes toward patients with HIV/AIDS. There was no consistent pattern of differences in negative attitudes and practices across the different health specialties surveyed.ConclusionWhile most health-care professionals surveyed reported being in compliance with their ethical obligations despite the lack of resources, discriminatory behavior and attitudes toward patients with HIV/AIDS exist among a significant proportion of health-care professionals in the surveyed states. Inadequate education about HIV/AIDS and a lack of protective and treatment materials appear to contribute to these practices and attitudes.
Sexual violence committed by combatants in Sierra Leone was widespread and was perpetrated in the context of a high level of human rights abuses against the civilian population.
Women in most of Herat Province, Afghanistan, have a high risk of maternal mortality. Human rights factors may contribute to preventable maternal deaths in the region.
Platform for Action) clearly articulated the need for women to have access to sexual and reproductive health services, including those for family planning, antenatal and delivery care, safe abortion where legal, postabortion care and treatment for sexually transmitted infections. They further recognised that refugee and internally displaced populations have particular reproductive health needs that must be met. These international agreements also stress the right of women to be free from all forms of violence and coercion. They have highlighted the multiple forms of violence against women, including intimate partner violence, sexual coercion, exploitation and rape in 'peaceful' times as well as during conflict situations.Inspite of these agreements and the increased attention to the issues, many women around the world lack access to quality sexual and reproductive health services. For those living in countries experiencing emergencies (mainly armed conflicts and natural disasters), access to these services is even more restricted. The situation is worst for those crises in which there is displacement of the population. It is estimated that approximately 75% of those displaced by crises worldwide are women and children, 1 and it is often they who bear the brunt of conflicts, facing daily deprivation and insecurity. Until recently, violence against women in emergencies, including in the context of displacement, received little attention from the international community, and there is much that is still unknown. Violence, however, particularly in the form of intimate partner violence, including during pregnancy, 2-5 and sexual violence against women and girls, is increasingly documented in crises. The latter is particularly a problem in crises associated with armed conflict where rape and other forms of sexual violence are used to humiliate and intimidate civilians and as a specific tactic in campaigns of ethnic cleansing. 6 In Bosnia and Herzegovina, for instance, rape was deliberately employed to demoralise men and women held in captivity. 7 In Darfur, Sudan, there were (and continue to be) widespread reports of women and girls abducted and raped, while in Colombia, gender-based violence including rape followed by murder, sexual servitude, coerced contraception and abortions perpetrated by armed actors was found to be extensive. 8,9 For women and girls, in particular, conflict situations from which they will usually try to flee present a sexually unsafe environment: at every stage of flight, displaced women and girls are vulnerable to rape and sexual abuse. They may be forced to exchange sex for money or basic resources as a survival strategy, and it is likely to be even harder for them to take protective measures than in nonemergency, nonrefugee situations. Furthermore, anecdotal reports suggest that other forms of gender-based violence, such as trafficking, sexual exploitation by humanitarian actors, and domestic violence may increase in the wake of conflict. 10 Women living in conflict situations or in camps fo...
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