Discriminatory Attitudes and Practices by Health Workers toward Patients with HIV/AIDS in Nigeria

Abstract

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.

Perceptions of Stigma and Discrimination in Health Care Settings Towards Sub-Saharan African Migrant Women Living With Hiv/Aids in Belgium: A Qualitative Study

“…Generally, participants acknowledged that the magnitude of stigma and/or discrimination has greatly decreased compared with previous years. As in previous studies (Surlis & Hyde, 2001;Letamo, 2005;Reis et al, 2005;Mahendra et al, 2007;Feyissa et al, 2012;Ekstrand et al, 2013), this study found some variation in the causes of stigma and discrimination in health care settings. It confirms that existing stigma and discrimination in society, transmission-related fear and institutional policies on HIV management, as well as lack of proper knowledge of HIV amongst health care workers not directly involved in the treatment of SSA migrant women with HIV, drive and endorse stigma feelings and discriminatory attitudes.…”

Attitude of health care workers to patients and colleagues infected with human immunodeficiency virus

“…Negative attitudes towards HIV-infected colleagues were also noted in previous studies in Nigeria, in which 43.6% of the HCWs studied were uncomfortable being assisted by an infected colleague, and 51.1% were uncomfortable sharing a bathroom with an infected colleague (Aisien & Shobowale, 2005). In another study (Reis et al, 2005), 40% of HCWs believed that infected HCWs should not be allowed to work in any area of health care that requires patient contact.…”

“…Studies have documented negative attitudes to PLWHA in health care settings in Nigeria and elsewhere (Adelekan et al, 1995;Fido & Al Kamezi, 2002;Hentgen, Jaureguiberry, Ramiliarisoa, Andrianantoandro & Belec, 2002;Quach, Mayer, McGarvey, Lurie & Do, 2005;Reis et al, 2005). Physicians and nurses have been reported to be uncomfortable when administering medical procedures to HIV-infected patients (Oyeyemi, Oyeyemi & Bello, 2006;Oyeyemi, Oyeyemi & Bello, 2008), while in one study (Fransman, McCulloch, Lavies & Hussey, 2000) more than half of respondents were found to be reluctant to perform invasive procedures on HIV-infected children.…”

Nurses’ knowledge and attitude to the care of HIV/AIDS patients in South East, Nigeria

“…12,20,21 Similarly, studies from several countries identified the various factors affecting stigmatized and discriminatory attitudes toward PLWHA among Health Care Workers to include level of irrational fear of HIV transmission, level of education, gender, stage of the disease, high-risk taking behaviour, individuals related to stigmatized identities, sources of HIV infection, relationship with an infected person, type of hospital, ethnicity and urbanrural locality. 22,23 To date, with the increasing knowledge of modes of transmission and infection-control measures, guidelines have now been established to ensure that staff and patients are adequately protected within the last decade. Unfortunately, it is believed that much fear and ignorance still exist.…”