Doctors and nurses with HIV and AIDS in sub-Saharan Africa

Ncayiyana, Dan

doi:10.1136/bmj.329.7466.584

Cited by 26 publications

(14 citation statements)

References 3 publications

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“…Over the coming years, sub-Saharan African health systems may lose up to one-fifth of their employees to HIV/AIDS [3]. This attrition may have a severe impact on regional human resources for health capacity, leaving critical efforts, such as the general roll out of antiretroviral therapy (ART), barely feasible [7,8]. However, while health workers tend to know where to go to obtain an HIV test, reluctance to test and low access to post-exposure prophylaxis (PEP) has been found in the literature [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“Othering” the health worker: self‐stigmatization of HIV/AIDS care among health workers in Swaziland

Vries

Galvin

Mhlanga

et al. 2011

Journal of the International AIDS Society

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BackgroundHIV is an important factor affecting healthcare workforce capacity in high-prevalence countries, such as Swaziland. It contributes to loss of valuable healthcare providers directly through death and absenteeism and indirectly by affecting family members, increasing work volume and decreasing performance. This study explored perceived barriers to accessing HIV/AIDS care and prevention services among health workers in Swaziland. We asked health workers about their views on how HIV affects Swaziland's health workforce and what barriers and strategies health workers have for addressing HIV and using healthcare treatment facilities.MethodsThirty-four semi-structured, in-depth interviews, including a limited set of quantitative questions, were conducted among health workers at health facilities representing the mixture of facility type, level and location found in the Swaziland health system. Data were collected by a team of Swazi nurses who had received training in research methods. Study sites were selected using a purposive sampling method while health workers were sampled conveniently with attention to representing a mixture of different cadres. Data were analyzed using Nvivo qualitative analysis software and Excel.ResultsHealth workers reported that HIV had a range of negative impacts on their colleagues and identified HIV testing and care as one of the most important services to offer health workers. They overwhelmingly wanted to know their own HIV status. However, they also indicated that in general, health workers were reluctant to access testing or care as they feared stigmatization by patients and colleagues and breaches of confidentiality. They described a self-stigmatization related to a professional need to maintain a HIV-free status, contrasting with the HIV-vulnerable general population. Breaching of this boundary included feelings of professional embarrassment and fear of colleagues' and patients' judgements.ConclusionsWhile care is available and relatively accessible, Swaziland health workers still face unique usage barriers that relate to a self-stigmatizing process of boundary maintenance - described here as a form of "othering" from the HIV-vulnerable general population - and a lack of trust in privacy and confidentiality. Interventions that target health workers should address these issues.

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Section: Introductionmentioning

confidence: 99%

“Othering” the health worker: self‐stigmatization of HIV/AIDS care among health workers in Swaziland

Vries

Galvin

Mhlanga

et al. 2011

Journal of the International AIDS Society

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“…While the HIV prevalence rate among health workers in Malawi is not known, studies conducted elsewhere suggest that AIDS is a major cause of death among health workers in high prevalence countries (World Health Organization [WHO], 2006). In South Africa a study conducted by Human Sciences Research Council (HSRC) found a prevalence rate of 15.7% amongst health workers and that between 1997 and 2001, 13% of the health workers had died from HIV- and AIDS-related illnesses including TB (Ncayiyana, 2004; Shisana et al, 2002). …”

Section: Introductionmentioning

confidence: 99%

Negotiating multiple barriers: health workers' access to counselling, testing and treatment in Malawi

et al. 2010

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Malawi is facing a severe HIV and AIDS epidemic with an estimated 12% of its population living with the virus. Health workers are on the front lines of the HIV epidemic and they face the risk of HIV infection in both their personal and professional lives. This mixed method study aimed to explore the enablers and barriers to HIV counselling and testing and antiretroviral therapy by health workers in Malawi. After qualitative data were collected through in-depth interviews with health workers in the Mchinji and Nsanje districts, a survey questionnaire was constructed and administered to 906 health workers in eight districts in Malawi. A majority (76%) of health workers surveyed reported having undergone HIV testing and counselling, of whom 74% reported repeat testing. A striking result of the study is that 22% of health workers reported testing after occupational exposure to HIV. The proportions of respondents reporting that they tested after experiencing symptoms, or self-testing for HIV were 11% each. The in-depth interviews and the survey revealed multiple challenges that health workers face to accessing HIV testing, counselling and treatment, including fear of a positive result, fear of stigma and lack of confidentiality. Additional barriers included health workers’ personal acquaintance with those conducting testing, along with their perception of being “role models” which could exacerbate their fears about confidentiality. Given health workers’ critical role in HIV delivery in Malawi, there is need to develop solutions to help health workers overcome these barriers.

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“…In many African countries, current concerns about the health labour market focus on overall poor working conditions, shortages of skilled personnel, skewed distributions within countries, a rapidly increasing external brain drain and impact of HIV/ AIDS, which is aggravating and accelerating these problems (Dovlo 2005;Kober & Van Damme 2004;Narasimhan 2004;Ncayiyana 2004;Thupayagale-Tshweneagae 2007;Van Damme et al 2008;WHO & UNAIDS 2006). Adaptation of actual ART delivery models (which are doctor-intensive) to make them less HRH-intensive is needed (Dovlo 2004;Hongoro & McPake 2004).…”

Section: Introductionmentioning

confidence: 99%

Involving new actors to achieve ART scaling‐up: difficulties in an HIV/AIDS counselling and testing centre in Cameroon

Yakam

Gruénais

2009

International Nursing Review

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The study was qualitative. Observations were carried out in the service and in-depth interviews conducted with health workers and actors of Cameroon's National AIDS Control Committee. These interviews were recorded and transcribed. The material was analysed using keywords. KEY RESULT: The involvement of new actors in a context of human resources for health shortage and health system crisis creates confusion and role conflicts, which lead to frustration. It favours the appearance of chinks within which these new actors slip and 'find their way' in the system; it finally raises problems related to their legitimacy and position within the existing hierarchy. KEY POLICY MESSAGE: It is necessary, when involving new staff members (particularly when they do not belong to internationally recognized health professionals such as nurses, doctors and pharmacists), to redefine roles and build precise task-shifting procedures so that everyone may still have a place in the whole system and feel useful.

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Doctors and nurses with HIV and AIDS in sub-Saharan Africa

Abstract: “We're going to run out of people before we run out of money”

Cited by 26 publications

References 3 publications

“Othering” the health worker: self‐stigmatization of HIV/AIDS care among health workers in Swaziland

“Othering” the health worker: self‐stigmatization of HIV/AIDS care among health workers in Swaziland

Negotiating multiple barriers: health workers' access to counselling, testing and treatment in Malawi

Involving new actors to achieve ART scaling‐up: difficulties in an HIV/AIDS counselling and testing centre in Cameroon

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