Reis Chen, Heisler Michele, Amowitz Lynn L, Moreland R Scott, Mafeni Jerome O, Anyamele Chukwuemeka, Iacopino Vincent
Physicians for Human Rights, Boston, Massachusetts, USA.
PLoS Med. 2005 Aug;2(8):e246. doi: 10.1371/journal.pmed.0020246. Epub 2005 Jul 19.
Nigeria 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.
Fifty-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.
While 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.
尼日利亚估计有360万艾滋病毒/艾滋病患者，全球每11名艾滋病毒/艾滋病患者中就有1人来自该国。本研究是对一个国家卫生部门中针对艾滋病毒/艾滋病感染者的歧视进行的首次基于人群的评估。本研究的目的是描述卫生部门歧视行为和态度的性质及程度，并指出可能的促成因素和干预策略。该研究对尼日利亚四个州111个医疗机构中的1021名尼日利亚卫生保健专业人员（包括按职业确定的324名医生、541名护士和133名助产士）进行了横断面调查。
54%的卫生保健专业人员（550/1021）来自公立三级医疗机构。9%的专业人员报告拒绝为艾滋病毒/艾滋病患者提供护理，9%表示他们拒绝艾滋病毒/艾滋病患者入院。59%的人同意艾滋病毒/艾滋病患者应住在单独的病房，40%的人认为可以通过外表判断一个人的艾滋病毒感染状况。91%的人同意当患者艾滋病毒呈阳性时应告知工作人员和卫生保健专业人员，以便他们保护自己。40%的人认为感染艾滋病毒/艾滋病的卫生保健专业人员不应被允许在任何需要接触患者的卫生保健领域工作。20%的人同意许多艾滋病毒/艾滋病感染者行为不道德，活该患病。治疗和预防艾滋病毒所需的基本物资供应不足。12%的人同意治疗艾滋病毒/艾滋病患者的机会性感染浪费资源，8%的人表示治疗艾滋病毒/艾滋病患者是浪费宝贵资源。报告在并非始终采取普遍预防措施的机构工作的提供者更倾向于对艾滋病毒/艾滋病感染者采取限制性政策。报告在艾滋病毒治疗和伦理方面培训不足的提供者也更有可能报告对艾滋病毒/艾滋病患者持消极态度。在所调查的不同卫生专业中，消极态度和行为没有一致的差异模式。
虽然大多数接受调查的卫生保健专业人员报告称，尽管资源匮乏，但他们仍遵守道德义务，但在所调查州的相当一部分卫生保健专业人员中，存在对艾滋病毒/艾滋病患者的歧视行为和态度。对艾滋病毒/艾滋病的教育不足以及缺乏防护和治疗物资似乎促成了这些行为和态度。
