Sekoni O O, Owoaje E T
Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Afr J Med Med Sci. 2013 Mar;42(1):47-57.
Stigma and discrimination pose major obstacles to accessing care and support by People Living With HIV/AIDS (PLWHA). Information on HIV stigma and discrimination towards PLWHA among Nigerian health workers has mainly been at higher levels of care. This paper examined HIV stigma and discrimination at the primary health care level with the objective of identifying its occurrence and determinants among health workers at this level.
A total sample of all health care workers (341) at the primary health care level in Ilorin, Kwara State were surveyed via questionnaire between July and August 2007 to obtain information on their sociodemographic characteristics and the four domains of stigma viz: fear of casual transmission of HIV, shame and blame, discrimination and disclosure.
Majority of the respondents had fear of casual transmission of HIV (87.7%), exhibited shame and blame (89.4%), reported observing discrimination against PLWHA by other health workers in their facilities (97.7%) and believed that disclosure of patients HIV status to health workers was imperative. Nurses/midwives were more likely to have fear of casual transmission of HIV and believe that disclosure of HIV status of patients was imperative. Respondents who had received in service training were less likely to exhibit shame and blame (p < 0.05).
Stigma occurred in all stigma domains among this group of health workers but previous training was found to play a role in the reduction of shame and blame. Training of health care workers within the context of the various stigma domains is advocated.
耻辱感和歧视对艾滋病毒/艾滋病感染者(PLWHA)获得护理和支持构成了重大障碍。关于尼日利亚卫生工作者对PLWHA的艾滋病毒耻辱感和歧视的信息主要来自更高层级的医疗机构。本文研究了初级卫生保健层面的艾滋病毒耻辱感和歧视情况,目的是确定其在这一层级卫生工作者中的发生情况和决定因素。
2007年7月至8月期间,通过问卷调查对夸拉州伊洛林初级卫生保健层面的所有医护人员(共341人)进行了抽样调查,以获取他们的社会人口学特征信息以及耻辱感的四个方面,即:对艾滋病毒偶然传播的恐惧、羞耻和指责、歧视以及信息披露。
大多数受访者存在对艾滋病毒偶然传播的恐惧(87.7%),表现出羞耻和指责(89.4%),报告称观察到所在机构的其他卫生工作者歧视PLWHA(97.7%),并认为向卫生工作者披露患者的艾滋病毒状况势在必行。护士/助产士更有可能害怕艾滋病毒的偶然传播,并认为披露患者的艾滋病毒状况势在必行。接受过在职培训的受访者表现出羞耻和指责的可能性较小(p < 0.05)。
在这群卫生工作者中,所有耻辱感方面都存在耻辱现象,但发现先前的培训在减少羞耻和指责方面发挥了作用。提倡在各种耻辱感方面的背景下对医护人员进行培训。