Bott Sarah, Neuman Melissa, Helleringer Stephane, Desclaux Alice, Asmar Khalil El, Obermeyer Carla Makhlouf
Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon, Institute for Global Health, University College London, London, UK, Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA and Institut de Recherche pour le Développement, Unité Mixte Internationale de Recherche Translationnelle sur le VIH et les Maladies Infectieuses Dakar, Sénégal.
Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon, Institute for Global Health, University College London, London, UK, Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA and Institut de Recherche pour le Développement, Unité Mixte Internationale de Recherche Translationnelle sur le VIH et les Maladies Infectieuses Dakar, Sénégal
Health Policy Plan. 2015 Oct;30(8):964-75. doi: 10.1093/heapol/czu100. Epub 2014 Sep 17.
The rapid scale-up of human immunodeficiency virus (HIV) testing, counselling and treatment throughout sub-Saharan Africa has raised questions about how to protect patients' rights to consent, confidentiality, counselling and care in resource-constrained settings. The Multi-country African Testing and Counselling for HIV (MATCH) study investigated client and provider experiences with different modes of testing in sub-Saharan Africa. One component of that study was a survey of 275 HIV service providers in Burkina Faso, Kenya and Uganda that gathered quantifiable indicators and qualitative descriptions using a standardized instrument. This article presents provider perspectives on the challenges of obtaining consent, protecting confidentiality, providing counselling and helping clients manage disclosure. It also explores health workers' fear of infection within the workplace and their reports on discrimination against HIV clients within health facilities. HIV care providers in Burkina Faso, Kenya and Uganda experienced substantial rewards from their work, including satisfaction from saving lives and gaining professional skills. They also faced serious resource constraints, including staff shortages, high workloads, lack of supplies and inadequate infrastructure, and they expressed concerns about accidental exposure. Health workers described heavy emotional demands from observing clients suffer emotional, social and health consequences of being diagnosed with HIV, and also from difficult ethical dilemmas related to clients who do not disclose their HIV status to those around them, including partners. These findings suggest that providers of HIV testing and counselling need more resources and support, including better protections against HIV exposure in the workplace. The findings also suggest that health facilities could improve care by increasing attention to consent, privacy and confidentiality and that health policy makers and ethicists need to address some unresolved ethical dilemmas related to confidentiality and non-disclosure, and translate those discussions into better guidance for health workers.
在撒哈拉以南非洲地区迅速扩大人类免疫缺陷病毒（HIV）检测、咨询和治疗工作引发了一些问题，即在资源有限的情况下如何保护患者的同意权、保密权、咨询权和护理权。多国非洲HIV检测与咨询（MATCH）研究调查了撒哈拉以南非洲地区客户和服务提供者在不同检测模式下的经历。该研究的一个组成部分是对布基纳法索、肯尼亚和乌干达的275名HIV服务提供者进行调查，使用标准化工具收集可量化指标和定性描述。本文介绍了服务提供者对于获得同意、保护保密、提供咨询以及帮助客户应对信息披露方面所面临挑战的看法。还探讨了卫生工作者在工作场所对感染的恐惧以及他们关于医疗机构内对HIV患者歧视的报告。布基纳法索、肯尼亚和乌干达的HIV护理服务提供者从工作中获得了巨大回报，包括因拯救生命和获得专业技能而产生的满足感。他们也面临严重的资源限制，包括人员短缺、工作量大、物资匮乏和基础设施不足，并且他们表达了对意外暴露的担忧。卫生工作者描述了因观察客户遭受感染HIV带来的情感、社会和健康后果而产生的沉重情感负担，以及因与那些不向周围人（包括伴侣）透露其HIV感染状况的客户相关的艰难伦理困境而产生的负担。这些发现表明，HIV检测和咨询服务提供者需要更多资源和支持，包括在工作场所更好地预防HIV暴露。这些发现还表明，医疗机构可以通过更多关注同意、隐私和保密来改善护理，并且卫生政策制定者和伦理学家需要解决一些与保密和不披露相关的未解决的伦理困境，并将这些讨论转化为对卫生工作者更好的指导。
