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艾滋病毒/艾滋病患者、隐私与保密;加纳阿散蒂地区两家健康中心的案例

HIV/AIDS clients, privacy and confidentiality; the case of two health centres in the Ashanti Region of Ghana.

作者信息

Dapaah Jonathan Mensah, Senah Kodjo A

机构信息

Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Department of Sociology, University of Ghana, Legon, Accra, Ghana.

出版信息

BMC Med Ethics. 2016 Jul 16;17(1):41. doi: 10.1186/s12910-016-0123-3.

Abstract

BACKGROUND

While most studies on HIV/AIDS often identify stigmatization and patients' unwillingness to access health care as critical problems in the control of the pandemic, very few studies have focused on the possible consequences of accessing health care by sero-positives. This paper examines the socio-psychological trauma patients experience in their desire to access health care in two health facilities in the Ashanti Region of Ghana.

METHODS

Through participant observation, informal conversation and in-depth interviews, data were collected from health workers and clients of the voluntary counselling (VCT) and antiretroviral therapy units in the two hospitals. The data gathered were analysed and categorized into themes and supported with illustrative quotes obtained from health workers and clients.

RESULTS

The study found that the mere presence of a person at the HIV counselling centre or clinic is enough for the person to be labelled as or suspected to be HIV patient. It demonstrates that stigmatization may occur not only in the community but also overtly or covertly, in the health facility itself. Consequently, for many HIV/AIDS patients, access to antiretroviral therapy and treatment of related nosocomial infections are problematic. Besides, the study found that many clients and potential users of services were uncomfortable with the quality of care given by some health workers, especially as they overtly and covertly breached confidentiality about their clients' health status. This has compelled many patients and potential users of the services to adopt a modus vivendi that provides them access to some care services while protecting their identity.

CONCLUSION

The paper argues that by examining issues relating to privacy and confidentiality in the provision of care for and use of services by seropositives, more light will be shed on the whys of the limited uptake of HIV-related health care services in Ghana.

摘要

背景

虽然大多数关于艾滋病毒/艾滋病的研究常常将污名化以及患者不愿寻求医疗保健视为控制这一流行病的关键问题,但极少有研究关注血清反应呈阳性者寻求医疗保健可能产生的后果。本文探讨了加纳阿散蒂地区两家医疗机构中患者在寻求医疗保健时所经历的社会心理创伤。

方法

通过参与观察、非正式交谈和深入访谈,从两家医院的自愿咨询检测(VCT)和抗逆转录病毒治疗科室的医护人员及服务对象那里收集数据。对收集到的数据进行分析并归类成主题,并用从医护人员和服务对象那里获取的说明性引语加以佐证。

结果

研究发现,一个人只要出现在艾滋病毒咨询中心或诊所,就足以被贴上艾滋病毒患者的标签或被怀疑是艾滋病毒患者。这表明污名化不仅可能在社区中出现,在医疗机构内部也可能公开或隐蔽地发生。因此,对于许多艾滋病毒/艾滋病患者来说,获取抗逆转录病毒治疗以及治疗相关医院感染存在问题。此外,研究发现许多服务对象和潜在服务使用者对一些医护人员提供的护理质量感到不满,尤其是因为他们公开或隐蔽地泄露了客户的健康状况。这迫使许多患者和潜在服务使用者采取一种妥协方式,在保护自己身份的同时能够获得一些护理服务。

结论

本文认为,通过审视在为血清反应呈阳性者提供护理和服务使用方面与隐私和保密相关的问题,将能更清楚地了解加纳艾滋病毒相关医疗保健服务利用率有限的原因。

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