Rude doctors = deprived patients

Ugandan health workers' ill-treatment of HIV-positive people could adversely affect the access of these patients to treatment, a new study by local NGO Uganda Network for Law Ethics and HIV/AIDS (UGANET) has revealed.



The baseline survey, HIV/AIDS and Human Rights Violations in Uganda, surveyed 600 people in five Ugandan districts, and found that rude and unapproachable doctors and nurses intimidated HIV-positive people to the extent that patients were too afraid to consult them about issues such as the correct administration of medicines.



"Some health workers say that they do not waste their medicine on a dead body; they blame us for bringing the disease," said one respondent, from the eastern district of Pallisa. "One day I cried when health staff were pointing at me, [saying] that it was not possible for me to survive even if they put me on ARVs."



Another patient complained that because she had tuberculosis, she was rudely ordered to wait for her appointment far away from the health workers lest she infect them with the disease.



"It has come out clearly and persistently that indeed some health workers discriminate against people with HIV, yet they should be accorded the most care and treatment considering the situation in which they live," said Musiime Michael Koima, assistant programme officer at UGANET.



The report found that patients' access to treatment was also hampered by the long distance from patients' homes to health units, frequent cases of drugs being out of stock, and the amount of time spent waiting for medicines. Patients spent up to eight hours waiting to refill their antiretroviral prescriptions and reported that health workers often showed up late for work.



Stigma



According to a recent study by the International Center for Research on Women (ICRW), the health sector is one of the main settings where HIV-positive individuals, and those perceived to be infected, experience stigma and discrimination.



"Studies show that HIV-related stigma in this context is pernicious, and that its physical and mental health consequences to patients can be damaging," the authors said. "Both experienced and perceived stigma and discrimination are associated with reduced utilization of prevention services - including programmes to prevent mother to child transmission, HIV testing and counselling - and accessing care and treatment."



The ICRW study recommended increasing awareness among health workers of what stigma is and the benefits of reducing it; addressing health workers' fears and misconceptions about HIV transmission; ensuring that health workers have the information, supplies and equipment necessary to practice universal precautions; and preventing occupational transmission of HIV - such as gloves for invasive procedures, containers for sharp medical instruments, and disinfectant for hand-washing - and specific policies related to the care of patients with HIV.



"With sensitization about the rights of people living with HIV, ethics and human rights in general, the health worker-patient relationship will improve," said UGANET's Koima. "There is need for dialogue between the two parties."



According to Zainabu Akol, head of HIV programmes in the Ministry of Health, all HIV training programmes conducted by the government incorporate lessons on stigma and discrimination.



"A few health workers are still judgemental of HIV patients, which is morally and ethically wrong," she added.



This is not the first time Ugandan health workers have been accused of discrimination against people living with HIV. In 2006, local NGO Foundation for Human Rights Initiative released a report that documented allegations that nurses and midwives in the labour ward at the country's largest referral facility, Mulago Hospital, verbally abused, and refused to provide medical assistance to, expectant mothers on the grounds of their HIV status.



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