Academic journal article Journal of Health Population and Nutrition

HIV-Related Discriminatory Attitudes of Healthcare Workers in Bangladesh

Academic journal article Journal of Health Population and Nutrition

HIV-Related Discriminatory Attitudes of Healthcare Workers in Bangladesh

Article excerpt

INTRODUCTION

Discriminatory attitudes towards people living with HIV (PLHIV) among healthcare workers (HCWs) have been observed in many countries (1-8). There has been no systematic study of discriminatory attitudes among HCWs, and to date, the only information available in Bangladesh in this regard is anecdotal evidence and the occasional newspaper reports. As the consequences of discriminatory attitudes are severe in terms of both public health and human rights (8), this study aimed at fulfilling this gap.

Discrimination by HCWs towards PLHIV includes: HIV testing without consent; breaches of confidentiality; denial of treatment and care; refusal of admission to a hospital; refusal to operate or assist in clinical procedures; cessation of ongoing treatment; early discharge from hospital; judgemental attitudes of hospital workers; physical isolation in the ward; restrictions on movement around the ward or room; restricted access to shared facilities; denial of hospice facilities; refusal to lift or touch the dead body of an HIV-positive person; and reluctance to provide transport for the dead body of an HIV-positive person (2,9,10).

The concept 'discrimination' (action) is often equated with stigma (attitudes). However, the reality is not always like that. Some researchers have argued that discrimination is similar to enacted stigma which refers to the 'real experience of discrimination' (11,12). Major and O'Brien have argued that discrimination is an instrument of stigmatization (13) while Collymore has stated that stigma and discrimination are two separate entities but closely linked (14). This study adopted the the oretical position that discrimination is an outcome of stigmatization (13,15) and attempted to measure discrimination using hypothetical questions about readiness of HCWs to interact with or provide healthcare services to PLHIV (16). The principal assumption underlying this approach is that refusal to interact or provide treatment is the reflection of discrimination.

MATERIALS AND METHODS

Study design and recruitment of participants

The original study from which the findings presented in this paper were taken was designed to identify the levels and correlates of different aspects of stigmatizing and discriminatory attitudes among HCWs and to document the real-life experience of PLHIV. However, in this paper, only the discriminatory attitudes of HCWs are presented.

Recruitment and procedure

The study was cross-sectional in nature. Five hundred twenty-six HCWs (315 males, 211 females) interviewed for the study were recruited from the three cities (Dhaka, Chittagong, and Sylhet) of Bangladesh from the following different types of healthcare settings: teaching hospitals; non-teaching hospitals; and HIV diagnostic centres. The sample was purposively selected, and all HCWs in the three settings were asked to participate. Trained medical and social science graduates interviewed the HCWs face-to-face. Data were collected during February-May 2005.

Questionnaire and measures

A structured questionnaire with some open-ended questions was developed for data collection which covered the following: sociodemographic and religious variables; contact with HIV-positive people in the workplace; knowledge about HIV and AIDS; irrational fear about transmission of HIV; and discriminatory attitudes.

Measures

Discriminatory attitudes

The dependent variable--discriminatory attitudes--was measured via 16 items (Table 1) selected covering both social- and healthcare-related discriminatory attitudes towards PLHIV. The items were selected from previous research (1,3,17-22). The HCWs were asked to rate each item on a five-point Likert scale, indicating their agreement or disagreement (1=Disagree strongly; 2=Disagree somewhat; 3=Neither agree nor disagree; 4=Agree somewhat; and 5=Strongly agree). The average score on the discriminatory attitudes scale was 36. …

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