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Indian doctors discriminating against HIV patients

Nov 30, 2009

It has been found that the HIV patients are being discriminated against. Discrimination hurts most when it comes from healthcare settings because people who go to hospitals are already in physical distress or pain, writes S. Mohammad Afsar, ILO Technical Specialist (HIV/AIDS), South Asia on the eve of World AIDS Day.

“At the time of my delivery, I faced discrimination from my doctor. She abused me and asked in a very derogatory manner why I had got pregnant. Finally, she refused to do the delivery,” shared Asha, an HIV-positive women from Karnataka, in a 2009 advocacy video produced by the National AIDS Control Organisation (NACO); Ministry of Labour and Employment; and the International Labour Organisation (ILO).

Unfortunately, Asha’s painful brush with discrimination is not a solitary instance. At a recent HIV/AIDS training session in New Delhi for medical doctors, on exploring attitudes, I observed how deep-seated an informed doctor’s negative attitudes can truly be.

For that session, a person living with HIV had been invited to join in the discussion. The group had not been informed of his status in advance. After a while of sitting in the discussion circle, the gentleman shared his life before and after the HIV infection and concluded that he was leading a healthy and productive life for over 10 years from when his HIV status had been detected. It was then that a lady doctor, who sat right next to him in the circle, made her dislike quite obvious.

On learning of his status, her expression changed. She first turned her face in the other direction, and then started to slowly inch her chair away from him. Finally, she got up and moved to sit on another chair at a fair distance from him. It is not difficult to foresee how she would respond when asked to attend a delivery for an HIV-positive mother. I recalled what Asha had shared with me about her experience with a healthcare provider.

In an ILO study (2002) on the extent of stigma and discrimination in India, nearly 34% of the HIV-positive people interviewed had mentioned that they had faced stigma and discrimination in healthcare settings.

Refusal to attend to HIV-positive pregnant women and to conduct deliveries; refusal to give injections, food and to change bed sheets; and refusal to do surgery were some common forms of discrimination faced by HIV-positive people at the hands of healthcare providers.

Discrimination always hurts but it hurts most when it comes from healthcare settings because people who go to hospitals are already in physical distress or pain. We have been living in the age of AIDS for the last three decades. We have learnt that seeing HIV from a moralistic lens has not helped.

HIV prevention programmes will succeed if people living with HIV are not discriminated against. Reducing HIV-related discrimination, therefore, is a prevention strategy. In this direction, we still have a long way to go.

The recently published UNAIDS-WHO AIDS Epidemic Update 2009 presents a good mix of positive trends as well as challenges. New HIV infections have been reduced by 17% over the past eight years.

However, new infections in some countries continue to rise. The number of AIDS-related deaths has declined by over 10% in the past five years, largely because access to antiretroviral treatment (ART) is getting better, and people are able to live longer. Treatment to HIV-positive pregnant mothers has resulted in preventing around 200,000 new infections globally among children since 2001.

However, universal access to treatment will remain elusive until discrimination in healthcare settings reduces. While policies and legislations are useful they are not enough in themselves. Attitudes need to change and this requires a well-planned and coordinated training effort for healthcare providers. It may take time to cover all in a big country like India but an effort must be made. And the earlier the better. After all, the AIDS story is about people – men, women and children.

In an ILO-supported project amongst migrant construction workers in Maharashtra, I met two young sisters in 2009. They had migrated from Uttar Pradesh to Mumbai after their respective marriages to two brothers, who worked as construction workers. Both of them were AIDS widows and living with HIV. “My husband died of AIDS in 2002. I have two children; one of them is also HIV-positive. I need work to support my children. I want to educate them as much as I can,” shared the elder sister.

However, while the other sister had similar dreams she knew that rejection would be part of her life: “After my husband’s death, I started working in a women’s hostel as a cook. My supervisor came to know of my status and sacked me.”

The main needs of people living with HIV are broadly: An end to HIV-related stigma and discrimination; access to available treatment; and access to regular work that would translate into income. All these three requirements need our complete attention and focus. World AIDS Day is a time to renew our commitment to work on these issues. The solution, which does not lie with the health ministry alone, calls for a multi-sectoral response.

The AIDS epidemic report brings out an important lesson: The impact of the programme is high where HIV-prevention and treatment programmes are integrated with other health and social welfare services. This integration may take a while but it is the right thing to do.

I appeal to my medical doctor friends to not turn your face away from people living with HIV: Only you are equipped to give them that healing touch.

The writer is ILO Technical Specialist (HIV/AIDS), South Asia. The views expressed in this article are his own.

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