Perspectives of community health care workers (CHCW'S) on destigmatisation of HIV and AIDS

Abstract

It has been over 3 decades since the emergence of the epidemic of HIV and AIDS, yet there is still the issue of stigma and discrimination that is faced by people affected and infected by HIV and AIDS across the spectrum. This has acted as a barrier for voluntary HIV counselling and testing for many people in the society. HIV and AIDS related stigma impacts on many levels in society from the individual, family and community. There are various contexts in which stigma related to HIV and AIDS occurs, such as the health care setting, the family, the educational sector, the work place and the society at large. Stigma and discrimination has been observed to be prevalent from a geographical, societal and historical level in society. Two major types of stigma have been written about immensely and they are namely; anticipated and enacted stigma. The former, referring to the perceived stigma by mostly individuals towards the self and the latter being acts of discrimination enforced by those who have prejudices towards PLHIV. This calls for intervention strategies to be devised from a co-operative level in order to alleviate stigma and discrimination related to HIV and AIDS. As much as many studies have focused on accounts of PLHIV in order to understand the phenomenon of HIV and AIDS related stigma, rarely could one find an inquiry that seeks the standpoints of those who are involved in rendering services to people affected by HIV and AIDS especially at community level. Thus, the rationale for this study was to give a voice to community health care workers in order to tackle HIV and AIDS stigma and discrimination and the goal was to explore and describe the perspectives of community health care workers on destigmatisation of HIV and AIDS.

A qualitative inquiry was employed in order to explore and understand the perspectives of community health care workers on destigmatisation of HIV and AIDS. An attempt to conduct an applied research was done by means of engaging in a collective case study research design in order to gain multiple viewpoints of the participants involved in the study rather than to rely in a single case. A total of 13 community health care workers from 2 non-governmental/non-profit organisations in Hammanskraal were interviewed, in the form of 2 focus group interviews that were conducted separately. The data that was collected from these focus group interviews was later transcribed verbatim and analysed by the researcher. The researcher also relied on field notes collected during the interviews to identify themes and sub-themes as they emerged.

The following themes and sub-themes emerged from the study: Fear: fear of HIV and AIDS, fear of stigma and discrimination by health care professionals, fear of disclosure and fear of exercising one’s rights; Social support: family as a support system and support groups; Lack of some knowledge and information about HIV and AIDS: education about HIV and AIDS; Health care professional’s attitudes and behaviour towards PLHIV: discrimination through patient’s clinical information, separation of patients in the clinic, lack of trust between patients and health care professionals, stigma and discrimination by other clinic staff and strategy to address the attitudes and behaviour of health care professionals towards PLHIV; Disclosure: disclosure to the public, disclosing to family, non-disclosure and importance of disclosure.

The findings of the study showed that there is an underlying thread of fear that is experienced by people affected and infected by HIV and AIDS in relation to the illness itself, stigma and discrimination by health care workers, a fear of disclosure and fear to exercise one’s rights. It also revealed that there appears to be a lack of knowledge and information concerning the epidemic in the community and that education can best address this concern. Furthermore, the study findings also showed that attitudes of health care professionals are problematic and perpetuate stigma and discrimination especially through treatments of PLHIV in the health care settings such as clinics and hospitals, even more so by other staff members. Community health care workers provided a strategy they thought would best address the abovementioned issue. Social support in the form of family support and support groups were thought to be vital in alleviating stigma and discrimination related to HIV and AIDS. The issue of disclosure was also regarded as key in ensuring that stigma is mitigated, especially when done in public. This will empower other community members, but not totally disregarding the family and, that the opposite of disclosure can also be detrimental.

The recommendations of the study included emphasis on informal education and the use of mass media in order to educate the community on HIV and AIDS. The reinforcement of ethical conduct and the understanding of patient’s rights by health care professionals were also recommended. Support systems such as the family and support groups were also recommended as important in fighting the issue of HIV and AIDS related stigma.