In Uganda, the health system does not yet recognise stigma and discrimination as a human rights issue. Health professionals, knowingly and unknowingly, stigmatise and discriminate against people living with HIV. The Action Group for Health, Human Rights and HIV/AIDS (AGHA)’s Anti-Stigma Campaign unites health workers with communities to stop HIV and AIDS-related stigma.
AGHA training
Sandra Kiapi tells more.
Despite Uganda’s success story in the HIV and AIDS fight, the problem of stigma and discrimination remains rampant in the context of HIV and AIDS. For example, according to the 2006 Uganda Demographic and Health Survey, only about 26 per cent of female respondents and 36 per cent of male respondents expressed attitudes of acceptance towards people living with HIV on four common measures of stigma. Only about three-quarters of women felt that a child of primary school age living with HIV should go to school. Just over a half (58 per cent) of women and three quarters (75 per cent) of men in northern districts stated that they would buy fresh vegetables from a shopkeeper living with AIDS. Socially there is still a lot of self denial across the spectrum.
Health professionals sometimes stigmatise others, both knowingly and unknowingly. Stigma, silence, discrimination and denial, as well as a lack of confidentiality, undermine prevention, care and treatment efforts and increase the impact of the HIV epidemic on individuals, families, and communities. This is largely due to lack of awareness of the fundamental right to non-discrimination based on HIV status.
The Action Group for Health, Human Rights and HIV/AIDS (AGHA), a non-governmental organisation (NGO) based in Uganda, was founded in July 2003 to mobilise health professionals and health consumers to address issues of human rights as they relate to health, with a specific focus on HIV and AIDS. AGHA brings together doctors, nurses, other health professionals, NGOs and other institutions interested in promoting the right to health, to create local and national networks dedicated to global health advocacy.
AGHA has set up a strong mechanism for connecting patients and health workers to address stigma and discrimination in health facilities. It works to open dialogue between district leaders, health professionals and people living with HIV and AIDS about how to institutionalise programmes to decrease discrimination in health facilities. AGHA’s four year old Anti-Stigma Campaign has yielded positive results both for people living with AIDS and for health workers. The campaign started by uniting people living with HIV and AIDS and health worker leaders in a series of “training for trainers” in Lyantonde, Rakai, Tororo and Kampala. These leaders then formed “Stigma Task Forces” in each respective district and trained their peers to combat stigma and discrimination in their health care settings.
The Stigma Task Forces have trained more than 200 health workers and have carried out targeted advocacy at critical moments. When the Foundation for Human Rights Initiative came out with a report of terrible stigma in the Mulago (Uganda’s National Referral Hospital) maternity ward, the Mulago task force, comprised mainly of nurses (the same cadre accused of the most stigmatising behaviour) held a training session for their peers. In Tororo Hospital, stigma and discrimination issues have been incorporated in the Continuing Medical Education for health workers.
Seeing the success of this model, AGHA decided to focus more intensely on the hospital level in these key districts. We wanted to see what kind of measurable improvement our stigma outreach could have on patients if Task Force members went beyond training and moved towards community outreach and stigma monitoring. AGHA trained liaison persons to act as intermediaries between patients and health workers. Liaison persons are people living with HIV or AIDS who have a positive attitude to life and are in a position to understand the needs and concerns of patients. The liaisons have been integrated into hospitals and the community, and provide a much-needed bridge between patients and providers.
Liaison persons give health talks covering issues of anti-stigma and non- discrimination; provide counselling; educate people living with AIDS about nutrition and adherence to ART; and visit Prevention of Mother to Child Transmission and Antiretroviral Therapy clinics. They also participate in home visits where they reach out to people living with AIDS in communities. Liaison persons participate in meetings with hospitals administrators and with Quality Health promoters from the Ministry of Health where they discuss issues relating to their work. They also receive views through a suggestion box and the issues in these boxes are addressed directly or indirectly depending on their nature.
Reports indicate an increasing number of people accessing antiretroviral therapy. In Rakai, the number has increased by 75 per cent. After six months, the results are astounding, and a testament to community involvement:
- Reduced stigma and discrimination attitudes;
- Increased number of people coming for voluntary counselling and testing (VCT);
- Parents have brought children for testing;
- Increased freedom of expression by all the clients on HIV and AIDS issues;
- Majority of clients now keep their appointments;
- Clients get their treatment on time, and
- Improved respect among patients, and between patients and non–patients.
However, challenges remain. Discrimination exists among discordant couples and this is worsened by blame attitudes. Some reports of abuse by health workers have been received. Some clients still fear lining up in the pharmacy to collect their drugs. Other clients do not want to sit next to the very ill patients. In some instances, health workers pay more attention to the ‘well-to-do’ clients.
What the work has shown to be important is that health workers play a critical role in reducing stigma and discrimination and allowing citizens to access their right to health. Creating bridges between healthcare professionals and the community is vital and something we can build on for the future.
Sandra Kiapi is Executive Director at the Action Group for Health, Human Rights and HIV/AIDS (AGHA)
Website: www. aghauganda.org
Filed under: Rights to health
