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Vaishali Sharma Mahendra1, Laelia Zoe Gilborn1, Rupa Mudoi2, Sarita Jadav2, Indrani Gupta3, Shalini Bharat4, Rajendra Prasad2, Dev Mani Upadhyay3, Venkat Raman5, and Andrew A. Fisher, ScD6. (1) Horizons, Population Council, 53 Lodhi Estate, New Delhi, India, (2) Consultant, Horizons, Population Council, 53 Lodhi Estate, New Delhi, India, (3) Institute of Economic Growth, University Enclave, Delhi University (North Campus), New Delhi, India, (4) Tata Institute of Social Sciences, Sion-Trombay Road, Deonar, Mumbai, India, (5) Faculty of Management Studies, University of Delhi (South Campus), New Delhi, 110 021, India, (6) Horizons Program, Population Council, 4301 Connecticut Ave, NW, Suite 280, Washington, DC 20008, (202) 237-9400, afisher@pcdc.org
Introduction: Over 4 million people in India are estimated to be HIV-positive. As in other countries, people living with HIV/AIDS (PLHA) confront stigma and discrimination (S&D) in clinical settings. This study piloted a participatory approach to reducing S&D as a barrier to medical care. Methods: Formative research with health workers (HWs) and PLHA highlighted causes and manifestations of S&D in hospitals. Findings generated indicators for a “PLHA-friendly Checklist.” After a baseline survey (n=884) in 3 New Delhi hospitals on HW attitudes, knowledge and practices, managers and HWs reviewed facility-specific data, assessed their hospitals using the Checklist and developed action plans to address S&D. Progress was measured with a follow-up survey (n=885), checklist scores, and action plan accomplishments. Results: Limitations in staff knowledge, lack of policies protecting PLHA, and inadequate training and supplies for infection control, resulted in S&D. Upon reviewing data, managers, previously reluctant to acknowledge problems, set and achieved action plan goals such as establishing an HIV/AIDS care and management policy, enlisting NGOs to sensitize and train HWs, and disseminating information on universal precautions. The intervention was associated with improved practices among HWs. Doctors were significantly (p<0.05) more likely to seek informed consent for HIV testing (39% pre-intervention vs 54% post-intervention), arrange post-test counseling for patients testing positive (46% vs 64%), and wear gloves for at-risk procedures (65% vs 91%). Conclusion: Facility-specific data, the checklist and other tools provided to managers sparked action to make hospitals more “PLHA-friendly” and should be replicated elsewhere.
Learning Objectives:
Keywords: HIV/AIDS, Hospitals
Related Web page: Newsletter article, Dec 2002 www.popcouncil.org/horizons/newsletter/horizons(5)_6.html and Checklist http://www.popcouncil.org/pdfs/horizons/pfechklst.pdf
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.