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Addressing HIV-related discrimination in health care settings: a key part of the response
Source: | Author:hkb980dd | Published time: 2013-04-04 | 269 Views | Share:
World Health Day, which falls every year on April 7th, is a day to reflect on the importance of health, the health challenges which we face, as a society, and the action we can take to overcome obstacles and build a healthier society for everyone. In recent months, discrimination against people living with HIV (PLHIV) in health care settings has come to the forefront as a key obstacle to health in China.
For people living with HIV, discrimination in health care settings can constitute a serious obstacle to health; in serious cases, discrimination can even constitute a denial of the right to life. As well as resulting in negative health consequences for PLHIV, discrimination propagates fear and ignorance around HIV, reducing the willingness of those most at risk of HIV to seek access to prevention, treatment and care services.
 
Top government leaders have spoken out against discrimination in healthcare settings. Speaking on World AIDS Day 2012, then Vice Premier Li Keqiang spoke strongly against discrimination in health care settings.
 
Nevertheless, many PLHIV still encounter serious obstacles when trying to access treatment and surgery. At the end of 2012, Xiao Feng (not his real name), a Tianjin resident living with HIV, was allegedly denied surgery for cancer on the grounds of his HIV status. After falsifying his medical records to conceal his HIV status, Xiao Feng later received treatment, leading many to accuse the hospital of discrimination on the grounds of his HIV status.
 
Li Hu, a person living with HIV and representative of Haihe Zhixing, a Tianjin-based PLHIV organisation which has been engaging in advocacy around Xiao Feng’s case, talked about the impact of discrimination: “From the perspective of PLHIV, discrimination in health care settings is the most serious type of discrimination as it is related to the right to health and the right to survival, the most basic of rights. Denying medical treatment or surgery can in many cases be equivalent to denying someone the right to life.”
 
Xiao Feng’s case is by no means isolated. A study of more than 2000 PLHIV carried out by UNAIDS in China found that more than 12% had been refused medical care at least once since being diagnosed with HIV. In addressing discrimination in health care settings, there is an urgent need to empower health care workers with knowledge and skills, allowing them to take a leading role in the fight against discrimination. In an ILO study of over 2000 health care workers carried out in 2013, 34.9% of respondents admitted having been unwilling to provide treatment to a person living with HIV on a past occasion. A survey of 1292 Beijing health care workers found that only 39.7% had received training on HIV. 42.4% of health care workers said their hospital had never organised training on occupational exposure.
 
Ensuring enforcement of anti-discrimination laws will also be an essential tool. Liu Wei, a public welfare lawyer representing Xiao Feng gave details of the laws which prohibit HIV-related discrimination in heatlh care settings, which include the Ministry of Health Notice Regarding Management of People living with HIV/AIDS,  AIDS Prevention and Control Regulations, and the People's Republic of China Medical Practitioner Law. “A doctor’s duty is to heal the sick and save the dying,” said Liu Wei. “A doctor cannot refuse to treat a patient, just like a soldier cannot refuse to go to the front line. People living with HIV enjoy the same rights to health care as everyone else.”
 
Wu Rulian, Programme Officer at the ILO provided further detail. “Support needs to be provided to health care workers to ensure they are able to use standard precautions and provide services to people living with HIV without fear. At the same time, hospitals need to make sure they are aware of their legal and moral obligations to provide treatment to PLHIV, and take concrete steps to make sure that discrimination is not tolerated within their facilities.”
 
In addressing discrimination in health care settings, UNAIDS highlights the importance of human rights and ethics training to strengthen the capacity of healthcare providers, administrators and regulators. UNAIDS Acting Country Coordinator Taona Kuo explained: “Action must be taken to ensure that all of those involved in provision, administration and regulation of healthcare are empowered with information around HIV, as well as the negative impacts of discrimination. Recent moves to strengthen the capacity of designated hospitals to provide treatment to PLHIV are a positive step forward, but access to health care must also be guaranteed in general and specialist hospitals.”
 
WHO China Representative Michael O’Leary outlined the UN’s position on health care discrimination. “Action needs to be taken at multiple levels: awareness and training around HIV are key, and should be strengthened at all levels; at the same time, hospital administrations need to take steps to empower their staff to implement standard precautions; regulators and policy makers need to ensure that hospitals receive the resources they need, while at the same time taking steps to ensure that regulations prohibiting discrimination are properly enforced.”
 
Building healthy societies, where no one is denied health care, is key to achieving sustainable development. On World Health Day, and on every other day of the year, we must work to empower health care workers to provide services to people living with HIV, and protect the rights of people living with HIV to access treatment. The alternative to action is inaction, and that is not an option.