By The Nation
THE DISEASE Control Department (DCD) has unveiled plans to support healthcare workers regarding HIV-related programmes after finding many were affected by stigma associated with the disease.
The project is among the DCD’s contributions to Zero Discrimination Day.
“We will be promoting mutual understanding and reducing stigmatisation at healthcare facilities because they are the ones providing services to people living with HIV,” DCD specialist Dr Sombat Thanphasertsuk said yesterday.
The United Nations first celebrated Zero Discrimination Day on March 1 2014 after UNAids, a UN programme combating human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (Aids), launched a parallel campaign on World Aids Day in late 2013.
The ministry’s permanent secretary, Dr Sophon Mekthon, said: “Stigma is a root cause, a key driver and if we could manage this, I believe that ending the Aids epidemic would be easy.”
With support from civil society, the United States Agency for International Development and UNAids, the ministry has agreed to tackle stigma with a comprehensive system-wide programme.
To tailor the initiative to a Thai context, a survey was conducted among hundreds of healthcare workers in several provinces.
Researchers said the preliminary results were eye-opening. Over half the health workers said they took unwarranted “precautions” when people living with HIV were in their care. More than 60 per cent feared contracting an HIV infection while performing routine tasks and 90 per cent admitted to at least one stigmatising attitude.
The research became the basis for developing a stigma-reduction programme.
“What’s great is instead of hiding the results or denying them, the Ministry of Public Health has embraced them and said let’s use this information to make good healthcare workers even better,” said Steve Kraus, director of UNAids Regional Support Team for Asia and the Pacific.
The Chiang Dao Hospital then tested a pilot programme last October. The hospital’s director, Dr Kochaporn Inthawong, said: “We believed that the training would help strengthen our services and promote access to services for our clients as they would not feel stigmatised.”
About 30 hospital staff, including doctors, nurses, pharmacists and HIV peer educators received 12 hours of training over a three-day period. With presentations, interactive exercises, group discussions and reflections, the workshop aimed to get participants to recognise that stigma was a problem and then to talk about how as a group they could change and make improvements in the hospital.
After the workshop, pharmacist Kwandao Inta, said: “I now realise I stigmatised patients. I want all hospitals to organise this training, which should also last longer as it’s very useful.”
Thunyarat Thongkham, head of the hospital’s birth centre, found her attitudes started to change as she realised the impact of discrimination on clients.
Three months after the training, the impact was visible. The birth centre at the hospital has reversed a decades-old policy of assigning a particular bed in the delivery room for pregnant women living with HIV.
“Now my clients can use any bed,” Thunyarat said.
For Sakaodeuan Somkate, the day she learnt about her HIV-positive status is as fresh as ever. “I remember it was raining. I was told my test result was positive, I couldn’t believe it was me. I kept crying and crying.”
She says the transformation wrought by the destigmatisation campaign has been remarkable. “After the training, staff stopped blaming pregnant women with harsh words and became supportive, asking questions to try to better understand their pregnancies.”
Sakaodeuan is now one of about 400 people registered with Chiang Dao Hospital’s HIV programme. She is also an HIV peer educator.
“I decided to go from being a client to a service provider because I didn’t want other people living with HIV to feel excluded and avoid HIV services because of the way they were treated,” Sakaodeuan said.
Thailand has been held up as a global example because of its response to control HIV. In the early days of the epidemic, the country introduced the 100 per cent Condom Use Programme, which has been widely replicated. In 2014, Thailand became one of the first countries in Asia to offer free treatment to all people living with HIV. This approach has helped new HIV infections to fall dramatically from more than 140,000 in 1990 to 7,800 in 2014.
However, Aids-related deaths remain high at around 20,000 per year. Health authorities recognise that HIV-related stigma continues to prevent people from accessing the services they need.
Anan Muangmoonchai, who chairs the Thai Network of People Living with HIV/Aids (TNP+), said if society stopped the stigmatisation, people infected with HIV would have a better chance of learning about infections and receiving treatment in a timely manner.
“When they receive timely treatment, they can stay healthy and contribute to the country’s economic and social development,” he said.