Challenges to Achieve Positive Changes of Community Attitudes

Towards HIV/AIDs Patients, Children and their Families.

By

Dr. Awatif AlamAssociate Professor Community Medicine

College of MedicineKing Saud University

UN Declaration of Commitment on HIV/AIDs:

“HIV/AIDs constitutes - a global emergency.

* One of the most formidable challenges to human life and dignity.

* Interrupt the effective enjoyment of human rights undermines social and economic development

throughout the world.

* Affects all levels of society (national, community, family and individual).

Global summary of the HIV and AIDS epidemic,

December 2005

The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.

Number of people living with HIV in 2005 Total 40.3 million (36.7 – 45.3 million)

Adults 38.0 million (34.5 – 42.6 million)

Women 17.5 million (16.2 – 19.3 million)

Children under 15 years 2.3 million (2.1 – 2.8 million)

People newly infected with HIV in 2005 Total 4.9 million (4.3 – 6.6 million)

Adults 4.2 million (3.6 – 5.8 million)

Children under 15 years 700 000 (630 000 – 820 000)

AIDS deaths in 2005 Total 3.1 million (2.8 – 3.6 million)

Adults 2.6 million (2.3 – 2.9 million)

Children under 15 years 570 000 (510 000 – 670 000)

Adults and children estimated to beAdults and children estimated to beliving with HIV as of end 2005living with HIV as of end 2005

Total: 40.3 (36.7 – 45.3) million

Western & Central Europe

720 000720 000[570 000 – 890 000][570 000 – 890 000]

North Africa & Middle East510 000510 000

[230 000 – 1.4 million][230 000 – 1.4 million]

Sub-Saharan Africa25.8 million25.8 million

[23.8 – 28.9 million][23.8 – 28.9 million]

Eastern Europe & Central Asia1.6 million 1.6 million

[990 000 – 2.3 million][990 000 – 2.3 million]

South & South-East Asia7.4 million7.4 million[4.5 – 11.0 million][4.5 – 11.0 million]

Oceania74 00074 000

[45 000 – 120 000][45 000 – 120 000]

North America1.2 million1.2 million

[650 000 – 1.8 million][650 000 – 1.8 million]

Caribbean300 000300 000

[200 000 – 510 000][200 000 – 510 000]

Latin America1.8 million1.8 million

[1.4 – 2.4 million][1.4 – 2.4 million]

East Asia870 000870 000

[440 000 – 1.4 million][440 000 – 1.4 million]

Estimated adult and child deaths Estimated adult and child deaths from AIDS during 2005from AIDS during 2005

Total: 3.1 (2.8 – 3.6) million

Western & Central Europe12 00012 000[<15 000][<15 000]

North Africa & Middle East58 00058 000

[25 000 – 145 000][25 000 – 145 000]

Sub-Saharan Africa2.4 million2.4 million

[2.1 – 2.7 million][2.1 – 2.7 million]

Eastern Europe & Central Asia

62 00062 000[39 000 – 91 000][39 000 – 91 000]

East Asia41 00041 000

[20 000 – 68 000][20 000 – 68 000]South & South-East Asia

480 000480 000[290 000 – 740 000][290 000 – 740 000]

Oceania36003600

[1700 – 8200][1700 – 8200]

North America 18 00018 000

[9000 – 30 000][9000 – 30 000]

Caribbean24 00024 000

[16 000 – 40 000][16 000 – 40 000]

Latin America66 00066 000

[52 000 – 86 000][52 000 – 86 000]

Dynamics Governing Decision on Health Matters:

“A major challenge is addressing communication barriers”:-

* Strong intrinsic environment (partly society, culture).

* External environment.

* Lack of co-ordination between environments.

Factors affecting decision making:-

“Knowledge – Tradition – Stigma”

Knowledge:* Is supported in a society by interplay of :- EDUCATION (Governed by Ext. environment) and PERCEPTION (Governed by Int. environment)

Perception = Attitudes of Community = Level of adaptability to change

* ( Judge perception of community before applying intervention) .

Traditions:

* Governed by perception of elderly + societal norms.

* Inherited through generations in a community.

Stigma:• It is a major barrier to positive attitude in the

community.

• The negative attitude needs to be changed in order to achieve a positive impact of any programme in the community (De-stigmatisation).

• It is amenable to communication.

Management:

• Relation between (k) and (Att)Versus

(k) and (Behv.)

Examples of Stigma and Discrimination Issues:

I. Hospital/Health Centers:* Refusal to provide treatment for HIV/AIDs

related diseases,

* Refusal to admit pts. for care and treatment, * Refusal to operate or assist in clinical procedures,

* Restricted access to facilities like toilets and common eating places/drinking utensils,

Cont. Ex. S&D: I-Hospital:

* Physical isolation in the ward,* Cessation of ongoing treatment,* Early discharge from hospital,* Restrictions on movements,* Unnecessary use of protective gear and gowns by health care staff,* Refusal to touch the dead body of a HIV

positive person.

Examples of Stigma and Discrimination Issues:

II. Home and Community issues:* Severed relationships, desertion and separation.* Denial of share in property or access to finance.* Blocked access to spouse, children or other

relatives.* Physical isolation at home.

Cont. Ex. S&D: II- Home &Community:

* Blocked entry into common areas or facilities e.g. toilets.

* Blocked entry into common places in the neighborhood.

* Denial of death rituals.* Labelling and name calling.* Guilt tripping for burdening the family financially.

Cont. Ex. S&D:

III. Workplace Issues:* Removal from job.* Forced resignation.* Withdrawal of health insurance benefits. * Poor access to shared facilities.* Social distance.* Labelling and name calling.

Factors that Influence HIV/AIDs related Stigma and Discrimination:

* HIV/AIDs information (infection is a result of curses).* Lay cultural beliefs.* Sexual shame (people paying for their sins / generally perceived to be a STD.

Cont:- Factors that Influence HIV/AIDs related Stigma and Discrimination:

* Finance:- PLHAs are considered as an additional burden to the economics of low income groups.

- PWA carry the blame of inadequate family resources.

- Wish pts. die to save scarce family resources.

- Less discrimination towards rich and independent PWA.

Implications for communication planning:

1. Introducing a radical change will result in a strong resistance.

2. Sustained change requires continuous engagement with the community for identifying areas of willingness to change.

3. Designing strategies to make the change properly work.

4. Creating a supportive environment.

5. We cann’t depend on mass media alone to bring a significant gain in (k) among different segments of population.

6. There is a need to examine the characteristics of:* Source* Message* Media

In order to strengthen the (k)- (Att.) linkages. (k)- (Behv.) linkages

“The change in Att. and behv. relationship plays a major role in communication process”.

Cont’d. Implications for communication

Observed and proposed structure to address communication barriers:

Getting the communication process work:-

* Create enabling environment in the system (communication skills).

* Improve co-ordination between different environments.

* Identify mistakes in the system.

* Reduce the structural rigidity in the system.

Cont’d. Getting the communication process work:-

* Identify “Key change agent”.

* Design culturally adaptable campaign strategies, labelled with consistency (acting upon the same).

* The designed strategy needs to be fine tuned to the community.

“Fact”

The epidemic in each region of the world is influenced by the specific risk factors that are associated with spread of HIV/AIDs and the responses that have evolved to address it.

The role of epidemiologist in challenging the HIV/AIDs pandemic is (to develop new strategies to answer key questions) about:

* Transmission of HIV,* Natural history at molecular, host, and community levels,* Evaluation of treatment effectiveness,* Evaluation of intervention strategies,* Informing public health policy,Strengthening preventive approach.

The role of caring for patients with HIV/AIDs:-

I. Health care professionals:* Allocation of scarce resources for

research and health care.* The use of various methods of disease

control (e.g. mandatory testing).* Forced isolation.* Informing of sexual partner(s).* Education.* The determination of the responsibility

to treat infected patients.

Cont’d. The role of caring for patients with HIV/AIDs:-

II. Communities and individuals:-* Attitudes towards pts./families.* Traditions and values (indigenous).* Myths and pessimism.* Awareness of society (understanding). *

Avoid discrimination.* Demographic and economic impact on

societies.* Structural inequalities (poverty +

minorities).* Practice.

Impact of HIV/AIDs on children:- “ AIDs is wreaking havoc on childhood “.

* < 5% of HIV positive children receive treatment,

* Millions of children who lost parents (AIDs) go without support, (≈ 15 x 106),and lack

access to most basic care and preventive services .

Peculiar effects of HIV/AIDs pandemic on children and families:-

* Losing one or both parents.* Lack of guardian for children.* Rising nos. of orphans.* Mothers who silence themselves (concept).* Hidden patient (concept).* Parentification.* Barriers associated with seeking services.* Depression of caregivers.

Aims of the global campaign to invigorate action for millions of children affected by HIV/AIDs:

1. Prevention of mother-to-child transmission:

“To provide 80% of women in need with preventive services of transmission to their babies”.

2. Pediatric treatment: by 2010 provide ART + low cost antibiotics to 80% of children in

need”.

Cont’d. Aims of the global campaign:

3. Prevention: “By 2010 reduce the proportion of young people living with HIV by 25%”.

4. Protection and support of children affected by AIDs:

“by 2010, public support and services should reach 80% of children most in needs”.

Challenges to achieve Global Campaign aims:-

* Support by international leadership e.g. UNICEF.* Commitment of governments.* Prioritizing affected children by allocating

funding to their needs.* Encourage community understanding and

participation.

The challenge calls for multidisciplinary intervention that focuses on needs within the family system.

Act Forces Levels:-

* International,* National,* Partnerships,* Local governments,* NGOs,* Civil societies,* Individuals

Integrated HIV prevention andHumanitarian services

Mothers, Children and The “MDGs”:-

* the MDG targets and indicators reveals special priority to health and well-being of women, mothers and children.

* MDG: “Halting and reversing HIV and AIDs by 2015”.

Proposed Challenges:-

1. Awareness Campaigns:* Size of the problem.* Determinants.* Risky behaviours/Modes of trans.* Compassion towards victims.* Consequences and outcomes.* Is our community endangered.* Vulnerability of innocent individuals.* Rule of forgiveness.

Cont’d. Proposed Challenges:-

* I am not the judge.

* Save our children.

* Invest for the future development.

* Be part of the Globe.

“Stop AID”.

“Keep the Promise”.

Cont’d. Proposed Challenges:-

2. Preventive Education:* Why and how people become at risk of

infection.* How to reduce the risk?* Who provides the services?* Can I deal with a patient safely?

3. Encourage participation of pts., their relatives in group discussion (inspirational leaders are people living/affected by HIV/AIDs.(Critical to the AIDs response)

Cont’d. Proposed Challenges:-

4. Respect confidentiality and privacy of others.

5. Talk more about the problem – be realistic.

6. Diminish the impact of the problem on education.

Cont’d. Proposed Challenges:-

7. Funding and helping agencies caring for pts. and their families.

8. Utilization of non-traditional partners in fighting AIDs e.g.

* The media.* Religious organizations.* Business organizations.* Sports organizations.* Labour movement.

Cont’d. Proposed Challenges:-

9. Special attention to women and children and HIV.

10. Orphans help.

Specific Challenges for Health Care Sector:-* Encourage universally acceptable precautions.* Administer human rights education to health

care workers.* Education on the legal duties for health care

workers in view of PLHAs.* Providing counseling services for health workers to enable them cope with all emerging issues.

Specific Challenges for Health Care Sector:-

* Administering appropriate HIV/AIDs education to health care workers.* It is imp. to Challenge beliefs about causal

modes of transmission.* Encourage the great potential of religious

leaders to provide care, comfort and spiritual support to PLHAs.

* Public stand of religious leaders in support of PLHAs should be sought.

Conclusion:-

* Biomedical approach to HIV/AIDs cannot in isolation, improve the health of populations.

Conclusion:- Cont’d.

* Understanding and addressing the deeper social causes of

pandemics are essential.

Conclusion:- Cont’d.

* Broadening the discourse on ethics to include public health ethics could contribute to

reducing the impact of the pandemic.

Conclusion:- Cont’d.

“Everyone has a role to play in fighting HIV and AIDs”.

Conclusion:- Cont’d.

“All of us must recognize AIDs as our problem. All of us must make it our priority”.

UN Secretary General “Koffi Annan”

Thank you very much

Together WE CAN