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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Medical Stigma

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Main topics can be found within the left column; sub-topics and/or research reports can be found near the bottom of this page.  Thank you

 

"Dentists have a legal obligation to treat HIV-infected individuals, including patients of record and other persons who seek treatment when the office is accepting new patients. Under the Americans with Disabilities Act (AwDA) and many similar federal, state and local laws, a person with HIV is considered as having a "disability," as are persons who are perceived to have HIV, which may include patients who have had blood transfusions and openly homosexual patients. at should be noted that HIV is only one of many infectious diseases that are considered as disabilities under the AwDA and similar laws; e.g., hepatitis B and tuberculosis are also treated as disabilities). In a case decided shortly before the publication of this text, the first federal court ruling on a charge of HIV discrimination against a dentist upheld the constitutionality of the AwDA.

The Americans With Disabilities Act of 1990 is a federal law that protects persons with disabilities, including individuals with HIV and/or AIDS, from discrimination on the basis of their HIV and/or AIDS status, including discrimination in the provision of dental care. ff you feel you have been discriminated against in the provision of dental care because of your HIV and/or AIDS status, you should call the Department of Justice in Washington, D.C. at 1-800-514-0301." Dental Management of the HIV-Infected Patient

ADDITIONAL ARTICLES:

Document Name & Link to Document

Description

File Size /pdf

An Assessment of Hepatitis C Virus Knowledge, Attitudes and Practices among Primary Care Providers in Maine 89% of PCPs are currently seeing fewer than 10 Hepatitis C Virus patients and 74% have seen fewer than 10 Hepatitis C Virus patients in the past 3 years.  

Are Pharmaceutical companies Addresssing-stigma

Recommends that treatment efficacies be made known to the public in efforts that model the public relations and marketing communication practices of other healing disciphines

Pdf 270 kb

Attitudes to & management of HIV/AIDS among health workers in Ghana: the case of Cape Coast municipality Health Care Workers as key players in the prevention and management of diseases and important opinion and community leaders have become targets for studies, more so with the outbreak of HIV.  Their perceptions, attitudes and practices have implications for the management of diseases in both health centres and communities. 39 kb pdf

BioEthics: Palliative Care at Home: Reflections on HIV/AIDS Family Caregiving Experiences

This study explored the day-to-day experiences of family members providing care at home for their dying loved one with HIV/AIDS. In-depth interviews with seven caregivers were analyzed using grounded theory qualitative methods. A conceptualization of the family caregiving experience portrays HIV/AIDS caregiving as an intense, emotional, and powerful experience filled with pride and enrichment, and conversely, with anger and disillusionment.

 

Cure versus care

The term 'Quality of Life' is often heard... and said at the Hospice to remind us of our main aim and purpose. As most of our patients have been diagnosed with a terminal disease, further treatment is often inappropriate and cure is not always an option.

 

Death a Result of Insufficient Care

Poor staffing was the reason cited for the death of Mike Hurewitz, the living liver donor at Mount Sinai Hospital, New York, who died after a portion of his liver was transplanted into his brother.

 

Dental Management of the HIV-Infected Patient

Because the law is evolving and varies in some respects from state to state, dentists are advised to consult with their own personal attorneys for legal advice. That said, the easiest way to avoid legal problems - and to lessen the need for legal advice - is for dentists to treat HIV-infected patients just like they treat their other patients.

 

Dentists shun HIV patients Many dentists are refusing to treat people with HIV even though there is no risk of transmitting the disease if safety procedures are correctly followed. Experts have warned that continuing discrimination may force people with HIV to keep their condition hidden - which could cause problems if dentists fail to take adequate care. Research conducted by BBC News Online found seven out of 30 dentists contacted refused to commit to treating a person with HIV.  
Discriminatory Attitudes and Practices by Health Workers toward Patients with HIV/AIDS in Nigeria Nigeria has an estimated 3.6 million people with HIV/AIDS and is home to one out of every 11 people with HIV/AIDS worldwide. This study is the first population-based assessment of discrimination against people living with HIV/AIDS in the health sector of a country. The purpose of this study was to characterize the nature and extent of discriminatory practices and attitudes in the health sector and indicate possible contributing factors and intervention strategies. The study involved a cross-sectional survey of 1,021 Nigerian health-care professionals (including 324 physicians, 541 nurses, and 133 midwives identified by profession) in 111 health-care facilities in four Nigerian states.  
Discriminatory Attitudes and Practices by Health Workers toward Patients with HIV/AIDS in Nigeria Nigeria has an estimated 3.6 million people with HIV/AIDS and is home to one out of every 11 people with HIV/AIDS worldwide. This study is the first population-based assessment of discrimination against people living with HIV/AIDS in the health sector of a country. The purpose of this study was to characterize the nature and extent of discriminatory practices and attitudes in the health sector and indicate possible contributing factors and intervention strategies. The study involved a cross-sectional survey of 1,021 Nigerian health-care professionals (including 324 physicians, 541 nurses, and 133 midwives identified by profession) in 111 health-care facilities in four Nigerian states. Pdf 522 kb
Do people with HIV/AIDS disclose their HIV-positivity to dentists? Not disclosing one’s HIV status to the dentist, though, can have serious consequences, such as finding oneself deprived of care adapted to one’s state of health, whether it be because of a lack of systematic screening for oral lesions associated with HIV infection, an error in diagnosis, an inappropriate choice of treatment, or a risk of secondary infection related to certain treatments. 66 kb pdf

Doctors' and Nurses' Knowledge and Attitudes

This report presents responses to AIDS-related questions from a national sample of 958 physicians and 1,520 registered nurses in 1990-91. Questions included willingness to treat AIDS patients and whether they believe that they were professionally obligated and should be legally required to do so, attitudes toward homosexual men and intravenous drug users, knowledge about HIV (human immunodeficiency virus) transmission, perceptions of the risk of HIV contagion, precautionary practices, trust in HIV authorities, career plans, and attitudes toward mandatory testing and mandatory reporting.

 

Effect of Training Program on Physicians' Attitudes towards knowledge and Practice Patterns Related to Assessment and Screening of Clients with HIV/AIDS

it does point out that a training program can alter physicians' screening and testing practices as well as their attitudes towards clients with HIV/AIDS. This has implications for providers in remote rural areas or in medically underserved communities where access to formalized continuing education may be limited or offered at times not compatible with a busy practice.

 

Effects of Hospital Staffing and Organizational Climate on Needlestick Injuries to Nurses

Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses.

 

Expectations and social interactions of children with and without mental retardation.

Mentally retarded and nonretarded perceiver children (n = 40) conversed by telephone with a child who was described as a special or regular education student. Perceivers reported that special and regular education telephone partners behaved differently during the conversation even though observers who were unaware of how telephone partners had been described did not detect behavioral differences between them. These same observers did detect differences in stereotype related social behaviors of mentally retarded and nonretarded perceivers, but only when perceivers thought they were speaking to a regular education student. Observer ratings also suggested that nonretarded perceivers "talked down" to special education telephone partners. These results suggest that stereotypes about children with and without learning problems may become self-fulfilling prophecies by altering how children treat one another and by affecting how they interpret each other's behaviors.

 

Factors associated with refusal to treat HIV-infected patients: the results of a national survey of dentists in Canada

This study investigated dentists refusal to treat patients who have HIV. METHODS: A survey was mailed to a random sample of all licensed dentists in Canada,

 

Frontline: Realities of stigma in health care settings While the majority of health care professionals comply with ethical guidelines and do not deny care or treatment to people living with HIV (PLHIV), a disturbing number of health care professionals engage in stigmatising and discriminatory behaviour, according to studies presented at the recent XVI International AIDS Conference in Toronto. Health care workers are also reported to engage in practices that contravene codes of professional ethics, including HIV testing without consent and disclosure of confidential medical information without prior permission. This was revealed by Takawira Moses, who works with Medicin Sans Frontiers (MSF) in rural Zambia.  

Guidelines for National Human Immunodeficiency Virus Case Surveillance, Including Monitoring for Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome

CDC recommends that all states and territories conduct case surveillance for human immunodeficiency virus (HIV) infection as an extension of current acquired immunodeficiency syndrome (AIDS) surveillance activities. The expansion of national surveillance to include both HIV infection and AIDS cases is a necessary response to the impact of advances in antiretroviral therapy, the implementation of new HIV treatment guidelines, and the increased need for epidemiologic data regarding persons at all stages of HIV disease.

 

Healthcare Workers

By the end of the 20th century, 33.6 million men, women and children had been infected with HIV.  AIDS is clearly one of the greatest public health challenges of the era and, whilst there are continuous calls for a multisectoral response to the epidemic, there is abundant evidence that that response must, in most instances, be led by dedicated, committed health care workers

Pdf 431 kb

Hepatitis C a Greater Threat to Healthcare Workers Than HIV

The risk that healthcare workers will become infected with hepatitis C virus (Hepatitis C Virus) following an accidental needlestick is 20 to 40 times greater than their risk of HIV infection, according to data presented here at the International Conference on Emerging Infectious Disease.

 

Hepatitis C from Gammagard®, An Intravenous Immunoglobulin [IGIV]

In February, 1994 Baxter Healthcare Corporation withdrew from world markets Gammagard®, an immunoglobulin administered intravenously to those with acquired or congential immune disorders, after 112 people in the U.S. were reported having symptoms of hepatitis C, the most fatal form of the this liver disease.

 

Hepatitis C: Knowledge, Attitudes and Practices among Orthopedic trainee surgeons Only 16% of the surgical residents knew that there was a vaccine for hepatitis A. Though 84% knew that there was no vaccine for hepatitis C, the majority (56%) were unaware that Hepatitis C Virus was a sexually transmitted disease and 82% did not know about the possibility of it being transmitted perinatally  

Hepatitis C: a review of Australia’s response

"The newly diagnosed person also has to make decisions about who to tell about the diagnosis and to be aware of the possible consequences. Many report feeling isolated, ‘permanently scarred’ or ‘tainted’. People living with hepatitis C live with fears, myths and misinformation about the disease and with the projected anxieties of others."

"Discrimination, or the potential for it, is often reported. Hepatitis C has acquired the label ‘the drug addict’s disease’, thus adding to the stigma attached to a communicable disease. Discrimination can occur in social networks and in institutional settings such as schools, hospital, health and dental clinics, and child-care facilities, affecting access to services."

 

HIV/AIDS and cultural issues Health professionals, including medical students, have to learn to face and fight HIV and AIDS and deal with its medical and psychosocial effects.  In combating the disease and the stigma that surrounds it, education remains the best approach. 539 kb pdf

International Red Cross Launches Campaign Against Stigma of
AIDS

The international Red Cross announced Monday that it is
launching a new campaign to tackle the stigma and discrimination faced by people with HIV/AIDS -  prejudice that it says stokes the worldwide epidemic.

 

Issues of Racism in Healthcare Research

Decreasing health disparities and improving health services for minority and at-risk populations is one of the goals of the Department of Health and Human Services (DHHS) Healthy People 2010 initiative. However, the racism imbedded within American society, as evident through differences in areas such as socioeconomic status, living conditions, and educational opportunity, may be inadequately addressed in both medical and nursing research.

 

JACHO: Delays in treatment 

While hospital Emergency Departments (EDs) are the source of just over one-half of all reported sentinel event cases of patient death or permanent injury due to delays in treatment,

 

JAMA: The Role of Law and Litigation

An important subset of litigation relates to HIV/AIDS in the public health and health care systems, since the law affects health care institutions and professionals, patients, and public health policy in America. This subset of HIV/AIDS litigation includes testing and reporting; privacy, the duty to warn, and the right to know; physician standards of care in prevention and treatment; and discrimination and access to health care

 

Knowledge and attitudes of dental patients towards cross-infection control measures in Dental Practice Transmission of infection within a dental surgery may occur by direct contact of tissue with secretions or blood, from droplets containing infectious agent, or via contaminated sharps or instruments which have been improperly sterilized. The major route of cross infection in dental surgery is via infection through intact skin or mucosa due to accidents involving sharps, or direct inoculation onto cuts and abrasions in the skin  
Lessons From the SARS Epidemic The current hysteria over the severe acute respiratory syndrome (SARS) epidemic recalls Harry Truman's observation that "there is nothing new in the world except the history you don't know." Although a recent phenomenon, SARS has more in common with epidemics of the past than most people realize.  

National Surveillance of Dialysis-Associated Diseases in the United States, 1997

Incidence and types of infections among patients and staff

 117 kb pdf

Needlestick prevention bill includes new workplace rules

 

Each year 600,000 to 800,000 health care workers, including many physicians, are accidentally stuck by contaminated needles or other sharp objects. A bill that recently passed Congress aims to reduce that number.

 

New guidelines: clinicians should incorporate HIV prevention into ongoing care of patients CDC issued new guidelines that shift prevention education initiatives to those already infected.  One policy is to try to reach the infected community during routine visits to their healthcare providers.  The stigma of HIV/AIDS prevents many people from disclosing their diagnosis, and often healthcare providers are the only people with whom they can talk openly about the disease. 132 kb pdf

New Postexposure Protocol for Occupational Exposure to Bloodborne Diseases

From a recent study showing that zidovudine prophylaxis after percutaneous exposure to HIV can reduce the risk of seroconversion by almost 80 percent,

 

Nigeria: New Study Reveals Discrimination by Health Professionals Against People Living with HIV/AIDS is Fueled by Fear of Infection, Lack of Protection While the majority of Nigerian health care professionals comply with ethical obligations and do not deny care or treatment to People Living With AIDS (PLWA), a disturbing number of health care professionals engage in discriminatory behavior toward treatment and care of PLWA, according to a new study released today by Physicians for Human Rights (PHR). Health care professionals also reported engaging in practices that are against international and Nigerian codes of professional ethics including testing without consent and disclosure of confidential medical information without permission.  

Nurses: Fighting AIDS Stigma Caring for All

Stigma and discrimination block the march forward against HIV/AIDS. They fuel the HIV/AIDS epidemic by creating a culture of secrecy, silence, ignorance, blame, shame and victimization. Stigma prevents communities from addressing HIV/AIDS with the appropriate health care services or legal and educational strategies. What stops them is HIV prejudice. And all that will stop HIV prejudice is speaking openly about the facts

182 kb pdf

Occupationally Acquired HIV: The Vulnerability of Health Care Workers under Workers ' Compensation Laws

Approximately 800 000 needle-sticks and other sharp injuries from contaminated medical devices occur in health care settings each year, of which an estimated 16000 are contaminated by human immunodeficiency virus (HIV). Health care workers who are Occupationally infected by HIV are at risk of being left without workers' compensation coverage. In some states, the definition of an occupational disease is so restrictive that infected health care workers are unlikely to qualify for benefits. For those who are able to meet the definition, compensation is often inadequate.

 

On Stigma and its Public Health Implications

One of the curious features of literature concerning stigma is the variability that exists in the definition of the concept. In many circumstances investigators provide no explicit definition and seem to refer to something like the dictionary definition ("a mark of disgrace") or to some related aspect like stereotyping or rejection (e.g. a social distance scale). When stigma is explicitly defined many commentators turn to Goffman quoting his definition of stigma as an "attribute that is deeply discrediting" and that reduces the bearer "from a whole and usual person to a tainted, discounted one".

 

Patients of Brooklyn Clinic Are Sought After Outbreak of
Hepatitis C

The infected patients all underwent endoscopic exams, in which a flexible lighted instrument is used to inspect the stomach or bowel lining, over a three- to four-day period at the end of March at the Bay Ridge Endoscopy and Digestive Health Center

 

PHENOMENOLOGY

Phenomenology is a movement in philosophy that has been adapted by certain sociologists to promote an understanding of the relationship between states of individual consciousness and social life. As an approach within sociology, phenomenology seeks to reveal how human awareness is implicated in the production of social action, social situations and social worlds

 

Predictors of Mother-Adolescent Discussions About Condoms: Implications for Providers Who Serve Youth

 

Parents who communicate effectively about sexuality and safer sex behaviors can influence their adolescents' risk-taking behavior. Health care providers, particularly physicians, can facilitate this communication by providing to parents information about the sexual behavior of adolescents, the risks that adolescents encounter, condom use, condom effectiveness, and how to discuss condoms. They also can make referrals to programs that teach communication skills.

 

Red Cross Failing Blood Test

The risk of contaminated blood is one reason why the Food and Drug Administration is going to the mat with the Red Cross, which provides half of the nation's blood supply and has been violating blood safety laws for17 years.

 

Risk and Management of Blood-Borne Infections in Health Care Workers

Exposure to blood-borne pathogens poses a serious risk to health care workers (HCWs). We review the risk and management of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (Hepatitis C Virus) infections in HCWs and also discuss current methods for preventing exposures and recommendations for postexposure prophylaxis. In the health care setting, blood-borne pathogen transmission occurs predominantly by percutaneous or mucosal exposure of workers to the blood or body fluids of infected patients. Prospective studies of HCWs have estimated that the average risk for HIV transmission after a percutaneous exposure is approximately 0.3%, the risk of HBV transmission is 6 to 30%, and the risk of Hepatitis C Virus transmission is approximately 1.8%.

 

Sharing of Drug Preparation Equipment as a Risk Factor for Hepatitis C

Among injection drug users who do not share syringes, an important proportion of Hepatitis C Virus infections may be attributed to cooker/cotton sharing.

 

Spotlight: Reducing stigma and discrimination: Successful examples from the health care sector in Asia There is no shortage of studies demonstrating that stigma and discrimination is common in health care settings in Asia. Ask anyone living with HIV where they experience the most discrimination based on their serostatus, their occupation as a sex worker, or their injecting drug use: They will often reply that health workers are the ones that make them feel the worst. Stories of segregation in wards, refusal of care, and disclosure of status are common in the region.  
Stigma The 1999 report on mental health by the Surgeon General of the United States was regarded as a landmark document in the United Kingdom, as well as the United States. This was because of its straightforward identification of the stigma associated with mental illness as the chief obstacle to effective treatment of persons with mental disorders. Stigma (plural, stigmata) is a Greek word that in its origins referred to a kind of tattoo mark that was cut or burned into the skin of criminals, slaves, or traitors in order to visibly identify them as blemished or morally polluted persons. These individuals were to be avoided or shunned, particularly in public places. The word was later applied to other personal attributes that are considered shameful or discrediting.  

Stigma and Global Health: Developing a Research Agenda

"Typically, miners who are believed to be infected are shunned. They sit alone in buses that carry workers to the pit. They eat alone in the company kitchens because their colleagues are afraid to share utensils or crockery with them."

 

Stigma Interventions and Research for International Health

For public health, however, a suitable framework requires a working definition of stigma that recognizes the distinctive features of particular diseases in particular social and cultural contexts. One or a combination of various approaches to interventions may focus on controlling or treating target health problems, countering tendencies of those who stigmatize others, and supporting those who are stigmatized.

 

STIGMATIZATION AND ACCESS TO HEALTH CARE IN LATIN AMERICA: CHALLENGES AND PERSPECTIVES Stigma associated with mental illness produces a series of adverse conditions that can result in exclusion in health. From the perspective of health systems, however, this phenomenon has not been widely studied. Hence the purpose of this study is to establish the importance of stigma as a barrier to access to the health services, and to identify ways to reduce exclusion in health due to stigma that go beyond the protection of the rights of the individual and place it within the framework of the extension of social protection in health. Pdf 62 kb

Structural Collapse Sets the Scene for the Rapid Spread of HIV/AIDS Among Young People in Eastern Europe

The number of HIV infections in Eastern Europe has increased nine-fold in just three years, growing from less than 30,000 HIV infections in 1995 to an estimated 270,000 infections by December 1998. Ukraine has had the most dramatic epidemic, with an estimated 110,000 people living with HIV in December 1997, two-thirds of them injecting drug users. Since then the epidemic has grown rapidly

 

Study Fosters Patient-friendly Hospital Environment

As the number of people living with HIV/AIDS (PLHA) continues to rise, so do the demands on health care systems throughout the world. Stigma and discrimination against PLHA are reported to be severe in many public and private hospitals in India, a problem that is often aggravated by insufficient training of health care workers, lack of supplies to enact universal precautions, and inadequate policies.

 

The Discriminatory Attitudes of Health Workers against People Living with HIV

 

The results suggest that some health-care professionals discriminate against and stigmatise PLWA. For instance, 9% of professionals reported refusing to care for a patient with HIV/AIDS, and 9% reported that they refused a patient with HIV/AIDS admission to hospital. Two-thirds reported observing other health professionals refusing to care for a patient with HIV/AIDS, and 43% observed others refusing a patient with HIV/AIDS admission to hospital.  
The Integrated AIDS Program: Decreasing Stigma through Quality Services In 1999, when the Integrated AIDS Program (IAP), run by the Assumption Sisters of Nairobi, began its home-based care activities, clients were hard to come by. Though in 1999 HIV prevalence in sentinel surveillance sites of Thika district, where IAP is located, was recorded to be 34 percent and there were few other organizations providing home-based care, IAP couldn’t find many clients. Because stigma against People Living With HIV (PLWH) was so high, people chose to suffer in silence, alone, rather than seek care if it meant disclosing their status. People avoided even testing for HIV, since in many people’s eyes just taking the test was an admission of “guilt.” Pdf 704 kb

THE PSYCHIATRIC NOSOLOGY OF
EVERYDAY LIFE: CATEGORIES IN IMPLICIT
ABNORMAL PSYCHOLOGY

A basic assumption of constructionism is that knowledge originates in social interchanges. That is, people's everyday knowledge about "the way things are" is not given by the real world but is the result of an ongoing process of communication: People speak, write, and use signs and symbols actively and cooperatively and end up creating "reality" out of negotiated understandings.

 

VIOLENCE

Today more than 5 million U.S. hospital workers from many occupations perform a wide variety of duties. They are exposed to many safety and health hazards, including violence. Recent data indicate that hospital workers are at high risk for experiencing violence in the workplace.

 

Violence and Public Health The discussion was centred on the break in confidence or trust of all institutions and that there is urgent need of rebuilding partnerships to prevent societies from fighting and breaking apart.  

 


 

 

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