1. ICTC Team Training 1 Understanding Stigma and Discrimination

2. ICTC Team Training 2 We often view AIDS as something that can affect other people, people who are different from us, people who lead perverted or sinful lives. From here it is a short step to blaming People with AIDS for their own condition.

3. ICTC Team Training 3 Stigma “Setting aside certain persons or groups from the normal social order because they have some negative characteristic.” We devalue them We do this because we believe they are very different from us

4. ICTC Team Training 4 Discrimination “The unfair and unjust treatment of an individual based on his or her real or perceived HIV status.” When we set aside people or stigmatise them, it is easier to treat them differently. If a person feels stigma towards another, she /he can decide to not act in a way that is unfair or discriminatory.

5. ICTC Team Training 5 OPEN DISCRIMINATIONHIDDEN DISCRIMINATION Refusal to provide treatment for HIV/AIDS-related illness Refusal to admit for hospital care/treatment Refusal to operate or assist in clinical procedures Restricted access to facilities like toilets and common eating and drinking utensils Physical isolation in the ward (e.g. separate arrangements for a bed outside the ward in a gallery or corridor) Stopping ongoing treatment Early discharge from hospital Mandatory testing for HIV before surgery and during pregnancy Restrictions on movement around the ward or room Unnecessary use of protective gear (gowns, masks, etc.) by health care staff Refusal to lift or touch the dead body of an HIV- positive person Use of plastic sheeting to wrap the dead body Reluctance to provide transport for the body Delays in treatment; slow service (e.g. made to wait in queues, asked to come again) Excuses or explanations given for non-admission (but admission not directly refused) Shunting patient between wards/doctors/hospitals Keeping patient under observation without any treatment plan Postponed treatment or operations Unnecessarily repeated HIV tests Conditional treatment (e.g. only on the condition that the patient will come for follow up or join a drug trial programme).

6. ICTC Team Training 6 Informed Consent for HIV Testing The client agrees to HIV testing through giving his/ her informed consent. Informed consent is a deliberate and autonomous permission given by a client to a health-care provider to proceed with the proposed HIV test procedure. This permission is based on adequate understanding of the advantages, risks, potential consequences and implications of an HIV test result, which could be both positive and negative. This permission is entirely the choice of the client and can never be implied or presumed. (From ICTC Operational Guidelines)

7. ICTC Team Training 7 Discussion Question If mandatory testing for HIV before surgery and during pregnancy is described here as a discriminatory practice, then what about provider-initiated testing and counselling?

8. ICTC Team Training 8 Continuum between Care and Prevention

9. ICTC Team Training 9 Continuum between Care and Prevention – Effect of Stigma

10. ICTC Team Training 10 Continuum between Care and Prevention – Effect of Stigma

11. ICTC Team Training 11 Continuum between Care and Prevention – Effect of Stigma

12. ICTC Team Training 12 Why do we stigmatise and discriminate? Lack of awareness of how stigma affects People Living with HIV/AIDS Fear of human beings of being infected from ordinary contact with people already infected with HIV Associating people with HIV with behaviours that are immoral

13. ICTC Team Training 13 Universal Safety Precautions Risk reduction measure at the workplace. Practising Universal Safety Precautions means applying blood and body-fluid precautions universally to all persons regardless of their presumed infectious status.

14. ICTC Team Training 14 Universal Safety Precautions Staff working in the blood collection room and laboratory should observe the following precautions: Using gloves when handling blood samples Using disposable needles and syringes for drawing blood Practising routine hand-washing before and after any contact with blood samples Disposing of sharp instruments safely as per procedure, e.g., discard disposable syringes in a puncture-resistant container after disinfection with bleach solution

15. ICTC Team Training 15 Universal Safety Precautions Disinfection and sterilisation Kits for safe delivery of HIV-positive pregnant female patients Waste management

16. ICTC Team Training 16

17. ICTC Team Training 17 Post Exposure Prophylaxis (PEP) Comprehensive medical management to minimise the risk of infection among HCP following potential exposure to blood-borne pathogens (HIV, HBV, HCV). Includes counselling, risk assessment, relevant laboratory investigations, first aid and provision of antiretroviral drugs.

18. NACO Policy on Post Exposure Prophylaxis (PEP) Step 1: First aid in management of exposure – For skin – For the eye – For the mouth Step 2: Establish eligibility for PEP – First PEP dose within 72 hours – Assessing risk of transmission – Assess exposed individual Step 3: Counselling for PEP – Psychological support – Document exposure Step 4: Prescribe PEP Step 5: HIV chemoprophylaxis Step 6: Follow-up of an exposed person – Clinical follow-up – Laboratory follow-up ICTC Team Training 18