HIV Discrimination: Integrating Findings from a Six Country Study in Asia

1
HIV Discrimination Integrating Findings from a
Six Country Study in Asia

• Kit Yee Chan
• 29th September 2005
• Project Funded by Ford Foundation

2
Overview of Presentation

• Why study HIV/AIDS discrimination in Asia?
• Background of Project
• Research and Collaboration Approach
• Methodology Overview
• Findings in Health Care
• What Next?

3
Definitions

• HIV/AIDS-Related Stigma
• a process of devaluation of people either
  living with or associated with HIV/AIDS.
  (UNAIDS)
• HIV/AIDS-related Discrimination Discrimination
  follows stigma and is the unfair and unjust
  treatment of an individual based on his or her
  real or perceived HIV status. (UNAIDS)
• Relations?
• Stigma (marking/labelling) ?Discrimination
  (action)

4
Why Study HIV-related Stigma and Discrimination
in Asia?

• Stigma and discrimination described as the
  greatest barriers to effective epidemic control
• Asia described as the next battlefield for AIDS
• Research gap

5
Aim

• To provide a systematic situation analysis of
  structural forms of HIV related discrimination in
  selected sites in six countries
• China (Beijing)
• India (Trivandrum)
• Indonesia (Bali Jakarta)
• Philippines (Manila)
• Thailand (Bangkok)
• Vietnam (Hanoi)

6
Project Background

• 6 local research teams
• Project coordinated from Deakin University
  (Australia)
• UNAIDS (2000) Protocol for the Identification of
  Discrimination Against People Living with
  HIV/AIDS
• Allows cross country comparison
• Comprehensive and flexible
• Already implemented elsewhere

7
Methods

• Human rights approach
• 10 Key Areas (e.g. health, employment, housing)
• 37 items or situations

8
Health Care

• 1. Refusal to treat on grounds of HIV/AIDS
  status.
• 2. Different treatment on grounds of HIV/AIDS
  status.
• 3. Testing without knowledge.
• 4. Refusal to inform a person of the result of an
  HIV test.
• 5. Health controls, quarantine, compulsory
  internment, and/or segregation in hospital,
  clinic, nursing home etc.
• 6. Compulsory notification of HIV/AIDS status to
  sexual partner(s) and/or relative(s).
• 7. Non-confidentiality supplying names of
  individuals found to be HIV-positive to any other
  party, or knowingly or negligently allowing
  confidential files to be consulted.

9

• Three data sources
• legislation
• Institutional policies
• Institutional practice
• Approx 100 interviews per study
• Key Informants
• PLWHA

10

• Legal Definition of Discrimination
• any measure entailing an arbitrary
  distinction among persons depending on their
  confirmed or suspected HIV serostatus or state of
  health (UNAIDS, 2000, p.7)

11
Criterions

• 1. Where a HIV person is not treated in an equal
  manner as a HIV- person in a similar situation
• 2. May be the result of an action/omission, may
  be intentional/unintentional, direct/indirect
• 3. Not justifiable by legitimate objectives (e.g.
  public health, rights of others) and the means
  employed is (a) NOT proportionate to the aim
  pursued AND (b) does NOT constitute the least
  restrictive means available.

12
Deliberation Data Analysis
13
Scoring
14
Scoring
15
Scoring
16
Result Summary (Health Care)
17
Result Summary (Health Care)
18
Result Summary (Health Care)
19
Result Summary (Health Care)
20
Adding up the number of items where arbitrary
discrimination was found
21
Formula for calculating Indicator Score adapted
for health care
22
Indicator Score by Country
23
Ranking of Countries by Indicator Scores
24
Some problems with the indicator approach

• Nature of sampling
• Data access Quality of cases
• Negative connotation of discrimination
• Depth of investigation
• Time lapses, resources, witness availability
• Different administrative infrastructures
  institutional culture (role of written policies

25

• Issue of Standardisation
• Interpretability of the 3 criterions
• Interpretability of items
• Perspectives of researchers
• Different reference periods
• Not an indication for the magnitude of
  discrimination

26

• Findings Re-examined

27
Findings from Law/Policy

• Commonalities between studies
• Few instances of arbitrary discrimination in
  institutional policy
• issue of access
• Issue of availability
• Few instances of arbitrary discrimination was
  found in law
• Absence of legislation no direct
  discrimination (India, Thailand)
• Anti-discrimination legislation specific to AIDS
  (China, Philippines, Vietnam)

28

• PRC Medium Term Program for Prevention and
  Control of AIDS (1990/1992)
• Departments of health administration at every
  level i.e., National, Provincial, and City
  should appoint medical organizations for
  providing medical treatments and services to
  people with HIV and AIDS. Appointed health
  organizations should immediately admit and treat
  persons infected with HIV and AIDS patients, and
  should immediately arrange for health personnel
  to proceed with disease diagnosis and treatment.
  Refusal is not permitted. Medical personnel
  should act in strict accordance with professional
  ethics, protect patients confidentiality and not
  discriminate against them.

29

• PRC Medium Term Program for Prevention and
  Control of AIDS (1990/1992)
• Departments of health administration at every
  level i.e., National, Provincial, and City
  should appoint medical organizations for
  providing medical treatments and services to
  people with HIV and AIDS. Appointed health
  organizations should immediately admit and treat
  persons infected with HIV and AIDS patients, and
  should immediately arrange for health personnel
  to proceed with disease diagnosis and treatment.
  Refusal is not permitted. Medical personnel
  should act in strict accordance with professional
  ethics, protect patients confidentiality and not
  discriminate against them.

30
Predetermined Anti-Discrimination Measures

• Review and reform of laws in particular
  anti-discrimination laws
• Explicit anti-discrimination legislation with
  criminal and civil sanctions
• Development, dissemination and enforcement of
  professional codes of ethics/conduct
• Information/education campaigns explicitly
  targeted to promotion of non-discrimination,
  tolerance, inclusion, and support.
• Development and implementation of workplace
  policies, including sanctions for arbitrary
  discrimination.
• Provision of legal services, and litigation of
  precedent-setting cases.

31
In Practice

• Commonalities - 2 stage process
• Discover and/or communicate patients serostatus
  to others and
• Discriminatory treatment made possible by
  knowledge of patients HIV status
• Differences -
• Institutional variations in how serostatus is
  discovered and/or communicated.

32
So, what do all these mean?

• Underlying reasons for discrimination merit
  further investigation
• Considerations for the diversity in the reasons
  behind the discrimination
• Considerations of factors from the levels of the
  individual, institution to the wider health care
  system

33
Example Universal Precautions

• Cost Fear ??? Discrimination policy and/or
  practice

34
What Next?

• Points of intervention
• Antidiscrimination law/policy?
• Sanction?
• Education?
• Issues of enforcement
• Cost
• Infrastructure
• Cultural norms

35
Conclusions

• Counting discrimination is NOT enough
• Further research on distal drivers of
  discrimination is needed
• Effective solutions must be based on in-depth
  and holistic understandings of these factors

36

• Thank You
• Kit Yee Chan
• Email kit.chan_at_deakin.edu.au