SHARING EXPERIENCE FROM HEALTH PROVIDERS; HIV STIGMA AND DISCRIMINATION IN SERIRIT, BULELENG, BALI
Putu Theni Aryasih Dwi Hendrayani Sintha Kurnia Dewi Udayana University, Denpasar, Bali Corresponding author : email :
[email protected]
Background Method Results Lesson Learned
Background
Research Centre for Health Economics and Evaluation (ReCHEE)
Pattern of HIV epidemic in Bali
children
Partners Clients PMTCT: 1. Case findings 2. VCT 3. ANC 4. Referring PMTCT
FSW
decrease MTCT
Clients
Partners HIV
Source: Wirawan, D.N, 2010
children
The study was conducted in Kecamatan Seririt (subdisctrict), Buleleng regency.
60%
of pregnant women in Bali are seeking ANC services at midwives
Research Centre for Health Economics and Evaluation (ReCHEE)
Buleleng
regency ranked 2nd in the highest number of HIV cases in Bali. Seririt, ranked 3rd in the highest number of HIV cases among sub-disctricts after Gerokgak and Sawan. Midwives in Seririt already received training on basic knowledge on HIV and PMTCT.
Qualitative
study 3 Focus Group Discussion with 21 Midwives in-depth interviews with eight pregnant women who refuse VCT and one pregnant women who HIV positive
Method
Results
Research Centre for Health Economics and Evaluation (ReCHEE)
The barriers faced by midwives in casefinding and when referring pregnant women for HIV tests were: the community the health provider (midwives)
Stigma from the Community 1. There were stigma in the community on HIV (be excommunicated)
There were stigma in the community on HIV (be excommunicated) “…later
if other people know that I am positive… then no one will never mingle with me… that, according to me, is one of the factors why we could not encourage people to have the self-conscience to test themselves…” FGD 3.
(“…nanti kalau orang lain itu tahu saya positif…saya pasti tidak ada yang mengajak bergaul….itu sebenarnya kalau menurut saya itu mungkin penyebabnya…kenapa kita susah untuk menjaring orang atau menggiring orang untuk mempunyai kesadaran memeriksakan diri…” FGD 3.)
Stigma from the Community 2. Stigma on HIV that affect access to VCT (people will assume someone HIV+ when visit VCT clinic)
Research Centre for Health Economics and Evaluation (ReCHEE)
Stigma on HIV that affect access to VCT “….other
people will assume differently when someone visit the clinic (VCT clinic)…it is really scary…” FGD 1.
Stigma from Health Provider (midwives) 1. Concerns of decreasing number of patient visits
(“….pandangan orang begitu masuk ke kliniknya itu juga beda…dah…pasti ngeri dah…” FGD 1).
Worries of decreasing number of patient visits if midwives suggest their patients to undergo HIV test ”…once
there was a patient whom I thought was at risk.. I told her to do HIV test..uuh.. then after that she never comes again.. if this keeps on happening, I’ll be losing patients..” FGD 3. (”…pernah dulu pasien yang saya anggap berisiko…saya kasitau untuk tes HIV…ehhh…ndak datang-datang dia…kalau sering gitu…gimana ya…kan hilang ye pasien saya….” FGD 3).
Stigma from Health Provider (midwives) 2. Concerns in getting infected
Research Centre for Health Economics and Evaluation (ReCHEE)
Lesson learned Concerns in getting infected "....
the same with my friends in the service ... fear ..." FGD 2. (”….sama dengan teman-teman…ketakutan dalam pelayanan…” FGD 2.)
"....
yes ... there is a sense of fear especially the increasing cases of hiv ..." FGD 1. (“….ya… ada rasa ketakutan apalagi semakin meningkatnya kasus dari hiv ini,, …” FGD 1.)
In order to increase the potential role of midwives, there should be : Regular training, monitoring and refreshment (especially how to approach client, and encourage pregnant women to do HIV test). Provide HIV AIDS education through health promotion involving cross-sectoral cooperation and community leaders or public figures to reduce stigma and discrimination in the community.
Thank You
Research Centre for Health Economics and Evaluation (ReCHEE)
