The Intervention Of Aids-related Discrimination In The Process Of Health Services Research

【Objective】To explore effective intervention on health service providers to reduce HIV/AIDS related discrimination during health care services.【Methods】This study was a quasi-experiment with self-control and blank-control and 3 phases were included:baseline survey/needs assessment,intervention and evaluation.753 health staff(control group n=300,intervention group n=453) and 40 clients were investigated.Both questionnaire and interview(in-depth interview and focus group discussion) were conducted.During the intervention,training and propagandizing,participatory planning,constituting regulations and visiting were performed.SPSS13.0 software and Microsoft Office Excel 2003 software were used in data analysis.【Results】1.HIV/AIDS related discrimination during health care services in GejiuFive situations had been found,including "refusal to treat on grounds of HIV/AIDS status","different treatment on grounds of HIV/AIDS status","testing without knowledge","refusal to inform a person of the result of a HIV test" and "compulsory notification of HIV/AIDS status to sexual partner(s) and/or relative(s)". The first kind of situation rarely happened.Proportion of health staff who had practice other four kinds of behavior was 47.0%,68.3%,39.3%and 58.9%respectively.2.Attitudes towards people living with HIV/AIDS(PLHA) from health staff in GejiuOnly 5.3%of health staff would like to contact with PLHA in daily life,and 3.3%of health staff totally wouldn't.83.4%of health staff would like to treat PLHA and 14.3%of health staff would not.Willingness to contact with PLHA in daily life increased according to age,HIV/AIDS related knowledge,and frequency of contact with PLHA.It was also shown health staff in rural health institutions had higher willingness to contact with PLHA.Willingness to treat PLHA decreased according to age.Health staff who contacted more than 10 HIV positive patients per year were most disinclined to treat PLHA.Proportion of people who would like to treat PLHA was lowest in accoucheur while highest in paediatrician.And the proportion also increased according to perception of health staff to human fights of patients.It was also found there was positive association between willingness to contact with PLHA in daily life and to treat PLHA.3.Effects of interventionHierarchical multiple regression analysis indicated that intervention group scored 1.70 higher than control group(P＜0.01) in test of HIV/AIDS related knowledge, willingness to contact with and treat PLHA were both higher in intervention group (OR=1.98 and 0.41,respectively).Results of interview also showed positive change in intervention group on perception of HIV positives and "risk population",willingness to treat PLHA was also increased.Quantitative data didn't suggested positive change on perception of human rights of patients,but there were interviewees from intervention group who talked about protecting patients' rights.Several rules and regulations of standard precaution and occupational exposal were established at all of the 3 institutions after being intervened.Only one of the institution constituted rules about consultation for PLHA.【Conclusions】1.Five situations in which HIV/AIDS related discrimination may occur were found during health care services in Gejiu,including "refusal to treat on grounds of HIV/AIDS status","different treatment on grounds of HIV/AIDS status","testing without knowledge","refusal to inform a person of the result of a HIV test" and "compulsory notification of HIV/AIDS status to sexual partner(s) and/or relative(s)".2.Possible causes of HIV/AIDS related discrimination during health care services in Gejiu included:1) Ignoring of human rights of patients;2) Being short of communication skills with patients;3) Over caring of self health and incapable of self-protection;4) Traditional custom and professional regulation.3.Special intervention is necessary for reducing HIV/AIDS related discrimination during health care services.4.Necessary professional protection maybe effective in reduction of HIV/AIDS discriminated practice in health care services.