Stigma and Discrimination against HIV/AIDS patients (Youth Adult) by Health Workers in Ghana.

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After becoming more evident in 1980s, Acquired Immune Deficiency Syndrome (AIDS) managed to become a major health concern all around the world. According to the report presented by World Health Organization (WHO), global prevalence of AIDS has been estimated reach to about 36.7 million by the end of 2015. Hence, the incidence of the disease throughout the year of 2015 was recorded and measured to be 2.1 million (World Health Organization, 2016).

HIV or human immunodeficiency virus has caused about 35 million mortalities worldwide (World Health Organization, 2016). Amongst the affected countries, Ghana has been identified to be one of the states with highest prevalence of AIDS. According to statistics of UNAIDS, there are 2.7 million people living with AIDS in Ghana. Although, the prevalence rate is only 1.6%, 19,000 patients have been determined to be younger than the age of 14 years. Amongst the prevailing rates, 150,000 have been the women.

Ghana has presented high mortality rate that values for 160,000 deaths caused only due to the disease of AIDS in the year 2015 (Unaids.org, 2015). Majority of cases of AIDS in Ghana have comprised of the women and blood donors. Thus, health workers tend to reach to women more often than men for the purpose of screening. Moreover, it is considered necessary for every pregnant woman to go through HIV test in Ghana. Similarly, in every six months, most people voluntarily donate their blood to the hospitals. After donation of the blood and screening of the collected specimen, the health professionals get to know a large number of people who appear positive for HIV (Feldman, 1994).

A number of interventional steps have been taken to reduce, treat and control the spread of HIV infections among the population. The interventions include the formation of Technical Committee in 1985 to work with World Health Organisation for the control and prevention of AIDS.

Screening Facility in 1987 and AIDS control program manager was introduced in 1988. Other interventions included the pilot interventions and wide ranged educational interventions to subdue the increasing number of infected individuals (Feldman, 1994).

Although, the interventions were introduced in the very beginning still the effects of the interventions have not been deemed fruitful as indicated by the low condom use despite of the easy availability and reduced prices. One of the major barriers in the success of educational programs directed to educate the young people is stigmatization, which is basically recognized as the act of judgmental or accusation.

Social and cultural beliefs associate AIDS with female prostitutes and assume that the disease is contracted through intimate interaction of the patient with them or because they themselves have been performing the job. Residents of the most prevalent areas of the Ghana also think that AIDS can be transmitted by meeting and spending time with the infected people.

Those people are reported to follow self-assumed preventive measures e.g. not even attending funeral of a suspected patient. In general, the patients of AIDS in Ghana face a substantial amount of stigma and discrimination from common people and even health service providers. The study will aim to find out the factors leading to this discrimination and stigmatization by health workers against HIV infected young individuals.

The discrimination towards AIDS patients is not limited only to common residents of Ghana, but evidence reports stigmatization and discrimination towards patients by health workers as well, which makes the enigma even worse. The health services and preventive education is not available for the patients because of the behaviour of the doctors and other health service providers.

Detailed studies should be employed to estimate and determine the factors that lead to the improper administration of health care to the AIDS infected individuals so that interventions can be designed to reduce the stigma and discriminatory behaviours of health workers ultimately leading to prevention of controlled spread of the disease.

The research on the determinants of the stigmatization and discrimination against the HIV positive people will not only result in adding to the knowledge pool but also can be implied to generate interventions that can develop the value of lifetime of the people living with HIV/AIDS, and also help in reducing the spread of the life-threatening disorder.

Research Question / Aim

What factors lead health workers to stigmatize and discriminate against youth adult living with HIV/AIDS?

Study Objectives

• To gather and review literature regarding the stigmatization against people living with HIV/AIDS by Health workers in Ghana.
• To undertake critical review and identify the factors responsible for stigmatization and discrimination against HIV/AIDS patient by health workers in Ghana.
• To evaluate and analyse the results for the systematic review and formulate conclusions and recommendations.

The Underlying Problem

It has been 20 years since the world has undergone the epidemic of HIV/AIDS. Despite of extensive studies and community work, stigmatization and discrimination associated with the disease continues to impede the preventive approach. The persistent conservation of the attitude has been hampering people to get required care and support for their condition. Studies have expressed that the fear of stigma has been found associated with the factors leading people to refuse for screening, disclosing the information to their partners and  seeking medical assistance foe treatment and management. Ultimately, this attitude delivers negative attitude creating an internalized stigma. This notion is realized to be a firm barrier observed between the medicinal help and suffering patient (Stangl et al., 2013).

In light of these approaches, it has been realized that before dealing with the treatment modalities of HIV/AIDS, it is necessary to determine the stigma mechanism that has been clinging with the disease since the early days. Researchers and health care practitioners have identified various factors that may assist in combating the high prevalence of this disease. These elements have included the clinical preventive measures of voluntary male circumcision, preventive exposures to the prophylaxis and widespread screening and management for the disease on a population level (Dai et al., 2013: 256-263; Roberts & Matthews, 2012: 1555-1561). It has been deemed necessary that before implying to any of these approaches, it is first necessary to eradicate the factor of stigma from society. Only then, the effectiveness of these interventions will be attained (Earnshaw et al., 2013: 225).

Significance of the Study

Existing literature has highlighted that stigma plays a major role in the health conditions of people under the influence of race and ethnicity. Regardless of the identification of the factor, the social setbacks persist within the communities, where studies fail to provide any comprehensive insight for the mechanism of stigma driving the intense attitude.

Yet, it is a well – known fact that HIV/AIDS is by far the most stigmatized clinical disease that is facing stubborn hurdles for the treatment and management approach. Awareness regarding the associated risks and prevalence remains under discussion due to the sexual connotations of the disease thus, creating obstacles and discrimination for help and education.

This study had planned to address all the probable factors of stigmatization concerning HIV/AIDS in order to determine their mechanism. It has evaluated the factors on the levels of structure, victim and observer. It has been presumed that this study will identify the lingering processes of discrimination that ultimately leads to stigmatization and segregation.

The approach will then help the policy makers to plan their models of intervention and education as per the identified the factors and perception of the society. It will assist in producing long term impact on the planning and implementation of the clinical framework dedicated to the HIV/AIDS.

LITERATURE REVIEW

Human Immunodeficiency Virus (HIV)

Human immunodeficiency virus or HIV, along with its subtypes, ae known as retroviruses. These are considered as the primary source of AIDS. Montagnier (1985) asserted that HIV connects back to the family of RNA or ribonucleic acid lentiviruses.

These have been found to be responsible for suppressing the immune system and central nervous mechanism. It has been further noticed that these retroviruses live extended period of incubation that leads to the notion, where disease indications are not expressed even after the contraction of the virus (Montagnier, 1985: 689-993).

Origin and Transmission of Human Immunodeficiency Virus

These viruses have been originally found in the varying species of primates (Emerman & Malim, 1998: 1880-1884). Emerman & Malim (1998) have presented the transmission mechanism of these viruses. It has been discovered that lentiviruses are incapable of transmitting through the germ lines. Molecular epidemiology has suggested that HIV occurs in two types among the species that have been suffering from the contamination (Heeney, Dalgleish & Weiss, 2006: 462-466). These two types have included HIV 1 and HIV 2.

HIV 1 is very common worldwide and HIV2 causes and AIDS -like illness.  HIV gets transmitted by various means:

• It is transmitted by blood or body secretions like semen and vaginal fluid of an infected person.
• It is transmitted by unprotected sexual intercourse with an infected person.
• It can also be transmitted by using infected needles or needle stick injury.
• It can be transmitted from infected mother to baby during pregnancy, birth or lactation (Robbins et al., 2015: 243-256).

Indications of HIV Infection

This condition does not have definite symptoms that may be prominent so people often confuse them with simple flu. This is why the disease progresses and gets more and more lethal (Robbins et al., 2015: 243-256). Few of its symptoms may include (Kinloch-de Loës et al., 1993: 59-65):

• Fever,
• Sore throat,
• Headache,
• Pain in muscles and joint pain,
• Swollen glands and lymph nodes,
• Rashes in skin.

These symptoms may start after a few days or several weeks after a person gets infected. Then once the symptoms disappear that were caught initially, the patient again becomes symptom free for few time. And then the symptoms again reappear. This time the symptoms may be:

• Swelling in lymph nodes
• Extreme fatigue and tiredness
• Weight loss
• Fever
• Sweating in night

If the doctors find these symptoms in a person and doesn’t find any other cause of the symptoms and he decides to rule out for this disease. The doctor goes for find the antibodies in body secretions like urine, saliva or blood. Because the antibodies to this disease appear in body’s secretions.

Screening for HIV Infection

If the urine or saliva shows that the antibodies to this virus is found then the doctor would go for ELISA (enzyme linked immunosorbent assay) or a western blot. These two tests are blood tests. If the ELISA gets positive that means if the antibodies are found in the blood then we will go for western blot in order to confirm this disease.

Once the virus is in the body, the antibodies show up in the blood within 3 months at least but it can take as long as 6 months. So, if the patient thinks he might have got infected by the disease, it is better to get the tests redone at 6, 12 and 24 weeks (Robbins et al., 2015: 243-256).

Treatment for HIV Infection

The treatment for this disease is called anti-retroviral therapy abbreviated as ART. These medications slow down the process of the disease by halting the replication rate of the virus. These medications can actually decrease the viral load in patient’s body and help him live a healthy life. To see the progress of the disease, doctors go for two tests:

• Checking the viral load, that is the amount of virus in the blood
• CD4 cells, this shows the immunity of human body.

In the course of treatment there comes a time when the medication does not work. This is because the patient gets resistant to the medication. The drugs in the antiretroviral therapy include:

• Nucleoside reverse transcriptase inhibitor which include zidovudine, didanosine, stavudine, lamivudine, abacavir, tenofovir, combivir, trizivir, emtricitabine, truvada, epzicom.
• Non-nucleoside reverse transcriptase inhibitor: Nevirapine, delaviridine, efavirenz, etravirine, rilpivirine.
• Protease inhibitor: saquinavir, indinavir, ritonavir, nelfinavir, amprenavir, lopinavir, atazanavir
• Entry inhibitors: enfuviritide, maraviroc
• HIV integrase inhibitors.
• Raltegravir, elvitegravir, dolutegravir.

Pathogenesis of HIV Infection

It is a well-known biological factor that retroviruses are only capable of replicating inside the living body of the host cell. It does not contain the DNA or deoxyribonucleic acid. It has been seen that pathological mechanism of HIV progresses in pattern of life cycle that depends on the internal environment of the host cell and the population of virus in the affected region (Sundquist & Kräusslich, 2012).

The HIV is particularly attracted to the cells that express the CD4 receptor molecules on their membranes. Thus, upon invading the body, these viruses ultimately attacks such cells whereby they either fuse to the cellular membrane or enter the cell by the aid of endocytosis. The possibility of expression of the infections merely depends on the quantity of virions that attack the body and availability of the host cell that may provide the site for accommodation to these viruses. Therefore, it is presumed that the expression of CD4 receptor molecules is the determinant factor of expressing HIV associated indications (Sundquist & Kräusslich, 2012).

HIV can be contracted through the orifices of the body including the oral cavity, cervix and vagina, and the surface of digestive mucosa. The transmission can occur even without any disruption of the mucosal lining (Keele & Estes, 2011: 839-846; Belyakov & Berzofsky, 2004: 247-253). It has been noted that HIV depends on CD4 molecular receptors for gaining access to the cell host, where it can replicate in number to form a colony. These host cells mainly include the mononuclear phagocyte system. The system chiefly includes…….