Building the HIV/AIDS Capacity of Health Care Providers and Communities in Jamaica - Jamaica

This programme is based on the premise that stigma about HIV/AIDS, even among healthcare providers, prevents many people who might be helped by prevention and treatment measures from getting tested for the disease and seeking care in Jamaica and throughout the Caribbean.

JHPIEGO is adding to its scope of services in the country in partnership with the MOH by enhancing efforts to improve the quality of services by nurses and other providers working directly with HIV/AIDS patients. In order to achieve this goal, JHPIEGO is conducting (1) opportunistic infection and infection prevention training, into which JHPIEGO plans to integrate stigma and discrimination role plays, case studies, and messages to the healthcare providers being trained, (2) feedback sessions on data collected from client satisfaction surveys and health provider surveys on stigma and discrimination and quality of care, and, (3) a process for decreasing stigma and discrimination by health care providers in Jamaica. The intervention process will also provide NGOs with data documenting the way stigma and discrimination are manifested in Jamaica for advocacy regarding stigma and discrimination.

Specifically, the intervention is composed of two major components:

1. Building the capacity of health care providers at a public hospital to increase their skills to appropriately address the needs of people living with HIV/AIDS (PLWHAs) by cultivating non-discriminatory behaviours and attitudes. The hope is that health care providers will increase their knowledge of infection prevention and opportunistic infection management, as well as improving their behaviours and attitudes.
   
   To that end, JHPIEGO has developed a curriculum including: treatment of opportunistic infections (OI), an update of basic infection prevention (IP) practices, and concurrently promoting stigma-reducing behaviours. Approximately 30 staff from Kingston Public Hospital (KPH) have been trained; additional training has been requested by KPH and will be conducted in 2005.



2. Building the capacity of NGOs supporting PLWHAs to develop tools they can use to advocate for fair and compassionate treatment in the health care and other sectors. The idea is that PLWHAs and others in the community may benefit by seeking, and receiving, more appropriate care services.
   
   A quality of care exit interview survey was conducted and results were presented to KPH staff and leadership. Ministry of Health authorities and NGO support groups participated in development of the questionnaire. While conclusions are statistically insignificant based on the relatively small number of HIV+ participants, the data do suggest that HIV+ people receive profoundly worse treatment than HIV- patients. For example, the sheets (bed linens) of HIV+ patients were changed far less frequently.

HIV/AIDS.

UNAIDS figures indicate that the Caribbean has the second highest prevalence of HIV in the world after Sub-Saharan Africa; Jamaica is particularly hard hit. A 2004 UNAIDS report revealed that an estimated 22,000 Jamaicans are infected with HIV/AIDS. According to Jamaica's National KABP Survey in 2000, more than a third of men and women surveyed knew a person with AIDS (living or dead), and, for 10% of those surveyed, the person with AIDS was a close relative or friend. AIDS is the leading cause of death among young adults (15-44) in both Jamaica and the region as a whole. According to JHPIEGO, in Jamaica most HIV-positive persons do not seek testing or treatment until they are symptomatic, which limits the benefits they could get from early treatment of tuberculosis and other opportunistic infections. Delay in seeking care is related to a variety of factors, including widespread stigma and discrimination against people with HIV. While HIV/AIDS services are free throughout Jamaica, antiretroviral medications and lab tests such as CD4 counts have been prohibitively expensive. JHPIEGO has been working with the MOH since 2001 to reduce the transmission of HIV/AIDS in Jamaica by developing a national network of providers trained in HIV testing and counseling. Many community-based organisations are working in Jamaica to address the HIV epidemic and to empower communities at risk for, or experiencing the impact of, stigma and discrimination within and outside these communities.

JHPIEGO reports that Jamaica has a well-established health care system with primary health care services in the community. A great deal of clinical expertise exists among doctors, nurses and others in the health care sector; stigma and discrimination by health care providers, however, remains a challenge to expanding access to quality care. Many physicians refer HIV-positive clients to a small cadre of physicians willing to care for these clients. Anecdotal accounts of nurses and other staff refusing to touch HIV positive patients have found their way into the popular press. The attitudes of health care providers are a reflection of the societal attitudes in Jamaica, where HIV/AIDS is highly stigmatised.

JHPIEGO, an international health organisation affiliated with The Johns Hopkins University in Baltimore, MD, USA, trains and supports healthcare providers including doctors, nurses, midwives, and health educators. Working in limited resource settings throughout Africa, Asia, the Middle East, Latin America, the Caribbean, and Europe, JHPIEGO is focused on improving the health of women and children.