This study explored the prevalence of stigma and discrimination against PLHA in healthcare settings.
Poverty level was high among the study participants, with 21% reporting an income below the International Poverty line of 1.25USD per day, whereas another 44% were earning less than 2USD per day. This can both be a driver to get HIV/AIDS as well as a consequence of being HIV-positive. Poverty makes individuals vulnerable to HIV, while those who are diagnosed as HIV-positive are vulnerable to fall into poverty. (22)
Majority (67%) of the sample were aged between 21 and 40 years, which is economically the most productive age group. A report by WHO (23) has described HIV/AIDS as a challenge to both health and development.
One third of the respondents were tested without consent in this study. A study across Asia (8) reported that in China, Bangladesh and Sri Lanka more than 60% respondents had been tested without their consent. Paxton et al (24) found that only 52% of the respondents had given informed consent before testing. This is not only unethical (25) but it can also be detrimental to further treatment and prevention measures. (26) Testing without consent can lead to lack of taking up treatment, prevention and support services. (25,26) A study in India (24) found that individuals who were tested against their consent were more vulnerable to discrimination.
WHO defines key components for HIV testing services as informed consent, confidentiality, counselling (both pre and post-test) and direct referral to prevention, care and treatment services. (26) As a result of testing without consent, pre-test counselling is also missed. WHO recognises testing and pre-test counselling as the entry points to HIV care, prevention and support services.(27) Our study data suggest that post-test counselling is more common than pre-test counselling. This is not an ideal practice, as this does not prepare the individual for a positive test. A study from Uganda (25) concluded that both pretest and posttest counseling are needed to empower HIV-positive individuals to seek support within the community and thus handle stigma and discrimination in a positive manner.
Contrary to our findings, almost all participants were reported to have tested voluntarily and received both pre-test and post-test counselling in a study done in South Africa (28), a country with a high prevalence of HIV/AIDS. Voluntary testing can be encouraged where access to treatment and anti-retroviral therapy is available. (25,27) However, stigma can be a big barrier to voluntary HIV testing.
In this study, confidentiality was respected while handing out the test results. This is in contrast to other studies that found breach of confidentiality as a common problem. (24, 28) This could be because our study sample comprised 95% males; it would be interesting to know if there is a difference based on gender regarding this practice.
On receiving a positive test result, disbelief was the predominant...