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HIV discrimination among health providers in Malaysia by Dr Rubz

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Although doctors took oath that they will treat everyone the best they can and without judging anyone but discrimination still exist especially in HIV affected people. Due to this issue, Pertubuhan Advokasi Masyarakat Terpinggir Malaysia has taken a step to engage with doctors at government sector and desensitize them and find the line to stand together.

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HIV discrimination among health providers in Malaysia by Dr Rubz

  1. 1. Do we understand each others? Dr Ruby Bazeer @ Dr Rubz Executive Director of PAMT
  2. 2. How to break the wall? HCW vs Community (KAP)
  3. 3. Fear? Lack of knowledge? Less empathy?
  4. 4. • “A woman went to (a) hospital for treatment and they found out she was HIV positive. The doctor respected her confidentiality, but one of the nurses lived in her neighbourhood and told on her. It became a horrible situation for the woman.” • “Unfortunately, the most problematic area is that a lot of ongoing stigma and discrimination is in the hospitals and clinics,” As it is, even when patients know their rights, many are reluctant to challenge it because that would mean they have to reveal their status,says Professor Dr Adeeba Kamarulzaman, director of the Centre of Excellence on Research in AIDS (CERiA) and the head of University Malaya Medical Centre Infectious Diseases Department.
  5. 5. • Dr Beyrer, who was in Malaysia recently for the Lancet Series Symposium for HIV in People Who Use Drugs, describes the lack of human rights considerations in responses to HIV that still exist today as some sort of tug-of-war between human rights principles and political will.- http://www.thestar.com.my/Lifestyle/Health/2011/01/09/Human- rights-in-HIV/ • “Mainly, it’s because human rights principles, such as universal access to prevention, treatment, and care, and non-discrimination in that care, have so often clashed with strongly held social and legal constraints at country level. • “So, we see countries agreeing to universal access, but then politicians want to deny that access to people whose behaviours are seen as unworthy, illegal, or stigmatised. This includes drug users in many countries, people who sell sex, men who have sex with men, transgenders, prisoners, migrants, and the poor.
  6. 6. • Consent- verbal or written • Skip questions/procedure • Poor counseling-Poor information/explanation- window period • Late result- Negative not informed • Poor follow up especially during confirmatory test result • HCW Less empathy –reveal the positive result • Confidentiality –not 100% • Informing the partner/family – not duty of HCW • Different doctors - tx • KPI (quantity – more work) • Using name (TG) • Not enabling environment- Prakahwin together with VCT • Long procedure- too many rooms • Prejudice (All LGBT has HIV) • Time concern (Busy) • Assumption (KAP knows everything) • Misconception – What is LGBT?SW? Sex activity? • SOGIE- Sexual preference, MSM, TG, FSW • Poor history- pt not honest • Wrong wording –’ pelacur’ ASK YOURSELF – HOW TO IMPROVE HCW Poor rapport
  7. 7. KAP • Fear • Not ready • Poor knowledge • Prejudice (All HCW are discriminative) • Time concern (KAP are not morning glory) • Assumption/Phobia (Everyone is watching them) • Misconception – Counselor vs Trained Post basic • Misunderstanding (questionnaire) • Not being honest – Scared,don’t trust HCW • Not cooperative • Shame • Ignorance - Poor follow up • MIA/Defaulted - resistance • Previous bad experience • Curiosity – not sure to ask or not • Defensive mechanism • suicidal/depression Not demanding but rights to access universal service
  8. 8. Communication • Learn their street language • Use lame man words • Repeat words and keep asking them “ada faham? Ada soalan?apa yang tak faham?” • Tone – very important. • Eye contact, smiles • PRIVACY!
  9. 9. Universal health access KAP = HIV/STI • SRHR • Primary care – DM, HTN, RA, Gout, CA, • Mamography • Hormone therapy • Contraception • TB • Hep C • Hep B vaccine • Mental health – suicidal thoughts, depression, GID
  10. 10. KLINIK ANGGERIK COMMUNITY SENSITIVE CLINIC • Pilot project with KK Cheras Kuala Lumpur • SOGIE training with 8 staffs from KK Cheras; MO,Counselor,MA,Nurse,Pharmacist,Registra • Enabling environment – target zero discrimination, zero stigma • One special room – not unit! – Klinik Anggerik • Not just VST/VDRL but it is total health care including breast examination, papsmear,genital examination, bp, hormonal,dietary, referral for mamography with LPPKN and Hep B vaccine with Family Planning NGO • Special day – special time (Tuesday 2pm-5pm) • Due to demand, changed to Monday- Friday 9am-5pm but usually clients prefer after 2pm • No name calling, ORW will be guiding • Work closely with NGO (they refer us for any SOGIE question/case, legal/policy, shelter, peer support) • Due to good rapport, different NGO uses the facilities (PLHIV peer support group starts) • Now many clients request to go and many went second follow up.
  11. 11. If you can’t break the wall, “90:90:90 – It is a dream…” – Dr Shari’i A dream doesn't become reality through magic; it takes sweat, determination and hard work. -Colin Powell just jump over or go underneath… be innovative
  12. 12. Thank you

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