Role of Stigma and Culture in Reporting of BBFE


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Branch Medical Advisor ACC,
Adjunct Lecturer Occupational and Aviation Medicine, Otago University
45 Wilson Street, Wanganui, PO Box 435

(P46, Friday 28, Civic Room 1, 2.30)

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  • The research was conducted at Sheikh Khalifa Medical City in UAE, which is a comprehensive health service agency that is in effect the public health service of Abu Dhabi. The study was conducted in the hospital which is an emerging multi national tertiary health care facility with staff from all over the world. It was a two year intervention. In which a comprehensive BBFE program was introduced.
  • Move this slide forward
  • Not needed. You probably won’t have time
  • Need to say what your slide will discuss, as these are complex concepts. Maybe expand some of your discussion about culture?
  • This needs a LOT more explanation – make notes on these and read them!
  • Don’t like this slide – use one which shows reporting as crucial. Say that factors affecting reporting are Systemic factors Access factors KAP Culture! In our hospital the OH&S committee was given the task to involve HCPs and debate on how to develop a practical and effective program. As mentioned our challenges were different; the program had to be sensitive to the culture and legal environment. We started with developing a hospital policy and procedure for mandatory reporting.. it encourage reporting HCPs were involved so that they would own the program Mandatory immunization for Hepatitis B Development of a BBFE treatment protocol after consensus Read slide.. Each intervention will be discussed with reference to what we learned from it
  • First would read the 3 bullet points. What was the purpose of the in-depth interviews You will need to define and explain grounded theory Both need comprehensive and clear explanation!!!!!!!!! The exposure to infection was viewed by the participants as threatening every aspect of their lives: their health, their social standing in society and among peers, their family life, their professional life and employment, and their residence in the country. Then the 4 built point
  • The participants included two men and two women, who were employed as two doctors, a nurse and a lab technician. All four of the participants were expatriates; three from Asia, and one from Europe. The events resulting in BBFE for these participants included needlestick injuries and blood splashes.
  • Need to explain how you obtained the themes from the interview transcripts – the technique will not be familiar to delegates
  • Most accidents are unexpected, unplanned and unwanted – BBFE exposures similar to any accidents. The difference may be the potential seriousness of the consequences which are delayed, potentially life-threatening, and which have effects that permeate every aspect of their lives and livelihood, and those of their families. The HCPs participating in this study were clearly aware that BBFE was an occupational hazard of their work, and took this risk seriously, but nevertheless, when exposure occurred the experience was unexpected and shocking. 1 extract The participants described having performed the same procedures many times without any exposure or concern; knowledge of the patient’s disease status also tended to make them more cautious. 2 extract
  • Despite their knowledge of the infectivity – describe how physicians and surgeons view this – many are fatalistic – this may affect whether they seek help. Reduces compliance with post-exposure programme and reporting. Need to get accurate information to affected staff immediately. Role of counselling The emotional impact of an exposure from a patient known to have HIV but these were Hep C too was so significant that some of the HCPs described feeling as if they had lost everything, even before the outcome of exposure could be determined. 1 Extract The HCPs experienced many adverse psychological feelings, such as nervousness, anxiety, and depression following exposure. 2 Extract
  • Previous studies found negative attitude towards PLWHA; in our study the HCPs had a positive attitude but felt the tension between the risk and responsibility while performing their tasks. the participants came to question their continued involvement in their profession. However, once they had time to accept that exposure had occurred, moved from anger onto feeling that the risk was worth the professional satisfaction they achieved by serving others. Both extracts
  • Extract 1 and 2 This shows the severity of stress the HCPs were going through after the exposure. It is evident that the level of stress was not due to the biological consequence of the disease but due to the stigma associated with it and the way the society would react. (Next slide to compare)
  • On the other hand Ms. C and Dr. D had very different views of the same incident in a similar medical and legal situation. They did not show that level of stress mainly because they came form a society where HIV was more acceptable. Nevertheless, the stigma of HIV was still considered significant enough to impact on her future employability, and therefore of concern from an economic perspective A clear contrast Dr. D, who was exposed to hepatitis C rather than HIV, expressed similar concern regarding the impact of stigma associated with infectious disease on his future employment. He expressed frustration about the influence of political and religious views on what he viewed to be entirely a clinical issue.
  • all four people involved in this study faced possible legal implications in terms of their employment, residency in UAE, or both. Of note in this study, those participants who were from communities where HIV was stigmatized tended to be more concerned about the cultural consequences of the disease rather than the legal or financial consequences.
  • Differs from the NZ experience and most countries where BBFE programmes have been reported in that ACC or Workers Compensation kicks in to take care of the exposed person’s injuries, work incapacity and personal losses. Middle East countries because of their system discriminate against affected people and punishes them for illness sustained during their work as a health care provider!
  • The hospital had factors specific to the working environment to Middle East which were different from those of other developed countries; requiring an indigenous BBFE program. BBFE reporting was influenced by stigma, and other social factors (health insurance, financial motives, and support services) which need to be recognised and addressed to develop a BBFE. If the HCPs believed that post exposure PEP treatment gives a good opportunity to prevent disease (HIV) compared to the risk of not taking the PEP; they will report the exposure
  • The study suggests that BBFE reporting is not merely an organizational issue – it needs to be addressed at a societal level. Public awareness campaigns and advocacy is required to increase awareness of different modes by which HIV/AIDS can be transmitted and the availability of post-exposure treatment
  • Role of Stigma and Culture in Reporting of BBFE

    1. 1. Role of Stigma and Culture in Reporting of BBFE Towards 2020 Challenges and Changes in OH&S 28 October 2011 Dr. Moazzam Zaidi Dr. Robin Griffiths
    2. 3. <ul><li>Global burden </li></ul><ul><li>Definitions </li></ul><ul><li>Qualitative Research </li></ul><ul><li>Results </li></ul><ul><li>Conclusion </li></ul>
    3. 4. <ul><li>6.6 billion individuals round the globe </li></ul><ul><li>20 million health care providers </li></ul><ul><li>Approximately 3 million individuals are injured annually due to needlestick or sharp injuries. </li></ul><ul><li>18-35 HCPs acquiring HIV/AIDS </li></ul><ul><li>Ref: World Health Organization (WHO 2002) </li></ul><ul><li>Black 2006 </li></ul>
    4. 5. <ul><li>A percutaneous injury or contact of mucous membrane or non intact skin with blood, tissue, or other body fluids which are potentially infectious </li></ul><ul><li>Ref: CDC MMWR Vol. 50/No. PR-11 </li></ul>
    5. 6. <ul><li>According to Leininger “culture is the way of life which directs the actions and thoughts of a group of people. He stressed that culture had a significant influence on the health practices of the people” </li></ul><ul><li>Ref: Leininger, 1978 </li></ul>
    6. 7. <ul><li>The dictionary definition of stigma is “a symbolic mark” although stigma today is widely used and understood with reference to adverse social processes. </li></ul><ul><li>Ref: Weiss MG, Ramakrishna J, Somma D. Health-related stigma: Rethinking concepts and interventions. Psychology, Health & Medicine. 2006;11(3):277 - 87. </li></ul>
    7. 8. Blood or Body Fluid Exposure Sero Conversion Concern Incident Outcome <ul><li>Primary Prevention : Policies / Procedures </li></ul><ul><li>HCPs participation </li></ul><ul><li>Immunization </li></ul><ul><li>Treatment protocol </li></ul><ul><li>Lab/ Pharm </li></ul><ul><li>Awareness & Reporting </li></ul><ul><li>Secondary Prevention: </li></ul><ul><li>Counselling </li></ul><ul><li>Post Exposure Prophylaxis </li></ul><ul><li>Follow up </li></ul>
    8. 9. <ul><li>HCPs exposed to HIV and Hep. C </li></ul><ul><li>In-depth interviews </li></ul><ul><li>Analysis using “grounded theory” principles </li></ul><ul><li>The data showed that due to cultural differences, individuals exposed to the same disease within the same legal system could have different concerns. </li></ul><ul><li>Ref: Willig 2008 </li></ul>
    9. 10. <ul><li>2 Physicians </li></ul><ul><li>1 Nurse </li></ul><ul><li>1 Lab technician </li></ul><ul><li>3 Asia </li></ul><ul><li>1 Europe </li></ul>
    10. 11. <ul><li>1) Experiencing the unexpected, </li></ul><ul><li>2) Inevitability and finality, </li></ul><ul><li>3) Impact of stigma, </li></ul><ul><li>4) Responsibility and risk, </li></ul><ul><li>5) Legal and financial implications. </li></ul>
    11. 12. <ul><li>“ This accident was totally unexpected … how could I even think that the instrument would slip from my hand and the sample would be splashed onto my face… I never thought that this could happen” (Ms. B) </li></ul><ul><li>“ I was not distracted I was more cautious than ever. But I had this bad feeling that this will go wrong” (Dr. A) </li></ul>
    12. 13. <ul><li>“ My partner had seen this [the exposure], he took over, I immediately went out and took off my gloves hoping it did not reach the skin but when I saw the blood … it was over. [Here the participant took a deep breath, shaking his head and stopped speaking for a while]”. (Dr. A) </li></ul><ul><li>“ It’s amazing how a single event can change one’s life”. (Ms.C) </li></ul>
    13. 14. <ul><li>“ At times I do think of changing my profession. In our profession we will always be exposed to these diseases. If not HIV something else, but this is the worst – it’s just does not kill you, it brings shame for you and your family in our society” (Ms. B) </li></ul><ul><li>“ I do think at times that this could happen again, why not change the profession? But then there are so many nurses which work all their life and nothing happens to them” (Ms. C) </li></ul>
    14. 15. <ul><li>“ I do not want to get HIV or AIDS. A girl getting this disease! Do you understand what that will mean? Everyone will start talking. Not just me, my family will be ruined. Our entire family lives in this country. If the disease won’t; the gossip will kill me”. (Ms. B) </li></ul><ul><li>“ I can still remember the look on the face of the pharmacist when she was giving me the HIV medication, like I had HIV already. My God it’s hard to live” (Dr. A) </li></ul>
    15. 16. <ul><li>“ The disease is known to have sexual transmission as a way of getting it, but I think people are aware of the occupational link and home is different than this place. I do not see religion being involved in it. But getting a job as a nurse with HIV will not be possible. I do not think any hospital will take me. So I am more concerned of the social and financial aspect, but I am hopeful it will all be ok” (Ms C) </li></ul><ul><li>“ I am a surgeon not a politician I do not think science and politics should be mixed. Disease is a disease it should not be stigmatized or politicized. Whatever evidence based medicine has proved we should follow and to my knowledge in Europe surgeons with hepatitis C can still practice” (Dr. D) </li></ul>
    16. 17. <ul><li>“ At present I am not thinking of where to stay. My priority is what is going to happen with me and what will my future be. Will I live or die with such a stigma. I don’t care where I would live. Does it make a difference?” (Dr. A) </li></ul><ul><li>“ I will be deported and the treatment is too expensive at home. I will lose my job and get a disease which is very expensive to be treated”; (Ms. C) </li></ul>
    17. 18. <ul><li>“ This kind of stress is horrible when I am performing my duty I do not ask if the patient has any of these diseases and if it does would I not treat it; then how can I lose everything if I get it as a result of my occupational exposure” (Dr. D) </li></ul>
    18. 19. <ul><li>Most important concerns and causes of stress arising from occupational BBFE were related to the social implications (i.e. stigma; legal and financial costs) rather than the biological consequences of the disease. </li></ul><ul><li>Social implications like these may negatively impact on reporting of occupational BBFE in UAE, but may need to be addressed at a societal rather than organisational level. </li></ul>
    19. 20. <ul><li>BBFE program: has to be sensitive to “Social Issues” </li></ul><ul><li>Post exposure counselling </li></ul><ul><li>Win the trust of HCPs: Post exposure prophylaxis </li></ul><ul><li>Awareness campaigns and advocacy is required to increase awareness of different modes by which HIV/AIDS can be transmitted and the availability of post-exposure treatment </li></ul>
    20. 21. Thanks