Barriers to HIV Care and Treatment by Doctors: A review of the literature

Abstract

This paper provides a review of the reported barriers that prevent doctors from managing HIV infected patients. The four most commonly reported barriers were: fear of contagion, fear of losing patients, unwillingness to care, and inadequate knowledge /training about treating HIV patients. Barriers to treating HIV infected patients is frequently reported in many countries and it is important for developing countries such as South Africa to learn from these experiences by identifying local problems so that constructive interventions and strategies can be developed to address these barriers, thereby improving the quality of patient care. Further research in respect of the local situation is required. IntroductionOver the last two decades acquired immunodeficiency syndrome (AIDS) has emerged as one of the most serious public health problems in the world, and by the end of 2003 it was estimated that 5.3 million South Africans were human immunodeficiency virus (HIV) positive, which corresponds to 21.5% of the population. 1 In the early phase of the HIV epidemic few doctors saw infected patients and treatment options were limited. As a result many doctors were reluctant to provide care to HIV infected patients and homophobia amongst doctors, fear of contact with patients and unwillingness to care were frequently reported. 2 However, there has been an exponential increase in the number of HIV and AIDS related cases and more doctors are encountering infected individuals. This review summarizes our current knowledge of barriers to treatment of HIV infected patients by doctors. MethodA comprehensive literature review was undertaken by searching the MEDLINE database, Psychlit, ISI Web, EBSCOHost, and Sabinet on line, for English language literature published between 1985 and 2004. The database search terms included keywords such as fear/s, barrier/s, concern, HIV, AIDS, attitudes, physician/s (doctor/s), practice, treatment, care and knowledge. A variety of combinations of these words were entered. All duplicate articles were removed and only studies that used doctors as the sample population were considered. Titles expressing comment, news items, opinion pieces or letters were rejected. ResultsThirty two relevant studies were identified from the literature search. The four most commonly reported barriers were: fear of contagion, fear of losing patients, unwillingness to care, and inadequate knowledge /training about treating HIV patients. (SA Fam Pract 2006;48(2): 55) AbstractThe full version of this article is available at: www.safpj.co.za Downloaded by [Moraine Comm College] at 04:

The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal

“… 13 Lack of time or a demand on the doctors’ time was a commonly cited reason for doctors not willing to manage HIV and AIDS patients in the developed world. 16 Our findings are consistent with other studies, where lack of infrastructure, or poor infrastructure, such as lack of support staff, the structure of a general practice, lack of specialty backup support for patients who develop complications, or lack of community social services or resources, 16 have presented barriers to doctors willing to manage HIV and AIDS patients.…”

“…15 In the 1990s, many studies recognised that the lack of, or inadequate, medical/clinical knowledge to treat HIV and AIDS was a barrier that resulted in doctors not wanting to manage these patients. 16 The present study confirms these trends, because lack of knowledge was associated with doctors not wanting to manage public-sector HIV and AIDS patients. Even though these doctors were managing private-sector patients, they may require additional knowledge to manage an increased load of patients, as would be the case if they were to manage both private- and public-sector HIV and AIDS patients.…”

Hearing the Voices of Wingless Angels: A Critical Content Analysis of Nurses’ COVID-19 Experiences

“…Nurses might experience an ethical paradox in deciding whether to provide treatment and care for patients with transmissible diseases. For example, unwillingness to treat patients with a transferrable virus was reported in 23% to 50% of healthcare workers in the US, 21% in Spain, and 14% in Canada [ 58 ].…”

Nurses’ willingness to care for patients infected with HIV or Hepatitis B / C in Vietnam

“…Healthcare workers may experience an ethical dilemma in deciding whether to provide treatment and care for patients infected with HIV, HBV or HCV. For example, unwillingness to treat patients with HIV has been reported in 23 to 50% of physicians in the United States, 21% in Spain and 14% in Canada [ 27 ]. The current study revealed that the percentages of Vietnamese nurses unwilling to provide care was similar to that reported among Japanese nurses (44% for HIV and 27% for HBV/HCV in Vietnam; 46% for HIV and 20% for HBV/HCV in Japan) [ 28 ].…”