Private public partnership for stigma free HIV service delivery in APAIDSCON network in India

      Background: Andhra Pradesh state has the highest HIV burden in India. Andhra Pradesh AIDS Consortium (APAIDSCON) the largest public health partnership a network of 20 medical colleges established to address HIV AIDS in India was spearheaded by SHARE India and funded in part by United States Centers for Disease Control & Prevention Cooperative agreement # U62/CCU025160-02. 2005 –2010
      Methods & Materials: Results of Interventions to reduce stigma and discrimination were analyzed. Both quantitative and qualitative methods were used. Adapted questionnaire on stigma and discrimination was used. Methods included In Depth Interviews with key stakeholders and patients to understand reporting of Stigma & Discrimination. Focus Group Discussions were used. Ethics committee approval was obtained.
      Results: The qualitative data indicated that stigma and discrimination present in the consortium among Health Care Providers due to the “fear element” was substantially decreased due to measures taken by the project like training and sensitization programs for HCPs, guidelines and protocol implementation to reduce stigma and discrimination, prevention of segregation i.e. separate bed or special identification marks during admission, staff compensation and facilitation of universal precautions. The qualitative data demonstrated that management of the sampled private hospitals never placed hurdles to admitting HIV positive cases. This created a conducive environment against stigma and discrimination. Instructions were given not to mention HIV positive status in patient's case record. Segregation of HIV positive patients for routine care was eliminated. After conclusion of the project follow up interviews of 117 in-patients from four of the sampled institutes demonstrated persistence of best practices with more than 96% of the PLHIV responding that there is no differential treatment or denial of treatment in these sites.
      Conclusion: Across the APAIDSCON consortium persistent efforts to remove the knowledge barriers had a salutary effect; HIV services could be provided without stigma and discrimination in the private sector. Grounded efforts with the managements both in private and public sector yield sustained results long after the intervention ended.