Stigma and discrimination can affect negatively the interactions of healthcare workers with HIV infected

clients or those perceived to be positive. Non informed staff in healthcare settings may perceive HIV

infected patients to be the biggest threat to their safety at work. Their attitudes can frighten those patients

and limit access to and utilization of HIV-related services. Sometimes they may go as far as withholding

health services from those believed or known to be HIV positive; or they may create segregated area for

them thus violating their fundamental human rights. As HIV-related prevention, care, and treatment are

scaling up in Namibia, access to these life saving services will be greatly influenced by the degree to which

health facilities welcome and respect the rights of HIV-positive clients.

Studies revealed that stigma and discrimination in health facilities have numerous causes: lack of

knowledge regarding the modes and risk of HIV transmission; judgmental attitudes, and assumptions about

the sexual lives of people living with HIV; fears of becoming infected. "Health worker's fears are not

unfounded"…"The number of cases of HIV infection through medical transmission is certainly not trivial;

transmission of hepatitis B and C is also a serious risk".

Some in depth anonymous discussions conducted with staff of the MOHSS by URC staff revealed some

problems worth considering and addressed. Those who sustained needle stick injuries and who did not

report to their supervisors experience such symptoms as: fear of stigmatization, uncontrollable crying,

extreme fatigue, insomnia, headaches, loss of appetite, stomach upsets, and disruption of the menstrual

cycle, among others. By refusing to be tested to learn about their HIV status they put themselves in the

awkward position of not receiving the appropriate care and support they deserve. If infected they put their

lives and those of their clients at risk. "To reduce stigma and discrimination in health care settings, we need

to address health care workers' fear about getting infected on the job, and their need to protect themselves

through standards precautions. They have to be trained to come to terms with their fears and anxieties

about their own sexuality and mortality, their prejudices". People working in the healthcare settings have no

more information than members of the general population. Unless exposed to special training and/or

information sharing they are unable to display the right positive attitudes.

In order to fight stigma and discrimination in the healthcare settings, to protect the human rights of patients

seeking HIV-related services, University Research Corporation (URC) will exposed 61% of HCP to relevant

training. The Trainer's Manual "Reducing Stigma and Discrimination Related to HIV and AIDS" develop by

ENGENDERHEALTH will guide the quarterly training sessions. The Plan Do Study Act (PDSA) session

that is held in each region every quarter will be used to apply this behavior change strategy in HIV/AIDS that

will empower the population of Health Care Providers to take informed decisions regarding their sexual life,

to disclose the information regarding work accidents in relation with infectious needles and sharps injuries,

and to carry out some ideal behaviors regarding patients infected with HIV/AIDS. It will also support the

workplace program of the MoHSS in order to assist healthcare workers in dealing with the HIV/AIDS

situation in their working environment.

This activity will be the continuation of the Provider knowledge that will be carried out in FY2007. The same

simple three components teaching approach will be followed: (1) Identification of training needs through a

pre-test questionnaire which addresses the knowledge/attitudes/practices regarding HIV/AIDS and ABC; (2)

training of target groups; (3) monitoring of the results of the training through post-testing the

knowledge/attitudes/practices regarding HIV/AIDS and ABC. As part of capacity building, and to ensure

sustainability of the intervention, URC will train MoHSS staff member, mostly supervisors (Control

Registered Nurse, Infection Control Nurse for example) as TOT. The trainees will take advantage of field

supervision and mentoring to assist in the dissemination of information. They will, in turn, train other

colleagues, who will continue dissemination during on the job training sessions. To enhance the global

effect of this strategy and to support further strengthening of MoHSS capacity, this activity will be integrated

with workplace programs.

The workplace program component whose principal aim is "Care of the Carers" will be carried out by

qualified psychologists who have the expertise on how to unlock the inhibitions and open the floodgates of

anger, sadness, and confusion, and create the right atmosphere for sharing of feelings and worries. They

will conduct counseling sessions, follow up progress and provide support in recovery when necessary.

These sessions will improve the Post Exposure Prophylaxis (PEP), will help the healthcare workers cope

with the stress associated with HIV activities in their work environment and will prevent burn out. With their

new level of knowledge and understanding of the epidemic, the trainees will drive the necessary changes in

their facility, thus creating a welcoming environment for people living with HIV. URC will provide also

technical support to MoHSS staff who wants to organize and maintain a better set up to alleviate pressure

during working hours including recreational and information sharing area. The psychologist will be asked to

train workplace program counselors as a mean of ensuring program viability

The target group will be all people working in the Health system including: janitors, cleaners, waste

handlers, guards, receptionists, gardeners, nurses, administrators, doctors, laboratory staff, etc. The trainer

will be required to adapt the curriculum for participants with various level of literacy. It is expected that by

the end of FY08, 875 (375 additional) healthcare workers will be exposed to the knowledge through PDSA

and 5,000 (2,225 additional) through supportive supervision; that 52 (26 additional) MoHSS health workers

will have been trained in ABC; that 3,700 healthcare workers will express confidence to seek medical help

and disclose the information to their superior if they get needle prick or sharp injuries, and 2,400 healthcare

workers will report positive change of behavior vis a vis patients infected with HIV/AIDS, Knowledge of

100% of those exposed will be improved, 100% of the trainees will offer good quality dissemination

sessions. Furthermore the workplace program will be extended from 1 to 3 regions; 20 counseling sessions

and 40 follow up will be conducted.

Baseline data will be available through an assessment of knowledge, attitude, and practice among

healthcare workers which will be carried out prior to the beginning of the training activities. They will serve

as a comparison basis for later evaluation of the program. Follow up will be conducted throughout the

execution of the activities using a checklist and data collection tools. A quarterly report will be produced and

shared with all stakeholders. Results and trends will serve as information for decision making and for

improvement plans during the feed back sessions to the field during PDSA sessions