UN Integrated Regional Information Networks - December 4, 2008

Hospitals are failing to protect their workers from HIV and tuberculosis (TB) infection, and healthcare workers often do not have adequate access to HIV/AIDS services, according to a World Health Organisation (WHO) study conducted in Kenya, Malawi, Zimbabwe, Mozambique and Ethiopia.

The WHO survey, released on Wednesday at the International Conference on AIDS and STIs in Africa (ICASA), in Dakar, Senegal, noted that despite the extremely high risk of acquiring TB in health facilities, not enough was being done to protect staff.

Mark Wheeler, a health policy consultant who presented the study findings, told delegates that the risk of acquiring TB was up to 20 times higher for the average health worker than for the general population.

The risk was even greater for staff working in TB wards: they were 80 times more likely to be infected with TB. "Employers, however, don't recognise [this] and don't provide adequate protection," Wheeler said.

Basic infection-control measures, such as providing handkerchiefs to TB patients to cover their mouths while coughing, and building separate TB wards, were not being applied, despite widespread knowledge about the effectiveness of such interventions.

The chances of becoming infected with HIV at work may be low, but Wheeler said the survey had found that the "fear of this happening is widespread and very real" among healthcare workers.

Nearly 70 percent said that they were inadequately protected from HIV at work, as they lacked gloves, soap, water and proper containers to dispose of needles.

Needle-stick injuries were "extremely frequent" in developing countries, but carried a low risk of HIV transmission. In fact, occupational transmission of HIV accounted for only between 2.5 and 4 percent of HIV infections among healthcare workers.

The study found that when staff were exposed to the virus at work, very few chose to use post-exposure prophylaxis (PEP) as a preventative measure because they often misunderstood how PEP worked, and believed that by using it they would be forced to have an HIV test.

Less than 40 percent of the 1,000 healthcare workers surveyed were aware of policies to protect them from infection and discrimination in the workplace, Wheeler noted.

Dr Yohannes Chanyalew of the International Labour Organisation (ILO) told delegates that workplace policies in the health sector could not stay "locked away in a drawer", and called on employers to educate their personnel about their right to be protected from HIV.

Wheeler admitted that not enough was known about HIV prevalence levels among healthcare workers, but it was generally accepted that infection levels were about the same as in the general population.

WHO official Mwansa Nkowane warned that HIV and TB were among the major causes of death in healthcare workers, and said urgent steps should be taken to provide them with adequate HIV/AIDS services.

According to Nkowane, 17 percent of healthcare workers' deaths between 1999 and 2005 in Botswana were due to HIV. "If no action is taken, this could rise to 40 percent by 2010," she told delegates at the conference.

The fear of HIV discrimination prevented many health workers from being tested for HIV; most were also not willing to be tested by colleagues. Wheeler noted that there were often high levels of mistrust between staff and management, which meant that self-testing was the most preferred method.

Levels of access to antiretroviral (ARV) treatment were more encouraging: easy access to the life-prolonging medication was reported by 72 percent of health workers, and staff were more willing to access the drugs at their own health facility, although many raised the need for a staff clinic.

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