Trinidad and Tobago: Quality of Care for People Living with HIV/AIDS

At present, in the Caribbean, the number of AIDS deaths represents two thirds of the reported AIDS cases. This situation is due to the following:

 Insufficient attention by regional and international policy makers, to care and support for people living with HIV/AIDS;

 Lack of widespread programmes of voluntary counselling and testing to diagnose HIV infections early, so as to facilitate behaviour change interventions;

 Lack of systems of care and referral for PLWHA and lack of monitoring coverage;

 Late diagnosis of HIV cases as, socially, HIV is a “disease to keep hidden”;

 Lack of skills among practitioners to manage HIV/AIDS cases, their judgmental attitudes towards, and stigmatisation of PLWHA, as well as the lack of confidentiality;

 Absence of standards of care for opportunistic infections and anti-retroviral therapies and the laboratory machinery to support them.

Preliminary results of a two-part study of quality of care for PLWHA in Trinidad and Tobago exemplifies the above. The first part of the study of health institutions showed that testing without consent is common, and that patients tested are often not informed about their HIV+ status. Thus, partner notification and follow-up are not common practices. Confidentiality is poor, fear among health professionals is high and isolation of PLWHA is common. HIV post-exposure programmes and infection control programmes through implementation of universal precautions are insufficient. There is little linkage between health institutions and community resources to ensure a continuum of care for PLWHA.

The second part of the study, from the perspective of care receivers, showed that only 5% of the 53 adult PLWHA interviewed had received pre- and post-test counselling, and only half received either. Only 6% were receiving PCP prophylaxis, and 2% TB prophylaxis. None had received any kind of preventive vaccinations. Two-thirds were not satisfied with the health care provided to them and one-third were avoiding health institutions because of the lack of confidentiality.

The study concluded that continuous training and sensitisation of health care providers is paramount to ensure good quality care of PLWHA in Trinidad and Tobago. The creation of linkages between health institutions and community resources is essential too for a continuum of care and support for PLWHA.

For the Caribbean, at this stage in the HIV/AIDS epidemic, strengthening the capacity of countries to respond and improve care and support of PLWHA is one of the most important priorities facing this region. Since persons infected with HIV are the source of the epidemic, improvements in programs of testing, counselling, follow up and care, combined with measures to increase acceptance and decrease stigma, will impact positively on prevention.

SOURCE: CAREC HIV/AIDS/STI Strategic Plan, 2001-2005.