from policy to practice: case study of hiv testing programs for pregnant women in ukraine

From Policy to Practice: Case Study of HIV Testing Programs for Pregnant Women in Ukraine

HealthRight (formerly Doctors of the World-USA) works with local partners to build lasting access to health in excluded communities.

HealthRight Mission

Case Study of HIV Testing Programs for Pregnant Women in

Ukraine• Research is being conducted in two

sites: Donetsk and Slaviansk

• A total of 60 women (regardless of HIV status) and 25 medical providers will be interviewed.

HIV/AIDS in Ukraine Prevalence By Region Per 100,000

455 454 442

334

268

Dnipropetrovsk Odesa Donetsk Sevastopol AR Crimea

Health Systems Data

577,769 Pregnant Women

1200 Maternity Hospitals 476 Antenatal Clinics

27 AIDS Centers

Antenatal Care Coverage in Antenatal Care Coverage in UkraineUkraine

Health Systems Data

60% of PlannedCounseling Rooms

Opened

60%

40%

90%

99%

1999 2008

Health Systems Data

60% of PlannedCounseling Rooms

Opened

60%

40%

Confidential Counseling Rooms Opened

Rooms Already Opened Rooms In Development

40%

60%

Informed ConsentInformed Consent

According to Ukrainian law, HIV According to Ukrainian law, HIV testing should be conducted with testing should be conducted with voluntary informed consent.voluntary informed consent.

In addition to not receiving In addition to not receiving counseling, many of the women counseling, many of the women we interviewed we interviewed were not tested were not tested in accordance with informed in accordance with informed consent procedures. consent procedures.

The 3 C’s of HIV Testing

Informed ConsentInformed Consent

““When I came for the When I came for the consultation, I was told that consultation, I was told that my results were ready and my results were ready and everything was fine. But I everything was fine. But I had not signed any consent had not signed any consent forms.”forms.”

- - Survey participant, October Survey participant, October 2009 2009


Counseling Counseling

AlthoughAlthough Ukrainian law also Ukrainian law also stipulates that HIV testing must stipulates that HIV testing must be accompanied by counseling, be accompanied by counseling, the majority of the women we the majority of the women we surveyed said they received surveyed said they received negligible pre-test counseling negligible pre-test counseling and insignificant post-test and insignificant post-test counseling.counseling.



“ “ I came for a blood test. I was I came for a blood test. I was told to get tested, buy a told to get tested, buy a syringe, and cotton wool. I syringe, and cotton wool. I was not even told it was an was not even told it was an HIV test when I gave blood.”HIV test when I gave blood.”

- - Survey Participant, October Survey Participant, October 2009 2009



“ “ I did not have any training I did not have any training and there is no psychologist and there is no psychologist [at our facility]. We must [at our facility]. We must become psychologists on our become psychologists on our own.”own.”

- - Healthcare Worker, October Healthcare Worker, October 2009 2009


ConfidentialityConfidentiality

National law National law mandates that HIV testing mandates that HIV testing and results are completely and results are completely confidential and cannot be disclosed confidential and cannot be disclosed to any oneto any one besides the patient besides the patient without written consent.without written consent.

Several of the women we surveyed said Several of the women we surveyed said their confidentiality was compromisedtheir confidentiality was compromised when they received their results. In when they received their results. In many instances, post-test counseling many instances, post-test counseling was done in the presence of another was done in the presence of another healthcare worker. healthcare worker.


Policy Recommendations

Based on our preliminary findings, HealthRight has identified the following policy recommendations:

Policies regarding patient confidentiality should be made more clear and enforced.

Health institutions must prioritize the training of healthcare providers in counseling procedures and must evaluate their progress. Our findings revealed that just two minutes out of the 24-minute antenatal care consultation are devoted to pre- and post-HIV test counseling.

More safeguards should be put into place and healthcare workers need more training in patient care and communication. The women we surveyed cited maltreatment from healthcare workers as the biggest violation of their rights.

.

“ “ A friend of mine found out A friend of mine found out she was HIV-positive after she was HIV-positive after she became pregnant. In the she became pregnant. In the hospital, she was treated like hospital, she was treated like a leper. She was placed in a a leper. She was placed in a separate ward and no one separate ward and no one would talk to her. After she would talk to her. After she gave birth, the doctors gave birth, the doctors looked her as if she should looked her as if she should have thought twice before have thought twice before having her baby.”having her baby.”



““In the maternity ward, I met a In the maternity ward, I met a girl who was HIV-positive and girl who was HIV-positive and drug-addicted. She was in the drug-addicted. She was in the late stages of both her late stages of both her pregnancy and the disease, pregnancy and the disease, but the hospital staff treated but the hospital staff treated her like a dog. They didn’t her like a dog. They didn’t even call her by name, just even call her by name, just ‘Hey, you!’”‘Hey, you!’”



““At the clinic, only one of the At the clinic, only one of the healthcare workers cared healthcare workers cared about me. The rest of them about me. The rest of them just barked at me. I even just barked at me. I even argued with one of them, argued with one of them, asking her ‘Why do you treat asking her ‘Why do you treat me so badly? I am a human me so badly? I am a human being, too!’” being, too!’”



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from policy to practice: case study of hiv testing programs for pregnant women in ukraine

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