[G12480] In the absence of political will: barriers to HIV prevention in international settings

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] In the absence of political will: barriers to HIV prevention in international settings

[AUTHOR(S):] P.C. Stephens¹, D. Indyk, A. Gurtman, E. Rivadeneira, G. Kiperman², D. Moulton³, E. Szyld⁴

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. G12480

[ABSTRACT:] Issue: Absence of political will is a barrier to HIV prevention particularly in times of economic crisis and when the under-served differ from the majority.

DESCRIPTION: A Mt. Sinai School of Medicine/Fogarty-funded project to reduce perinatal HIV transmission was initiated in 1999 by a joint US/Argentine team at a public hospital serving 1.3 million residents of La Matanza, an area of villas/barrios bordering Buenos Aires, Argentina. At project initiation, the team faced the serious risk and barrier of occupational/nosocomial HIV transmission.

Example: Neonatal Intensive Care Unit [NICU], staff moved from infant to infant without gloves, barriers, or hand-washing units. Lacking hierarchical support for a remedy, the team presented a seminar for administrative/medical staff to discuss recent findings on the survival of HIV in body fluids, injection equipment and surfaces. The presentation, in Spanish and English, segued to discussion of the scientific mechanics of handwashing and the resultant reduction in no socomial transmission. Staff were not criticized nor were current practices discussed. Two days later, US project staff entering the NICU were directed to an antiquated but adequate, newly-repaired handwashing unit. By the 2000 site visit, the NICU was equipped with gloves, disposables, sinks, and plumbing.

Lessons Learned/

RECOMMENDATIONS: It is important to recognize and respect the political arena and economic constraints on the staff. The errant practices were not due to carelessness but to habituation to scarcity. The materials presented simultaneously to procurement and care staff were scientific, grounded in empirical data, and assumed a desire for quality care/personal safety. Each person was thus able to buy in to new protections without discussion of previous gaps. Change was not without cost: with no new funds appropriate cuts were made elsewhere. The solution was accomplished via a joint committee of administrative and medical staff.

Presenting author: P. Clay Stephens

1School of Public Health, State University of New York at Albany, PO Box 2320, Albany, New York, 12220, United States.

2Dept. Community Medicine, Mt. Sinai School of Medicine, New York, New York, United States.

3HIV/AIDS Activist, Independent Researcher, Provincetown, Massachussetts, United States.

4HIV/AIDS Activist, Independent Researcher, Provincetown, Massachussetts, United States.

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