June 2006

Studies in Brief
On the frontlines: Kenyan health workers confront HIV-related challenges at work and home

Occupational risk of exposure to HIV is a serious concern for most health workers in Kenya. Photo credit: Curt Carnemark/World Bank

Health workers are the backbone of HIV services and key to their successful delivery. But findings from a national study of health workers in Kenya reveal that many are ill equipped to cope with occupational exposure to HIV and the demands of caring for HIV patients both at work and at home.

The study, conducted by the Kenya Ministry of Health National AIDS and STI Control Program with support from Horizons and CDC Kenya, consisted of interviews with a nationally representative sample of 1,897 medical personnel in 245 health facilities located in 28 districts in Kenya. In addition, researchers held 24 focus group discussions with health workers in selected facilities.

The vast majority of health workers in Kenya are worried about occupational exposure to HIV. Ninety-three percent reported that they were “very concerned” about getting infected with HIV on the job. This may be due to the fact that for many, potential exposure to HIV is a reality that they have already faced. Nearly one in five health workers reported a recent event where they could have been exposed to HIV at work, and among these, half had experienced multiple exposures. To add to their concern, more than half of the health workers indicated that their facility did not have written guidelines about what to do in case of occupational exposure to HIV.

Post-exposure prophylaxis (PEP) is an important recourse for health workers who are inadvertently exposed to HIV. But although 61 percent of health workers said they know what PEP is, nearly one in five of these could not correctly describe it. Yet even among those who were knowledgeable, of those who also reported an incident of potential HIV exposure, only 45 percent sought it. The main reasons for not seeking PEP among this group was lack of sufficient information (37 percent) followed by fear of the process and what could follow (28 percent).

Survey findings also revealed that Kenyan health workers often lacked basic infection control items at their facilities, another possible cause of worry about getting infected at work. A third or more of the sample reported inadequate supplies of water, soap, and disinfectant at their workplace. About a fourth of health workers also indicated a lack of sharps containers and gloves at their facilities.

In addition to caring for HIV-positive patients in the workplace, many health workers must confront the disease in their personal lives as well. About a third of health workers surveyed had an immediate family member who was HIV-infected or who had died of AIDS. In addition, one out of every five health workers were caring for an HIV-infected immediate family member at the time of the survey. The greatest burden was in Nyanza province, the province with the highest HIV prevalence in the country, where 59 percent of respondents reported HIV infection among immediate family members.

Despite working in the health field and frequent personal connection to the disease, nearly a third of health workers in Kenya had never been tested for HIV. This includes half of enrolled nurses, who represented the bulk of health care providers in the country.

The low levels of testing were not due to a lack of availability of testing services. In fact, health workers strongly believed that they could take a confidential HIV test at work. However, among those who had not been tested, most (42 percent) said it was because they had “not thought about it.” Nearly a quarter of respondents were afraid of the results and others feared the stigma associated with the disease. Perhaps because of stigma and concerns about confidentiality, 73 percent of respondents were interested in self-testing.

Among health workers involved in HIV testing, those who had been tested reported more confidence in recommending an HIV test, and conducting pre- and post-test counseling and couple counseling and testing.

Recommendations

Data from this national study suggest an urgent need to strengthen infection control supplies, procedures, and guidelines in Kenyan health care facilities. This includes the need to educate health workers about PEP, including how to use it and access it as well as to overcome fears of taking it.

In addition to addressing the risks of occupational exposure, health workers with HIV-infected relatives need to be supported to cope with the additional burden of providing care to HIV-infected persons in and outside their workplace. Finally, there is a need to support and encourage HIV testing among health workers, which may include exploring the possibilities of self-testing as an option.

As Karusa Kiragu of Horizons/PATH, a principal investigator of the study summarized, “The health care system must not only care for the patients but also ensure that its human capacity remains strong and motivated. Health care professionals need a secure and supportive work environment if they are to be effective partners in combating the HIV epidemic.”

For more information about this study, please contact Karusa Kiragu (kkiragu@pcnairobi.org).

—Hena Khan

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© 2006 The Population Council, Inc.

See Also

• FRONTIERS

• Population Council – Infants and Children

• Population Council – Journals and Newsletters

• Population Council – Policy Development

• Population Council – Prevention

• Population Council – Stigma and Discrimination

• Population Council – Treatment, Care and Support

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This page updated 15 September 2006

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