Cover Image
close this bookCaring with Confidence - Practical information for health workers who prevent and treat HIV infection in children (AHRTAG, 1997, 60 p.)
View the document(introduction...)
View the documentAcknowledgements
View the documentIntroduction
close this folderSection 1. How HIV and AIDS affect young children
View the document(introduction...)
View the document1.1 Children infected with HIV
View the document1.2 Children affected by HIV
View the document1.3 Children vulnerable to HIV
close this folderSection 2. Preventing HIV infection in young children
View the document(introduction...)
View the document2.1 Mother-to-child transmission
View the document2.2 Preventing and treating HIV infection in women
View the document2.3 Breastfeeding
View the document2.4 Other interventions to reduce transmission
View the document2.5 Transmission through blood transfusion
View the document2.6 Acquired infection
close this folderSection 3. Diagnosis, treatment and care
View the document(introduction...)
View the document3.1 Diagnosis and testing of infected children
View the document3.2 Treatment and care
View the document3.3 Affected children
close this folderSection 4. Issues for health workers
View the document(introduction...)
View the document4.1 Pressures on health workers
View the document4.2 Preventing transmission in health facilities
View the document4.3 Advising and counselling caregivers
View the documentSection 5. Selected resources
View the documentGlossary
View the documentAppendix 1 - Basic facts about HIV and AIDS
View the documentAppendix 2 - Example of a workshop to explore issues around HIV/AIDS and young children

4.1 Pressures on health workers

The increase in the number of women and children with HIV and AIDS is creating additional demands on health services and on health workers. Health workers face many pressures. These include:

· shortages of staff as colleagues become sick themselves because of HIV

· lack of skills or time to diagnose and manage children with HIV

· lack of resources for diagnosis and treatment including basic drugs for managing common infections

· higher numbers of children who require treatment and who fail to respond to standard treatment

· absence of services for referral for counselling, testing, treatment or community-based care

· overcrowded hospitals

· dealing with families' worries, fears and concerns and with death in young children on a daily basis

· stigma because of working with mothers and children with HIV

· fears about their own risk of HIV infection

· powerlessness because of lack of knowledge and few available resources to do very much, and feeling that little is being achieved despite their best efforts.

Heavy demands on health services add to the pressures on health workers.

Sean Sprague/Panos Pictures

Health workers need opportunities to share information and provide support to each other.


All these contribute to health worker 'burn out' and may result variously in increased sickness, absence, early retirement, general stress and unhappiness at work. Health workers may feel sad, helpless, angry and tired. It is important for them to be able to talk to others about how they feel and to seek help when they need it.

Other steps need to be taken to reduce the pressure on health workers at national, district and primary or local levels.

At a national level, these steps could include:

· encouraging support for people with AIDS groups, with care and support as the main focus, and encouraging better integration of care and support activities with prevention activities

· developing clear policies and guidelines for diagnosis, treatment and care of children with HIV and AIDS

· promoting information dissemination, education and awareness-raising about HIV and AIDS in children

· continuing support for effective management of childhood illness

· emphasising prevention of infection in women by promoting safer sex, ensuring blood safety and avoiding unnecessary blood transfusions, and supporting effective STD control

· promoting children's rights and services for children, and models of care that encourage social integration and address discrimination

· implementing policies to ensure protection of children against sexual abuse and exploitation

· identifying interventions and therapies that work, and promoting them

· aiming for better discussion and knowledge of risks of infection at work and implementation of workable safety guidelines.

Careful handling of needles and other sharp instruments can reduce the risk of HIV transmission to health workers.

Heldur Netocny/Panos Pictures

At district level:

· supporting community groups and home-based care programmes

· providing training and ongoing support for health workers

· establishing links with sectors outside the health service

· adapting guidelines to the local situation and making them available to health workers

· involving members of the community (including people affected by HIV/AIDS) and primary health care workers in planning activities

· allocating resources carefully and planning services, especially providing essential drugs and supplies such as gloves

· developing systems to improve the continuum of care, referral and support for families providing home care, including encouraging links between district teams and NGOs.

At primary and community level:

· developing mechanisms for staff to share new information and provide support to each other, to help them talk about their problems and feelings, and to make their work more rewarding

· providing counselling services for health workers

· forming integrated home care networks involving community members, health workers and other service providers to improve care, provide mutual support and establish realistic expectations

· creating working links with NGOs, support groups, churches, and home and community care organisations

· developing training materials on home care and encouraging information sharing between support groups, community organisations, family members and health workers.