RESUMEN
The northeast region of Thailand is suffering from an early but rapidly growing HIV/AIDS epidemic, particularly among rural people. Policies and programmes have been implemented at national level to deal with the country wide problem. This case study examines the situation at district level, and considers how well prepared doctors and nurses in district hospitals and health centres are to deal with the burgeoning epidemic. It assesses the knowledge, attitudes and practices of these health workers, and also local management polices and the cost impact of implementing universal precautions. A self-administered questionnaire was given to all 120 nurses in the distrit, and formal observations, using a check-list, were made of the hospitals and health centres. Indepth interviews were held with the directors of nursing, supply officers, nurse counsellors, and doctors. The attitudes and feelings of nurses were explored in focus group discussions. Results showed that though general knowledge about transmission of HIV and universal precautions was reasonably good, practices did not always reflect that knowledge. For example, needles were frequently recapped, and the rate of needlestick injury was extremely high (64% in the previous two years). Other gaps in some areas included confusion about disinfectant solutions, an proper disposal of infectious waste. There was no proper reporting and follow-up system for needlestick injuries. Nurses had a great fear of becoming infected in the workplace, and of being themselves stigmatised. In general this not lead them to avoid caring for infected patients. Rather, they showed great compassion for them. However, some nurses and doctor placed great reliance on knowing their patients HIV status, in the belief that it would enable them to better protect themselves. This sometimes led to compromise in the area of confidentiality. There is a keenly felt lack of support systems for nurses. While inservice training has taken place, nurse counsellors trained, and some homecare services in operation, there appears to be a lack of forward planning for the inevitable increase in demand on services for chronically ill patients and treatment of opportunistic infections. A clear picture of the cost impact could not be gained, and this also reflects a lack of planning capacity. Nurses and doctors in general perform very creditably in difficult circumstances. However, as a mater of urgency, authorities need to address a number of issues such as improved inservice training, implementation of proper procedures for needlestick injuries and waste disposal, and forward planning.