Stimatizing HIV Infections

Stigma and Discrimination Related to HIV/AIDS
Lesson Objectives
Define and identify HIV/AIDS-related stigma and discrimination Better understand international and national human right issues
Clarify personal values and attitudes with regard to HIV/AIDS prevention and care
Know how to address stigma and discrimination in the context of providing HIV services
The Microsoft Word Dictionary defines stigma as the shame or disgrace attached to something regarded as socially unacceptable. Sociologists have taken this a bit further. In a seminal study on stigma in 1963, stigma was defined as an attribute that is seen as deeply discrediting to a person or group (Goffmann). Those attributes could be an illness, physical deformity, aberrant behaviour or social group (based upon religion or ethnicity, etc.). Stigma lets people or groups see differences or "others" in a negative light while confirming their own sense of normalcy and decency. Subsequent researchers have viewed this more as a social process that creates or perpetuates social inequities and which is used to legitimise discrimination. While this is generally true, stigma can also be a primal human responseparticularly in the case of fearing a disease that is transmissible and potentially incurable.
Definition
Stigma and discrimination
Stigma refers to unfavourable attitudes and beliefs directed toward someone or something Discrimination is the treatment of an individual or group with partiality or prejudice Stigmatization reflects an attitude
Discrimination is an act or behavior
Root Causes
1.The role of knowledge about HIV and AIDS and fear surrounding it
Ogden and Nyblade believe that the fear of transmission from casual transmission, and the various "what if scenarios" are the result of 1) the lack of specific, in-depth information about HIV transmission, 2) fear-based public messaging, and 3) the evolving nature of knowledge about HIV and AIDS.
2.The role of values, norms, and moral judgment
This stigma is exacerbated by the seriousness of the illness, its mysterious nature, and its association with behaviours that are either illegal or socially sensitive (e.g., sex, prostitution, and drug use). Also relevant is the perception that HIV infection is the product of personal choice: that one chooses to engage in "bad" behaviours that put one at risk and so it is "one's own fault" if HIV infection ensues."
Expressions and forms of stigma
Ogden and Nyblade divide stigma into four loosely defined groups: physical, social, verbal and institutional. Social stigma Isolated from community Voyeurism: any interest may be morbid curiosity or mockery rather than genuine concern Loss of social role/identity: social `death`, loss of standing and respect Physical stigma Isolated, shunned, abandoned Separate living space, eating utensils Violence
Forms of stigma (contd.)

Verbal stigma Gossip, taunting, scolding Labelling: in Africa: "moving skeleton," "walking corpse," and "keys to the mortuary." In Vietnam: "social evils," and "scum of society." Institutionalised stigma Barred from jobs, scholarships, visas Denial of health services Police harrassment (eg of sex workers, HIV-positive actvists in China, outreach workers in India)
Challenge
HIV-related stigma is increasingly recognized
as the single greatest challenge to slowing the spread of HIV/AIDS

HIV/AIDS a threefold epidemic

HIV AIDS Stigma, discrimination, and denial
Human rights
Freedom from discrimination is a fundamental human right Discrimination on the basis of HIV/AIDS status, actual or presumed, is prohibited by existing human rights standards Discrimination against persons living with HIV/AIDS (PLWHA), or those thought to be infected, is a clear human rights violation
Effects of stigma
Social isolation
Limited rights and reduced access to services

HIV/AIDS related stigma fuels new HIV infections Secondary stigma (stigma by association)
Stigma in service delivery
Discourages access to ANC services
Prevents access to counselling , HIV testing and MTCT services

Discourages disclosure of HIV test results to partner(s) Discourages acceptance of MTCT interventions Inhibits use of safer infant-feeding practices Confers secondary stigmatisation on the child
Addressing stigma
Interventions addressing HIV-related stigma can take place at all levels:
National
Community and social/cultural

MTCT site/facility
Individual
National Level Interventions to Address Stigma

Support Human rights legislation National efforts to scale up ARV treatment Funding for PPTCT services, and training Share MTCT success stories
Community Level Interventions

In

the community, promote
HIV awareness and knowledge MTCT activities as integral to health care and HIV/AIDS prevention and treatment Referrals to and from MTCT services Awareness of MTCT interventions
Community level interventions (contd.)

Support
Partnership with schools, social and community organizations
PLWHA ( people living with HIV/AIDS) in implementing initiatives

Networking with needed linkages
Ongoing training
Programme level interventions

Integrate MTCT into antenatal services Encourage partner involvement Enlist partner and family support to decrease HIV transmission
Addressing stigma
Educate and train healthcare providers in

HIV transmission Activities to address stigma Awareness of language that describes PLWHA MTCT-related policies
Counselling and safer infant feeding practices
Addressing stigma
Enlist managers help to ensure policies and procedures are in place and implemented for:
Non-discrimination policies Confidentiality Universal precautions
Post-exposure prophylaxis (PEP)
Summary
Stigmatisation reflects an attitude

Discrimination is an act or behaviour Stigma and discrimination are often linked to violations human rights Human rights declarations affirm all peoples rights to be from discrimination, including discrimination based HIV/AIDS status.
HIV/AIDS-related stigmatisation and discrimination can discoura access to key HIV services, including:

Testing MTCT services Antenatal care ARV prophylaxis
Summary contd
Stigma discourages -Disclosure of HIV status -Acceptance of safer infant-feeding practices -Access to education, counselling, and treatment even when such services are available and affordable The MTCT programs and staff can help reduce stigma and discrimination in the healthcare setting, in the community, and at the national level Encourage MTCT staff to serve as role models Involve PLWHA Promote partner participation and community support

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Stigma and Discrimination Related to HIV/AIDS

Stigma and discrimination

Discrimination is an act or behavior

2.The role of values, norms, and moral judgment

Expressions and forms of stigma

Forms of stigma (contd.)

as the single greatest challenge to slowing the spread of HIV/AIDS

HIV AIDS Stigma, discrimination, and denial

Limited rights and reduced access to services

Stigma in service delivery

Discourages access to ANC services

Prevents access to counselling , HIV testing and MTCT services

Interventions addressing HIV-related stigma can take place at all levels:

Community and social/cultural

National Level Interventions to Address Stigma

Community Level Interventions

the community, promote

Community level interventions (contd.)

Partnership with schools, social and community organizations

PLWHA ( people living with HIV/AIDS) in implementing initiatives

Programme level interventions

Educate and train healthcare providers in

Counselling and safer infant feeding practices

Non-discrimination policies Confidentiality Universal precautions

Post-exposure prophylaxis (PEP)

Stigmatisation reflects an attitude

Testing MTCT services Antenatal care ARV prophylaxis

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