Stigma and Discrimination Related to HIVAIDS

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Stigma and Discrimination Related to HIV/AIDS

• Dr KANUPRIYA CHATURVEDI
• Dr S.K. CHATURVEDI

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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

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Definition

• 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 response-
  particularly in the case of fearing a disease
  that is transmissible and potentially incurable.

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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

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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."

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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

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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)

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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

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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

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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)

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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

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Addressing stigma

• Interventions addressing HIV-related stigma can
  take place at all levels
• National
• Community and social/cultural
• MTCT site/facility
• Individual

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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

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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

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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

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Programme level interventions

• Integrate MTCT into antenatal services
• Encourage partner involvement
• Enlist partner and family support to decrease HIV
  transmission

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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

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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)

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Summary

• Stigmatisation reflects an attitude
• Discrimination is an act or behaviour
• Stigma and discrimination are often linked to
  violations of human rights
• Human rights declarations affirm all peoples
  rights to be free from
  discrimination, including discrimination based
  on HIV/AIDS status.
• HIV/AIDS-related stigmatisation and
  discrimination can discourage access to key HIV
  services, including
• Testing
• MTCT services
• Antenatal care
• ARV prophylaxis

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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