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Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
Presentation of stigma in CALD clients in Victoria
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Presentation of stigma in CALD clients in Victoria

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Drawing on practice reflections from Multicultural Health & Support Service (MHSS) projects with international students, people who inject drugs, newly arrived migrant and refugee communities, and …

Drawing on practice reflections from Multicultural Health & Support Service (MHSS) projects with international students, people who inject drugs, newly arrived migrant and refugee communities, and people living with chronic hepatitis B, Daniel Reeders (Senior Project Worker, MHSS) discuss similarities and differences in how disease stigma operates in CALD communities.

This presentation was given at the AFAO Positive Services Forum 2012.

Published in: Health & Medicine
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  • 1. Presentations of stigma inCALD clients in Victoria: themesfrom critical reflective practiceDaniel Reeders B.A., LL.B. (Melb)Senior Project WorkerMulticultural Health & Support ServiceCentre for Culture, Ethnicity & Healthdanielr@ceh.org.au | 03 9342 9713
  • 2. About MHSS• Statewide service working with African and Asian communities around blood-borne viruses and sexually transmitted infections (BBV/STI)• A program of the Centre for Culture, Ethnicity and Health (www.ceh.org.au/mhss).Acknowledgments & DisclosuresI am drawing on findings from projects funded by Victorian Government Department of Health, Gilead Sciences, Bristol-Myers Squibb, and the Cancer Council of Victoria.
  • 3. Scope• Written for relevance to positive services staff, focused on clients rather than communities• Looking at stigma for migrants/refugees in Australia, quite different in countries of origin• Not stating essential truths about other cultures; I‟m sharing from my own learning process moving from positive health to CALD BBV, and my perspective is partial and relative – as much about Western health professional culture as any refugee or migrant cultural background.
  • 4. what is stigmaGoffman (1963)• mark or attribute• deeply discrediting• particular social interaction
  • 5. what is stigmaLink & Phelan (2001)1. Labelling of differences2. Stereotyping of those labelled3. Categories allowing separation of us / them4. Status loss, discrimination, unequal outcomes5. Enabled by power relationsParker & Aggleton (2003)• Stigma enables power relations & social order
  • 6. what stigma is not
  • 7. what stigma is not“Our principal findings show, firstly, that moral orsocial stigmatisation does not in any simple wayderive from fear, ignorance or inaccuratebeliefs but that it is also established andcontinually reinforced by official campaignsaddressing HIV/AIDS.” (Gausset et al, 2012)• Stigma is not ―just‖ anything.
  • 8. stigma in Western culture• Having HIV is a secret you choose to disclose• Stigma can be resisted by speaking up, refusing to be silenced, „reclaiming‟ identity, forming community within the category• This implies stigma applies to one layer of identity, and it is changeable over time
  • 9. stigma in Asian communities“If someone was a carrier of such disease it wouldmean: be careful when you come near me as Iam an outlaw. Therefore no one would want to bein such situation and deprived of all protectionand rights.”• Vietnamese man, quoted in McNally & Dutertre, 2006, p158.
  • 10. stigma in Asian communities“I am afraid that people will rang kiat me.Everyone is the same, and they think the sameabout the illness. It does not matter how manythousand people have HIV/AIDS within thepopulations of more than 60 millions, I would saythat only zero percent will accept people livingwith HIV/AIDS.”• “Pailin”, Thailand woman living with HIV, quoted in Liamputtong, Haritavorn & Kiatying-Angsulee 2009, p158.
  • 11. relative differencesCompared to Western cultures, stigma in thesequotes is• permanent• fundamental• contagious• paradigmaticCloser to Goffman (1963) „spoiled identity‟.Takehome — the stakes are much higher for aCALD PLHIV contemplating disclosure.
  • 12. sources & methodsAcross our projects the same 7 themes co-occur whenkey informants, clinicians and support workers talkabout CALD clients facing stigma. Projects include:• Double Trouble: CALD MSM sexual health• International Students‟ Sexual & Reproductive Health Needs Analysis• Cultures of Care in Emerging Communities• SRH Needs of Newly-Arrived Refugees• Hepatitis B is Family Business (campaign)Methods were thematic and discourseanalysis, triangulation of reflective practice & literature
  • 13. “7S” model of stigma presentation• Stigma• Shame• Silence• Secrecy• Stress• Sleeping problems• Somatisation
  • 14. stigma(s)Migrants and refugees are always dealing withmultiple overlapping sources of stigma.HIV stigma in countries of origin may be lowerthan it is in Australia, where it is always intensifiedby migrant and refugee stigmas, even for CALDpeople living without HIV.
  • 15. shameShame is bodily and emotional but also social.“Shame is the intensely painful feeling orexperience of believing we are flawed andtherefore unworthy of acceptance andbelonging.” (Brown, 2007)
  • 16. silenceSilence refers to paralysis of all kinds ofaction, not just speech and other forms ofexpression.―(Shame) produces a generalised silence becauseany topic could accidentally reveal the underlyingpremise – and through the suspicious inspectionof every utterance produced by thisfear, everything that is said comes to standfor, and be linked with, the hidden secret. Itbecomes a truth that is impossible not toexpress, so that silence becomes the only safeoption.‖ (ISSRH report, forthcoming)
  • 17. secrecy (or shiftiness)This is a correlate of silence. To clinicians it canseem like the person is hiding something.―Where our focus on confidentiality tries toaddress a simple, rational fear of onwarddisclosure, shame-induced silence is different – itis a loss of trust in your ability to control what youmean when you speak.‖ (ISSRH report)
  • 18. stress, sleep, somatisation• CALD clients living with stigma will be dealing with significant amounts of stress• CALD clients in distress often present with sleeping problems or somatisation – what a Western patient might present in mental and emotional terms may be translated into a bodily malady, often stomach upset.
  • 19. summaryDeveloping culturally competent accounts• In addition to the social and structural aspects of stigma, CALD clients/patients challenge positive services to describe, recognise and understand the affective, expressive and bodily dimensions of stigma experience.• The focus in Western postmodern cultural theory on the changeability of identity may lead us to underestimate the permanence and fundamentality of stigma in CALD communities; Goffman got it right with „spoiled identity‟.
  • 20. summaryImplications for service providers• “What‟s the point of treatments? I can never recover my position and relationships with the community.”• Refusing referrals because, in our health system, you have to continually retell your story (and interpreters may register as an audience).• Clients can become „clingy‟ – but ongoing relationship with the same provider and small group strategies can be incredibly meaningful: acceptance and belonging.
  • 21. contact detailsFor questions, references, copies of paperscited, please e-mail danielr@ceh.org.au

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