Stigma & discrimination associated with hivaids
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  • 1. Stigma & discrimination associated with HIV/AIDS Department of Population & Family health 22/10/20121
  • 2. Presented by  Liyew Mekonnen(2nd year reproductive health speciality student)2
  • 3. Outline of the presentation  Introduction  Forms of stigma  Contributing factor for stigma and discrimination associated with HIV/AIDS  The consequence of stigma and discrimination associated with HIV/AIDS3
  • 4. Session objectives At the end of this session you will be able to  Differentiate the term stigma and discrimination associated with HIV/AIDS  Identify different forms of stigma associated with HIV/AIDS  Explain different causes of stigma associated with HIV/AIDS  Identify the impact of stigma and4 discrimination associated with HIV/AIDS
  • 5. Introduction  Stigma is defined as undesirable or discrediting attribute that a person or group possesses  it is reduction of that person’s or group’s status in the eye of the society.  Stigma can result from  physical characteristics, such as the visible symptoms of the disease or  from negative attitude toward the5 behaviour of a group Such as
  • 6. Intro….  Discrimination which can be expressed as both negative attitudes of particular behaviour or action  It is a distinction that is made about a person that results in their being treated unfairly and unjustly on the basis of their belonging ,or being perceived to belong to a particular group.6
  • 7. Stigma and discrimination associated with HIV/AIDS  HIV/AIDS-related stigma refers to  prejudice,  discounting,  discrediting,  and discrimination  It is directed at people perceived to have AIDS or HIV, and the groups and communities with whom they are associated (Herek, 1999).7
  • 8. Cont…  UNAIDS defines HIV-related stigma and discrimination as: "... a process of devaluation of people either living with or associated with HIV and AIDS  Discrimination follows stigma and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status.((UNAIDS, 2003).8
  • 9. Stigma is experienced at the individual and societal level  At the individual level  AIDS stigma takes the form of behaviours, thoughts, and feelings that express prejudice against people living with HIV or AIDS, and can also be experienced by persons perceived to be living with HIV/AIDS.  At the societal level,  AIDS stigma is manifested in laws, policies, popular discourse, and the social9 conditions of persons living with
  • 10. Forms of stigma can be categorized into 1. Physical  Isolation  Separating sleeping quarters  Marking and separating eating utensils  Separating clothing and bed linens  No longer allowing person to eat meals with family  Confinement to certain rooms of house10
  • 11. Intro…  Isolation  No longer allowing person to participate in housework (e.g. cooking food)  Public rejection (refuse to sit next to person on bus, bench, at church, tea shops or in bars)  Violence  Beatings  Being kicked  Throwing stones  Arrests11
  • 12. 2. Social  Isolation  Reduction of daily interactions with family and community  Exclusion from and shunning at family and community events  Loss of social networks  Decreased visits from neighbors12
  • 13. Loss of identity/role  Viewed and treated by community as having no future  No longer considered productive member of society  Automatically associated with “social evils” (e.g., drug use, sex work)  Loss of power, respect, and standing in community  Loss of right to make decisions about own life13  Loss of marriage and childbearing
  • 14. 3.Language/Verbal  Gossip  Speculation on how person acquired virus  Spreading rumors  Whispering behind back  Taunting  Insults  Finger-pointing  Threats14
  • 15. Cont…  Expressions of blame and shame  Scolding (e.g., blamed for not listening to elders)  Blamed for bringing “bad luck” to whole family15
  • 16. Cont..  Labelling and use of derogatory words to describe people living with HIV or AIDS  In Africa: “moving skeleton,” “walking corpse,”16
  • 17. 4. Institutional  Loss of livelihood/future  Loss of employment  Loss of customers/business  Denial of loans, scholarships, visas  Loss of housing  Denied housing  Eviction by landlord  Differential treatment in schools  Teachers supporting the idea of separating children of HIV+ people to “protect” other17 students
  • 18. Cont…  Differential treatment in health are settings  Shuffled between providers to avoid caring for HIV+ patient  Denial of health services  Provision of substandard treatment  Use of separate medical tools for people with HIV or AIDS  Place patients with HIV in separate rooms18
  • 19. Cont…  Differential treatment in public spaces  Refusal of services  e.g., will not be served food by vendors  or not served in shared containers19
  • 20. Cause of stigma and discrimination 1. Knowledge and fears:  Lack of Basic & in-depth knowledge about HIV  On research conducted in Ethiopia 2003  a male respondent from the rural site in Ethiopia says, “A healthy person might be infected if he sleeps with PLHA and if he uses an infected person’s needle and plates and cups.”20
  • 21. Cont…  Fears of casual transmission  If the family suspected that one member has the HIV/AIDS, they think that the cows eat the grass in the compound and the grass could have been contaminated by the condom thrown in the field after use. So if children drink milk produced in such families, the children can be infected. (Rural man, Ethiopia)  Fear of death21  Is a powerful fear of what is known to be a
  • 22. Cont… 2. Sex, morality, shame and blame  stigmatizing language and discriminatory behaviour centers on the sexual transmission of HIV.  When asked why HIV is not considered a “normal disease,” an urban woman in Ethiopia replies, “This is because it is transmitted22 through sexual contact.”
  • 23. Cont….  Blame :Largely because of the belief that youth lead a careless life and are highly sexually active, young people are blamed for getting HIV through their promiscuous, immoral, and “improper” behaviour.23
  • 24. Consequences of stigma and discrimination associated with HIV/AIDS  Private and public disclosure of HIV status is limited  Preventive behaviours, such as using condoms, discussing safer sex with a partner, and the prevention of mother-to- child transmission, are not adopted24
  • 25. Cont…  Care and support is often undermined when accompanied by stigma,  for example in the form of judgmental attitudes and physical isolation; or in terms of passing on an HIV patient from provider to provider because none are willing to administer treatment  People with HIV and AIDS may experience25 stigma when care is reduced over time
  • 26. Cont…  People who have HIV and AIDS may delay care until very ill and travel farther or pay more in search of non- stigmatizing care26
  • 27. How Stigma and Discrimination Impact Each Step in the PMTCT Cascade 1. Initiating use of ANC  As routine opt-out HIV testing becomes standard and well-known in ANC clinics,  women may avoid ANC services if they fear HIV testing and lack of confidentiality of HIV test results.  women who are HIV positive or suspect that they are may fear S&D from healthcare workers during ANC.27
  • 28. 2.Being offered an HIV test • Beyond the health system barriers to offering an HIV test in ANC (lack of test kits, workers not trained, other system breakdowns), there is the potential for health workers’ stigmatizing attitudes and stereotypes about who is at risk of HIV to affect who is offered HIV testing,28 • Health workers may be uncomfortable
  • 29. 3.Accepting an HIV test Pregnant women may decline an HIV test for fear of • being HIV positive, • unwanted disclosure if found to be positive, • and the S&D that may follow.  In Ethiopia, only 47 percent of pregnant women accepted HIV testing when offered, and qualitative interviews revealed the key role of fears of stigma in low testing uptake29 (Balcha, Lecerof et al. 2011).
  • 30. 4. Enrolling in PMTCT and/or HIV treatment services  Women may defer enrollment in these services at the time of HIV testing, often citing a need to go home and confer with their husband, and then never return to the health facility due to fears of HIV-related stigma.  In a study in Nairobi, stigma was the most commonly cited barrier for HIV-positive pregnant women’s failure to enroll in HIV care (77%)(Otieno, Kohler et al. 2010).30
  • 31. 5. Adhering to ART and follow-up visits during pregnancy  Even if women do enroll in PMTCT programs and/or HIV care Adherence becomes difficult if women need to hide HIV clinic visits and/or medications from others  In South Africa, pregnant women described having to hide their PMTCT medications from boyfriends, family31 members, and employers (Mepham,
  • 32. Cont…  Cross sectional Study conducted in jimma university hospital in 2007 among patients attending ART revealed that  The prevalence of disclosure concern and internalized stigma were 231 (86.3%) and 232 (85.9%), respectively.  245(90.7%) of the respondents reported a favorable attitudinal change on stigma with access to antiretroviral treatment.  There was a statistically significant association between duration of antiretroviral therapy and favourable effect of access to antiretroviral therapy on stigma reduction (p<0.005).32
  • 33. 6. Giving birth with a skilled attendant  Fears about lack of confidentiality, unwanted disclosure, and HIV-related stigma may cause some women to avoid childbirth in a health facility.  In urban Kenya, fears of unwanted disclosure and stigma from neighbors contributed to HIV-positive women’s decisions to give birth at home(Awiti33 Ujiji, Ekstrom et al. 2011).
  • 34. 7. Adhering to recommended infant feeding practices  Women may fear that following an infant feeding regime that is not the cultural norm/standard (e.g., exclusive breastfeeding or formula feeding) will lead to disclosure of HIV status.  In Kenya, HIV-positive women who did not stop breastfeeding at 6 months as34 recommended were most concerned
  • 35. 8. Bringing infant in for HIV testing  Stigma directed toward adult caregivers may translate into delays in seeking testing and care for infants.35
  • 36. 9. Adhering to maternal and infant follow-up visits and ART after the birth  After the birth, fears of stigma and discrimination can again be barriers to adherence to ART for infant and/or self, due to the need to hide visits and/or medications from others.  In Rwanda, infants of women who had not disclosed their HIV status to someone other than a partner were less36 likely to have received infant nevirapine
  • 37. HIV/AIDS doesn’t discriminate; people do37
  • 38. Reference 1. Evelyn P. Tomaszewski, MSW,UNDERSTANDING HIV/AIDS STIGMA AND DISCRIMINATION. HUMAN RIGHTS AND INTERNATIONAL AFFAIRS DIVISION, March 2012 2. Janet Turan, Laura Nyblade, and Philippe Monfiston3,AND DISCRIMINATION: KEY BARRIERS TO ACHIEVING GLOBAL GOALS FOR MATERNAL HEALTH AND ELIMINATION OF NEW CHILD HIV INFECTIONS, Health Policy Project ,july 2012 3. Laura Nyblade , Rohini Pande ,Aklilu Kidanu et al ,Disentangling HIV and AIDS stigma in Ethiopia ,Tanzania and Zambia. International Center for Research on Women (ICRW),200338
  • 39. Reference…. 4. Richard Parker,Peter Aggleton et al, HIV/AIDS- related Stigma and Discrimination: A Conceptual Framework and an Agenda for Action, Horizons Program,2002 5. Ross Kidd and Sue Clay ,UNDERSTANDING AND CHALLENGING HIV STIGMA, international research center on women, September 2003 6.Theodros S. et al Stigma Against People Living with HIV/AIDS Ethiopian journal of health science, July 2008 Vol. 18, No.239
  • 40. Thank you!!!40