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  • 2006 stigma nmac u

    1. 1. HIV/AIDS Stigma & Access to Care Carlos Velez, JD Director Technical Assistance, Training and Treatment Technical Assistance, Training and Treatment Division NATIONAL MINORITY AIDS COUNCIL
    2. 2. GOALS <ul><li>To examine the role HIV/AIDS related stigma plays in HIV testing behavior, disclosure of positive serostatus, and entry into HIV/AIDS care. </li></ul><ul><li>To examine the impact HIV/AIDS related stigma has on women of color and MSM of color. </li></ul><ul><li>To educate providers who serve minority communities on strategies to address HIV/AIDS related stigma. </li></ul>
    3. 3. OBJECTIVES <ul><li>Participants will be able to: </li></ul><ul><ul><li>define key terms associated with stigma development. </li></ul></ul><ul><ul><li>discuss the differences between key terms associated with stigma development. </li></ul></ul><ul><ul><li>learn about studies documenting the prevalence of HIV/AIDS stigma in the United States. </li></ul></ul><ul><ul><li>learn about and identify derivatives of stigma development. </li></ul></ul>
    4. 4. OBJECTIVES <ul><li>Participants will be able to: </li></ul><ul><ul><li>identify the relationship between HIV/AIDS Stigma and other stigmatized identities. </li></ul></ul><ul><ul><li>identify the relationship between HIV/AIDS stigma and barriers to HIV/AIDS services. </li></ul></ul><ul><ul><li>discuss the disparities in access to HIV/AIDS services and care experienced by racial/ethnic minorities. </li></ul></ul><ul><ul><li>define incidence and prevalence and differentiate between the two. </li></ul></ul>
    5. 5. OBJECTIVES <ul><li>Participants will be able to identify: </li></ul><ul><ul><li>potential programmatic components to reduce HIV/AIDS stigma. </li></ul></ul><ul><ul><li>organizational practices that serve as barriers to women of color and gay/MSM of color deciding to access HIV services. </li></ul></ul><ul><ul><li>organizational practices that may reduce the effects of HIV/AIDS related stigma. </li></ul></ul>
    6. 6. MODULE I KEY TERMS
    7. 7. Objectives <ul><li>Participants will be able to: </li></ul><ul><ul><li>define key terms associated with stigma development: stereotyping, prejudice, discrimination, racism,sexism, homophobia, addictophobia, xenophobia and stigma. </li></ul></ul><ul><ul><li>discuss the difference between stereotyping, prejudice, discrimination, racism, sexism, homophobia, addictophobia, xenophobia and stigma </li></ul></ul>
    8. 8. Key Terms <ul><li>Why do we discuss key terms? </li></ul><ul><li>The development of any type of stigma is related to prejudices and biases already in existence and rooted in our society. </li></ul><ul><li>In the following module participants will begin to understand how the development and formation of prejudices and biases in society assist in the formation of stigma directed towards a group(s) in our society. </li></ul>
    9. 9. KEY TERMS <ul><li>Stereotype </li></ul><ul><li>Prejudice </li></ul><ul><li>Discrimination </li></ul><ul><li>Sexism </li></ul><ul><li>Racism </li></ul><ul><li>Homophobia </li></ul><ul><li>Addictophobia </li></ul><ul><li>Xenophobia </li></ul><ul><li>Stigma </li></ul>
    10. 10. STEREOTYPE <ul><li>A belief that all members of a group possess the same characteristics or traits exhibited by some members of that group. </li></ul>
    11. 11. PREJUDICE <ul><li>Preconceived judgment of members of a certain race, gender, religion, or group. </li></ul>
    12. 12. DISCRIMINATION <ul><li>Unfair treatment of individuals of a particular, race, gender, religion, or group based upon prejudice or bias. </li></ul>
    13. 13. SEXISM <ul><li>Discrimination based on gender. Attitudes, conditions, or behaviors that promote stereotyping of social roles based on gender. </li></ul><ul><li>This may be in the form of behavior, policy, language or other actions. </li></ul>
    14. 14. RACISM <ul><li>Discrimination or mistreatment of an individual due to their membership in a particular race or ethnic group. </li></ul>
    15. 15. HOMOPHOBIA <ul><li>Various degrees of fear, dislike, and hatred of homosexuals or homosexuality. Such feelings may result in prejudice, discrimination, and hostile behavior towards people believed to be homosexual. </li></ul>
    16. 16. ADDICTOPHOBIA <ul><li>The fear of persons associated with, or thought to be associated with, substance abuse or illicit drug use. </li></ul>
    17. 17. XENOPHOBIA <ul><li>The fear of someone or something considered foreign. In this case foreign may refer to someone from another country or culture different from one’s own. </li></ul>
    18. 18. STIGMA <ul><li>Negative feelings, beliefs and behavior directed toward an individual or group due to a particular label or characteristic. </li></ul>
    19. 19. The Origin of “Stigma” <ul><li>“Stigma” </li></ul><ul><li>The term believed to be of Greek origin. </li></ul><ul><li>Stigma referred to “…bodily signs designed to expose something unusual and bad about the moral status of the signifier. The signs were cut or burnt into the body and advertised that the barer… was a blemished person, ritually polluted, to be avoided, especially in public places.” </li></ul>Source: Goffman, Ervin. (1963) Stigma: Notes on the management of spoiled identity. pg. 1.
    20. 20. The Formation of Stigma <ul><li>Stereotypes </li></ul><ul><li>Prejudice </li></ul><ul><li>Racism </li></ul><ul><li>+ Biases </li></ul><ul><li>= Stigma </li></ul>The creation of stigma is the result of existing stereotypes, prejudice, biases and other form of oppression in our society directed at individual and/or groups.
    21. 21. EXERCISE <ul><li>Pick a population at high risk for HIV (men who have sex with men (MSM), injecting drug users (IDUs), partners of IDUs. </li></ul><ul><li>Within that population, pick a demographic descriptor (example: African American, women, 25-34) </li></ul><ul><li>What are some issues this population has to contend or deal with in regards to the definitions just presented. </li></ul><ul><li>How has the government and media coverage impacted your assigned population throughout the HIV/AIDS epidemic. </li></ul><ul><li>Please write down your answers. </li></ul>
    22. 22. MODULE II THE ORIGIN OF HIV/AIDS RELATED STIGMA
    23. 23. Objectives <ul><li>Participants will be able to: </li></ul><ul><ul><li>define HIV/AIDS Stigma </li></ul></ul><ul><ul><li>understand the relationship between HIV/AIDS and stigma development. </li></ul></ul><ul><ul><li>discuss the prevalence of HIV/AIDS stigma in the United States </li></ul></ul>
    24. 24. HIV/AIDS Related Stigma <ul><li>What is HIV/AIDS related stigma? </li></ul><ul><li>The origin of HIV/AIDS related stigma. </li></ul><ul><li>The prevalence of HIV/AIDS related stigma in our society </li></ul>
    25. 25. HIV/AIDS Related Stigma <ul><li>“ Prejudice, discounting, discrediting, and discrimination directed at people perceived to have AIDS or HIV and at the individuals, groups and communities with which they are associated.” </li></ul>Source: Herek, G.M., et al. (1996). AIDS and stigma: A conceptual framework and research agenda. Research work of the National Institute of Mental Health. Pg. 1.
    26. 26. HIV/AIDS STIGMA <ul><ul><li>“ AIDS stigma is manifested through discrimination and social ostracism directed against individuals with HIV and AIDS, against groups of people perceived to be or likely to be infected, and against those individuals, groups, and communities with whom these individuals interact.” </li></ul></ul>Source: Herek, G.M., & Capitanio, J.P. 1998. Symbolic prejudice or fear of infection? A functional analysis of AIDS-related stigma among heterosexual adults. Basic Applied Social Psychology, 20(3), 230-241.
    27. 27. HIV/AIDS STIGMA <ul><ul><li>HIV/AIDS Related Stigma: An Epidemic </li></ul></ul><ul><ul><li>“ It is imperative that steps be taken to address the serious problem of stigmatization associated with HIV disease. This has been referred to as a second epidemic that must be stopped.” </li></ul></ul>Source: Chesney, M. & Smith, A., 1999. Critical delays in HIV testing and care. The potential role of stigma. American behavioral scientist, (42)7, 1162-1174. Pg. 1170.
    28. 28. Two targets of HIV/AIDS-related Stigma <ul><li>Primary : Targets those individuals with HIV/AIDS or those who are perceived to be HIV-infected. </li></ul><ul><li>Secondary: Targets those individuals who care for and support individuals with HIV/AIDS: family members, partner, friends, professionals and organizational volunteers that work to support the cause. </li></ul>Source: Herek, G.M., et al. (1996). AIDS and stigma: A conceptual framework and research agenda. Research work of the National Institute of Mental Health.
    29. 29. IMPACT OF HIV/AIDS STIGMA <ul><ul><li>Direct impact not only on people living with HIV/AIDS, but also on individuals or groups in society perceived to be infected. </li></ul></ul><ul><ul><li>Also impacts those who serve as support or are affiliated in any capacity to HIV/AIDS. </li></ul></ul>
    30. 30. The Origin of HIV/AIDS Related Stigma <ul><li>To understand the present we must take a look at our past… </li></ul><ul><li>The link between stigma and disease is not a new phenomenon. </li></ul><ul><li>Throughout time stigmatizing attitudes and behavior have been directed at individuals and/or group(s) who suffer from or are associated with a particular health condition: leprosy, cholera, depression, substance abuse, and schizophrenia to name a few. </li></ul>
    31. 31. The Origin of HIV/AIDS Related Stigma <ul><li>A Look at the Past… </li></ul><ul><li>1981-An unknown health condition struck a number of gay men in the New York City and Los Angeles area. </li></ul><ul><li>Early media reports referred to HIV/AIDS as: “Gay disease”, “gay cancer”, or “gay plague”. </li></ul><ul><li>HIV/AIDS was commonly referred to as “gay-related immune deficiency” (GRID) by health care providers. </li></ul>Source: Herek, G.M., & Capitanio, J.P. 1999. AIDS stigma and sexual prejudice . American Behavioral Scientist, 42(7), 1130-1147.
    32. 32. The Origin of HIV/AIDS Related Stigma <ul><li>HIV an unknown epidemic: </li></ul><ul><li>At the time when the first cases were diagnosed, little to no information was available to the scientific community on the cause of the illness, the transmissibility, testing for the virus, nor an effective treatment. </li></ul><ul><li>The public knew that it was a fatal condition. </li></ul><ul><li>These factors only served to spread fear in society and shun individuals who belonged or were associated with “high-risk” groups. </li></ul>
    33. 33. The Origin of HIV/AIDS Related Stigma <ul><li>“HIV/AIDS related stigma grows out of preexisting prejudice and bias found in our society directed at marginalized groups such as: homosexuals, current or former drug users, racial/ethnic minorities, immigrants, and impoverished.” </li></ul>Source: Institute of Medicine. No time to lose: getting more from HIV prevention. Washington, DC: National Academy Press, 2001.
    34. 34. The Origin of HIV/AIDS Related Stigma <ul><li>Link between HIV/AIDS stigma and other stigmatized identities in society: </li></ul><ul><li>Sexuality-Early and current association between HIV and sexual transmission. Most associated with homosexuality. </li></ul><ul><li>Race/Ethnicity-Racist attitudes directed at communities of color and recent immigrants based on existing stereotypes. </li></ul>Source: Parker, R and Aggleton, P. (2002) HIV/AIDS-related stigma and discrimination: A conceptual framework and an agenda for action.
    35. 35. The Vicious Circle of Stigma & Discrimination Source: Parker, R and Aggleton, P. (2002) HIV/AIDS-related stigma and discrimination: A conceptual framework and an agenda for action. HIV/AIDS is associated with marginalized behaviors, and PLWH/A are stigmatized because they are assumed to be from a marginalized group. HIV/AIDS PLWH/A Marginalized Groups Ex.: GLB/T, IDU, Commercial Sex Worker Are seen as Are Seen as responsible for
    36. 36. The Vicious Circle of Stigma & Discrimination Source: Parker, R and Aggleton, P. (2002) HIV/AIDS-related stigma and discrimination: A conceptual framework and an agenda for action. Marginalized groups are further marginalized because they are assumed to have HIV/AIDS. HIV/AIDS PLWH/A Marginalized Groups Ex.: GLB/T, IDU, Commercial Sex Worker Are seen as Are Seen as responsible for
    37. 37. The Expression of HIV/AIDS Stigma <ul><li>Early images of the disease have had lasting effects on how the American public perceives HIV/AIDS and those individuals or groups associated with the disease. </li></ul><ul><li>Throughout the course of the epidemic, social scientists have studied the manner in which the general population has come to perceive individuals who are infected and those groups associated with HIV/AIDS infection. </li></ul>
    38. 38. The Expression of HIV/AIDS Stigma <ul><li>The prevalence of HIV/AIDS stigma in our society </li></ul>
    39. 39. PREVALENCE <ul><li>The total number of reported cases of an illness/disease from the onset or beginning of the epidemic or reporting of documented cases. </li></ul>Source: Gordis, L. 1996. Epidemiology. Pg. 32.
    40. 40. I NCIDENCE <ul><li>The number of newly reported cases of an illness or disease over a certain time period (generally a twelve month period). </li></ul>Source: Gordis, L. 1996. Epidemiology. Pg. 31
    41. 41. The Expression of HIV/AIDS Stigma <ul><li>The American public has suggested similar practice not much different than those utilized by the Greeks, directed at individuals or groups believed to be at risk of infection: </li></ul><ul><li>Quarantine measures for those infected with the virus </li></ul><ul><li>Universal mandatory HIV testing </li></ul><ul><li>Mandatory testing of immigrants </li></ul><ul><li>Tattooing individuals who are infected with the virus </li></ul>Source: Herek, G.M. (1990). Illness, stigma, and AIDS. In P. Costa & G.R. VandenBos (Eds.), Psychological aspects of serious illness (pp. 103-150). Washington, DC: American Psychological Association.
    42. 42. The Expression of HIV/AIDS Stigma <ul><li>Survey designed to assess negative feelings directed at PLWH/A in the U.S. from 1991-1999. </li></ul><ul><li>Negative feelings were rated in the following manner: anger towards PLWH/A, afraid of PLWH/A, and feelings of disgust directed at PLWH/A. </li></ul><ul><li>In total 3,700 individuals were surveyed from 1991-1999. </li></ul>Source: Herek, G., Capitanio, J., & Widaman, K. 2002. HIV-related stigma and knowledge in the United States. American Journal of Public Health, 2002, 92(3), 1-14.
    43. 43. Negative Feelings Toward PLWH/A Source: Herek, G., Capitanio, J., & Widaman, K. 2002. HIV-related stigma and knowledge in the United States. American Journal of Public Health, 2002, 92(3), 1-14.
    44. 44. The Expression of HIV/AIDS Stigma <ul><li>Researchers note that our society view those who are infected with the virus in one of two ways: “more deserving” or “less deserving” for contracting the virus. </li></ul><ul><li>This results in the assignment of blame directed at those individuals who are seen as “more deserving” for contracting the virus. </li></ul>
    45. 45. The Expression of HIV/AIDS Stigma <ul><li>Individuals attribute more blame, less sympathy, and more anger towards individuals who become infected through behavior that is perceived as “controllable” (ex. Sexual contact or sharing needles). </li></ul><ul><li>Individuals are perceived to be “less deserving” for having contracted the virus through transfusion or becoming infected by a partner unknowingly. </li></ul>Source: Herek, G.M., & Capitanio, J.P. 1999. AIDS stigma and sexual prejudice . American Behavioral Scientist, 42(7), 1130-1147.
    46. 46. The Expression of HIV/AIDS Stigma Source: Herek, G., Capitanio, J., & Widaman, K. 2002. HIV-related stigma and knowledge in the United States. American Journal of Public Health, 2002, 92(3), 1-14. Q: “People who got AIDS through sex or drugs use have gotten what they deserve.”
    47. 47. The Expression of HIV/AIDS Stigma Q: “Most people with AIDS are responsible for having their illness.” Source: Herek, G., Capitanio, J., & Widaman, K. 2002. HIV-related stigma and knowledge in the United States. American Journal of Public Health, 2002, 92(3), 1-14.
    48. 48. Public's views on personal responsibility for contracting HIV Q:“In general, it’s people’s own fault if they get AIDS.” Source: Kaiser Family Foundation Poll Report
    49. 49. The Expression of HIV/AIDS Stigma <ul><li>HIV/AIDS stigma has also resulted in the discrimination of individuals and groups associated with the virus. </li></ul><ul><li>Discrimination is extended to individuals who are infected or perceived to be infected due to their association or perceived association with a group already stigmatized in society. </li></ul>
    50. 50. The Expression of HIV/AIDS Stigma <ul><li>Discrimination has been endured by individuals who are infected or perceived to be infected in the following manner: </li></ul><ul><li>Physical violence directed at infected or perceived to be infected </li></ul><ul><li>Fired from a job </li></ul><ul><li>Evicted from their homes </li></ul><ul><li>Denial of services </li></ul><ul><li>Social prejudice </li></ul>Herek, G.M., et al. (1998). AIDS and stigma: A conceptual framework and research agenda. AIDS and Public Policy Journal, 13 (1), 36-47.
    51. 51. The Expression of HIV/AIDS Stigma <ul><li>Kaiser Family Foundation </li></ul><ul><li>From 1986-2000 conducted a survey to assess the public’s view on the level of discrimination directed at PLWH/A. </li></ul><ul><li>About 6,070 individuals have taken part in the survey. </li></ul>Source: Kaiser Family Foundation Poll Report
    52. 52. Public's views on discrimination against PLWH/A Q: “Do you think there has been a lot of discrimination against people with AIDS, or do you think their treatment has been generally appropriate?” Source: Kaiser Family Foundation Poll Report
    53. 53. The Expression of HIV/AIDS Stigma <ul><li>Other studies have documented discrimination directed at PLWH/A: </li></ul><ul><ul><ul><li>e.g., employment, health care, housing (Pryor, Reeder, & Landau, 1999) </li></ul></ul></ul><ul><ul><ul><li>e.g., threat of violence in correctional settings (Haggerty, 2000) </li></ul></ul></ul><ul><ul><ul><li>e.g., in-group prejudice and discrimination (Diaz & Ayala, 2001) </li></ul></ul></ul><ul><ul><ul><li>e.g., discrimination in provision of medical services (Gerbert et al, 1991) </li></ul></ul></ul>
    54. 54. The Expression of HIV/AIDS Stigma <ul><li>HIV/AIDS stigma: Impact on laws and policies </li></ul><ul><ul><li>Some Examples: </li></ul></ul><ul><ul><li>Language prohibitions in prevention program </li></ul></ul><ul><ul><li>Prohibition of needle-exchange program </li></ul></ul><ul><ul><li>Confidential Testing only </li></ul></ul><ul><ul><li>Immigration status not granted to those who are positive </li></ul></ul>
    55. 55. The Expression of HIV/AIDS Stigma <ul><li>In Conclusion </li></ul><ul><li>HIV/AIDS related stigma is directed at those individuals who are infected and/or associated with those groups affected in society </li></ul><ul><li>HIV/AIDS relation stigma stems from existing attitudes we hold in our society towards marginalized groups. </li></ul><ul><li>HIV/AIDS related stigma impacts those individuals who are directly and indirectly affected by this disease. </li></ul>
    56. 56. MODULE III HIV/AIDS STIGMA AND IMPACT ON ACCESS TO SERVICES AND CARE
    57. 57. Objectives <ul><li>Participants will be able to: </li></ul><ul><ul><li>recognize how HIV/AIDS related stigma negatively impacts: Testing and counseling seeking behavior, access to care, disclosure of HIV serostatus to others. </li></ul></ul><ul><ul><li>recognize health disparities faced by racial/ethnic minorities when accessing HIV/AIDS services. </li></ul></ul>
    58. 58. HIV/AIDS Stigma: Impact on Care <ul><li>Impact on testing and counseling services, access to care, and disclosure of positive serostatus to others. </li></ul><ul><li>Health disparities faced by racial/ethnic minorities when accessing HIV/AIDS services. </li></ul>
    59. 59. HIV/AIDS Stigma: Individual Impact <ul><li>Societal attitudes combined with perceived stigma towards HIV/AIDS directly impact whether or not individuals access testing and counseling services, health care and disclose their positive serostatus to others. </li></ul>
    60. 60. HIV/AIDS Stigma: Barrier to Care <ul><li>“PWAs have been shunned by strangers and family members, discriminated against in employment and health care, driven from their homes, and subjected to physical abuse. Fear of stigma has deterred individuals from being tested for HIV and from disclosing their seropositive status to sexual partners, family and friends.” </li></ul>Herek, G., Capitanio, J., & Widaman, K. 2002. HIV-related stigma and knowledge in the United States. American Journal of Public Health, 2002, 92(3), 1-14. Pg. 1.
    61. 61. HIV/AIDS Stigma: Barrier to Care <ul><li>Self-Stigmatization </li></ul><ul><li>The shame that PLWH/A experience when they internalize negative response and reactions of others. </li></ul><ul><li>This may lead to depression, withdrawal and feelings of worthlessness. </li></ul><ul><li>**Internalized-Stigmatization may also lead to isolation of the individual and limit the ability of the individuals to access critical services. </li></ul>**Source: Parker and Aggleton. HIV/AIDS-related stigma and discrimination: A conceptual framework and an agenda for action. May 2002.
    62. 62. HIV/AIDS Stigma:Impact on Testing & Counseling <ul><li>“Individuals…less likely to seek HIV testing in environments where they perceive workers to be judgmental about their sexual and drug use behavior” </li></ul>Valdiserri, Ronald. 2002. HIV/AIDS Stigma: An Impediment to Public Health. American Journal of Public Health 2002 92: 341-342.  
    63. 63. HIV/AIDS Stigma:Impact on Testing & Counseling <ul><li>In order for individuals to seek testing and counseling services: </li></ul><ul><ul><li>They must be knowledgeable about HIV/AIDS and how the virus is transmitted </li></ul></ul><ul><ul><li>They must feel that they are risk for contracting the virus </li></ul></ul><ul><ul><li>Have some knowledge of what the testing and counseling procedure entails </li></ul></ul><ul><ul><li>Knowledge about where to get tested </li></ul></ul><ul><ul><li>Most importantly…they must not perceive stigma </li></ul></ul>
    64. 64. HIV/AIDS Stigma:Impact on Testing and Counseling <ul><li>HIV/AIDS related stigma has been shown to delay testing and counseling seeking behavior by individuals who perceive high level of stigma directed at those who are positive or perceive to be positive in our society. </li></ul><ul><li>Individuals who belong to a “high-risk group” as deemed by society, may perceive stigma and not access or delay HIV testing and counseling services. </li></ul>Source: Chesney, M. & Smith, A. 1999. Critical delays in HIV testing and care: the potential role of stigma. American Behavioral Scientis t, 42(7), 1162-1174.
    65. 65. HIV/AIDS Stigma:Impact on Testing & Counseling <ul><li>Delay in HIV testing </li></ul><ul><li>Individuals who perceive greater amounts of HIV/AIDS stigma are less likely to get tested. </li></ul><ul><ul><ul><li>Stall et al. (1996) study of 828 gay and bisexual men unaware of their HIV status </li></ul></ul></ul><ul><ul><ul><ul><li>66% of the sample indicated HIV/AIDS stigma as the reason for not seeking an HIV test. </li></ul></ul></ul></ul>Source: Chesney, M. & Smith, A. 1999. Critical delays in HIV testing and care: the potential role of stigma. American Behavioral Scientis t, 42(7), 1162-1174.
    66. 66. HIV/AIDS Stigma:Impact on Testing & Counseling <ul><li>The link between stigma and positive serostatus. </li></ul><ul><li>Individuals who refuse an HIV test when one was offered were, 5 to 8 times more likely to test positive than those who agreed to testing. </li></ul><ul><ul><ul><li>Hull et al. (1988) found that individuals who were offered an HIV test and declined the test, did so for fear of becoming stigmatized. </li></ul></ul></ul>Source: Chesney, M. & Smith, A. 1999. Critical delays in HIV testing and care: the potential role of stigma. American Behavioral Scientis t, 42(7), 1162-1174.
    67. 67. HIV/AIDS Stigma:Impact on Testing & Counseling <ul><li>Decision to test and concerns that others may think less of us. </li></ul><ul><li>The manner in which HIV/AIDS testing and counseling is perceived by others, has been found to register concern with those who seek testing… </li></ul>
    68. 68. HIV/AIDS Stigma:Impact on Testing & Counseling <ul><li>Q: “If you were tested for HIV, how concerned would you be that people would think less of you if </li></ul><ul><li>they found out you had been tested?” </li></ul><ul><li>46% of the respondents expressed some level of concern. </li></ul>Source: KFF Health Poll Report. August 2000.
    69. 69. HIV/AIDS Stigma: Barrier to Care <ul><li>HIV/AIDS related stigma directly impacts the ability for an individual to access care. </li></ul><ul><li>Once diagnosed as HIV positive, individuals who exhibit concerns about being stigmatized are more likely to delay care and/or not to adhere to care. </li></ul>Source: Chesney, M. & Smith, A. 1999. Critical delays in HIV testing and care: the potential role of stigma. American Behavioral Scientis t, 42(7), 1162-1174.
    70. 70. HIV/AIDS Stigma: Barrier to Care <ul><li>Delay in access to HIV/AIDS care </li></ul><ul><li>Katz and Bindman (1992). A study of PLWH/A </li></ul><ul><ul><li>Those who perceive greater amounts of stigma are less likely to access HIV/AIDS care </li></ul></ul><ul><ul><li>Avoidance strategies such as, denial of serostatus, were listed among those given by participants in explaining why they had not accessed care. </li></ul></ul>Source: Chesney, M. & Smith, A. 1999. Critical delays in HIV testing and care: the potential role of stigma. American Behavioral Scientis t, 42(7), 1162-1174.
    71. 71. HIV/AIDS Stigma: Barrier to Care <ul><li>Health care providers as a barrier to care. </li></ul><ul><li>Negative attitudes and perceptions by health care workers directed at those who are positive contributes to the feelings of stigma. </li></ul>Source: Chesney, M. & Smith, A. 1999. Critical delays in HIV testing and care: the potential role of stigma. American Behavioral Scientis t, 42(7), 1162-1174.
    72. 72. HIV/AIDS Stigma: Barrier to Care <ul><li>Stigmatizing attitudes displayed by health care providers: </li></ul><ul><li>Health care providers have been found to be reluctant to work with HIV positive individuals. </li></ul><ul><li>87% of physicians and nurses report experiencing more anxiety when treating an AIDS patient as as opposed to other patient group. </li></ul><ul><li>Physicians and nurses view HIV patients as more responsible for their illness. </li></ul><ul><li>Physicians and nurses report a preference for treating those who contracted the virus through transfusion. </li></ul>Source: Chesney, M. & Smith, A. 1999. Critical delays in HIV testing and care: the potential role of stigma. American Behavioral Scientis t, 42(7), 1162-1174 .
    73. 73. HIV/AIDS Stigma: Barrier to Care <ul><li>Women and delay in care: </li></ul><ul><li>Women who tend to delay health care after being diagnosed with the virus, do so for fear of others becoming aware of their HIV status and the consequence this may bring. </li></ul><ul><li>Women who have had negative experiences with health care providers are reluctant to share their positive serostatus after being diagnosed. </li></ul>Source: Raveis, V. & Siegel, K., 1998. Factors associated with HIV-infected women’s delay in seeking medical care. AIDS care, 5(10), 549-562.
    74. 74. HIV/AIDS Stigma: Disclosure of Status <ul><li>The decision to reveal one’s HIV-positive status is associated with the level of comfort an individual has within their environment and their perceptions of the risks associated with the disclosure. </li></ul><ul><li>The more accepting, caring and nonjudgmental a social network is towards HIV, the more likely it is for individuals to disclose their status. </li></ul>
    75. 75. HIV/AIDS Stigma: Disclosure of Status <ul><li>Fear of rejection, fear of ostracism by family and friends, the loss of employment and physical violence have been reasons provided by individuals who are HIV positive for not disclosing their status. </li></ul>Source: Chesney, M. & Smith, A., 1999. Critical delays in HIV testing and care. The potential role of stigma. American behavioral scientist, (42)7, 1162-1174.
    76. 76. HIV/AIDS Stigma: Disclosure of Status <ul><li>“ Passing” to protect one’s self. </li></ul><ul><li>“Passing” is a term that refers to individuals who choose not to disclose their HIV status. </li></ul><ul><li>Passing- Is a method of protecting one’s self from becoming ill-treated and rejected by by family, friends, and others we may come into contact with. It also preserves normalcy when interacting with others. </li></ul>Source: Herek, G.M. (1990). Illness, stigma, and AIDS. In P. Costa & G.R. VandenBos (Eds.), Psychological aspects of serious illness (pp. 103-150). Washington, DC: American Psychological Association.
    77. 77. HIV/AIDS Stigma: Disclosure of Status <ul><li>The problem with “Passing”… </li></ul><ul><li>Individuals who do not disclose their status may experience stress and lead dual lives. </li></ul><ul><li>Individuals may isolate themselves to protect their secret: refuse to attend social functions, avoid overexposure to others that may give them away. </li></ul><ul><li>As symptoms progress avoidance may increase. </li></ul>Source: Herek, G.M. (1990). Illness, stigma, and AIDS. In P. Costa & G.R. VandenBos (Eds.), Psychological aspects of serious illness (pp. 103-150). Washington, DC: American Psychological Association.
    78. 78. HIV/AIDS Stigma: Disclosure of Status <ul><li>Consequences of not disclosing… </li></ul><ul><li>Impacts of the level of support family and friends may provide to the individual. </li></ul><ul><li>Increase the level of isolation of the individual which may lead to feelings of depression, anxiety and/or other mental health vulnerabilities. </li></ul>Source: Chesney, M. & Smith, A., 1999. Critical delays in HIV testing and care. The potential role of stigma. American behavioral scientist, (42)7, 1162-1174.
    79. 79. HIV/AIDS Stigma: Disclosure of Status <ul><li>Consequences of not disclosing… </li></ul><ul><li>Decrease in the available resources available to the individual. </li></ul><ul><li>Not disclosing status to health care provider prevent the individual from taking advantage of treatment. </li></ul>Source: Chesney, M. & Smith, A., 1999. Critical delays in HIV testing and care. The potential role of stigma. American behavioral scientist, (42)7, 1162-1174.
    80. 80. HIV/AIDS: Racial/Ethnic Health Disparities <ul><li>Health disparities faced by racial/ethnic minorities when receiving HIV/AIDS services. </li></ul><ul><li>The impact of Racial/Ethnic health disparities among communities of color when accessing HIV/AIDS services. </li></ul>
    81. 81. HIV/AIDS: Racial/Ethnic Health Disparities <ul><li>What is Racial/Ethnic health disparity? </li></ul><ul><li>“ the differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention” </li></ul>Source: Unequal Treatment: Confronting racial and ethnic disparities in health care. 2002
    82. 82. HIV/AIDS: Racial/Ethnic Health Disparities <ul><li>Quality of health care </li></ul><ul><li>“ Differences in the quality of HIV care are associated with poorer survival rates among minorities, even at equivalent levels of access to care.” </li></ul>Source: Unequal Treatment: Confronting racial and ethnic disparities in health care., p.5.
    83. 83. HIV/AIDS: Racial/Ethnic Health Disparities <ul><li>ACCESS VS . QUALITY OF CARE </li></ul><ul><li>Access to care does not equal quality of care for communities of color. </li></ul><ul><li>Having access to care does not guarantee quality of care. </li></ul>
    84. 84. HIV/AIDS: Racial/Ethnic Health Disparities <ul><li>Minorities access HIV/AIDS care at a lower rate than their white counterparts. </li></ul><ul><li>Once in care, racial/ethnic minorities receive lower quality of care. </li></ul>Source: Institute of Medicine Report. Unequal treatment: confronting racial and ethnic disparities in health care. National Academy press, 2002.
    85. 85. HIV/AIDS: Racial/Ethnic Health Disparities <ul><li>Racial/Ethnic Minorities: </li></ul><ul><li>Less likely to receive combination therapy </li></ul><ul><li>Less likely to receive drugs to address opportunistic infections </li></ul><ul><li>Less likely to be admitted to the hospital when presenting to the emergency department </li></ul><ul><li>Less frequently followed by a health care provider on a regular basis </li></ul><ul><li>Test late in the disease process.** </li></ul>Shapiro, et al. 1999. Variations in the care of HIV-infected adults in the US. JAMA, 281:24(June):2305-2315 **MMWR. Late versus early testing of HIV-16 sites, United States, 2000-2003. June 27, 2003/Vol.52/No.25.
    86. 86. HIV/AIDS: Racial/Ethnic Health Disparities <ul><li>In Conclusion </li></ul><ul><li>HIV/AIDS related stigma negatively impacts: Testing and counseling seeking behavior, access to care, disclosure of HIV serostatus to others. </li></ul><ul><li>Racial/ethnic minorities experience poorer health outcomes </li></ul><ul><li>Racial/ethnic minorities are less likely to receive the standard of care for HIV/AIDS services </li></ul>
    87. 87. MODULE IV HIV/AIDS STIGMA AND MANIFESTATION IN SOCIETY
    88. 88. Objectives <ul><li>Participants will be able to: </li></ul><ul><ul><li>identify the differences between instrumental, symbolic and courtesy stigma. </li></ul></ul><ul><ul><li>identify the relationship between HIV/AIDS Stigma and other stigmatized identities. </li></ul></ul><ul><ul><li>understand how individuals process stigmatizing attitudes: Introduction of the MODE model. </li></ul></ul>
    89. 89. HIV/AIDS: Related Stigma <ul><li>HIV/AIDS related stigma is manifested in our society through overt and covert behaviors directed at individuals who are HIV positive or believed to be infected based on their group association. </li></ul><ul><li>Perpetrators of AIDS Stigma * </li></ul><ul><li>“ Individuals who express negative attitudes or feelings directed at PLWH/A, or who engage in discrimination or other stigmatizing behaviors.” </li></ul>*Source: Herek, G.M., et al. (1998). AIDS and stigma: A conceptual framework and research agenda. AIDS and Public Policy Journal, 13 (1), 36-47.
    90. 90. HIV/AIDS: Related Stigma <ul><ul><li>Instrumental Stigma </li></ul></ul><ul><ul><li>Fear of contagion </li></ul></ul><ul><ul><li>Results from the fear that HIV is a communicable disease. Fear of contracting HIV from an infected person leads to the avoidance of individuals, or objects associated with said individuals, thought to be HIV positive </li></ul></ul><ul><ul><ul><li>Example: </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Homosexuals </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>IDU and other users of illegal drugs </li></ul></ul></ul></ul></ul>Source: Herek, G.M., et al. (1998). AIDS and stigma: A conceptual framework and research agenda. AIDS and Public Policy Journal, 13 (1), 36-47.
    91. 91. HIV/AIDS: Related Stigma <ul><li>Factors which promote Instrumental Stigma : </li></ul><ul><li>AIDS perceived to be unalterable, degenerative, and a fatal condition. </li></ul><ul><li>AIDS is widely understood to be transmissible; when a disease is contagious the person with the disease is often regarded as dangerous. </li></ul><ul><li>The more advanced stages HIV disease, its symptoms are perceived to be as repellent, ugly, or upsetting. </li></ul><ul><li>This is compounded by the tendency among a significant portion of the population to blame PLWH/A for their illness. </li></ul>Source: Herek, G.M., et al. (1998). AIDS and stigma: A conceptual framework and research agenda. AIDS and Public Policy Journal, 13 (1), 36-47.
    92. 92. HIV/AIDS: Related Stigma <ul><li>Symbolic Stigma </li></ul><ul><li>Result from the social meaning attached to HIV/AIDS. It is the association of HIV/AIDS with negatively evaluated groups in our society. </li></ul><ul><li>Using the disease to express attitudes toward the groups associated with it and the behaviors that transmit it. </li></ul><ul><li>Example: </li></ul><ul><ul><ul><ul><ul><li>Commercial sex workers </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>People of color </li></ul></ul></ul></ul></ul>Source: Herek, G.M., et al. (1998). AIDS and stigma: A conceptual framework and research agenda. AIDS and Public Policy Journal, 13 (1), 36-47.
    93. 93. HIV/AIDS: Related Stigma <ul><li>Factors which promote Symbolic Stigma : </li></ul><ul><li>Negative perceptions, stereotypes or attitudes that an individual may hold towards PLWH/A or those groups associated with the virus. </li></ul><ul><li>The representation and judgment directed at the behavior(s) associated with the transmission of the disease. </li></ul>
    94. 94. HIV/AIDS: Related Stigma <ul><li>Courtesy Stigma </li></ul><ul><li>Stigma directed at those connected with HIV/AIDS issues or HIV positive individuals </li></ul><ul><ul><ul><ul><li>Example: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Family, friend, support system for a PLWH/A </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Individuals associated with ASO’s </li></ul></ul></ul></ul></ul>Source: Snyder, M. et al. (1999) Punished for their good deeds: Stigmatization for AIDS volunteers. American Behavioral Scientist. 42(7), 1175-92.
    95. 95. HIV/AIDS: Related Stigma <ul><li>Factors which promote Courtesy Stigma : </li></ul><ul><li>The stigma directed at individuals who are perceived to be sympathetic to those individuals or groups associated with HIV/AIDS in some manner or capacity. </li></ul>
    96. 96. HIV/AIDS: Related Stigma <ul><li>The MODE Model & Attitude Formation </li></ul><ul><li>Russell Fazio (1990) </li></ul><ul><li>Attitudes drive the manner in which one behaves. </li></ul><ul><li>Some social behavior is spontaneous and some is deliberative. </li></ul>Source: Fazio, R.H. (1990) Multiple processes by which attitudes guide behavior: the Mode Model as an integrative framework. Advances in experimental and Social Psychology. (23)75-109.
    97. 97. HIV/AIDS: Related Stigma <ul><li>MODE Model: Two Processes </li></ul><ul><li>Automatic process </li></ul><ul><li>Person generates an attitude toward an object without much conscious thought (i.e., automatically). </li></ul><ul><li>Cost/Benefits process </li></ul><ul><li>Person weighs the costs and benefits of a particular attitude-relevant behavior. </li></ul>
    98. 98. The MODE Model Person Sees Attitude Object (e.g., gay man, sex worker, drug user) Automatic Process -Object is evaluated-an unconscious process Homosexual/promiscuous Sex worker /immoral Drug user/criminal Cost/Benefit Process -person weighs the cost of a particular attitude-relevant behavior Attitude towards individual expressed
    99. 99. HIV/AIDS: Related Stigma <ul><li>MODE Model </li></ul><ul><li>Automatic process group exercise </li></ul><ul><li>As quickly as possible generate adjectives that come </li></ul><ul><li>to mind when you think of: </li></ul><ul><ul><ul><ul><ul><li>Boss </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Mother </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>America </li></ul></ul></ul></ul></ul>
    100. 100. HIV/AIDS: Related Stigma <ul><li>Relevance for Reducing HIV/AIDS Stigma </li></ul><ul><li>Changing behavior, even if the attitude does not immediately change, can result in eventual change in the attitudes. </li></ul><ul><ul><li>MODE Model is useful in terms of theoretical model to ground the behavior that is expressed by those who display HIV/AIDS related stigma. </li></ul></ul><ul><ul><li>May be included in grant applications to address HIV/AIDS stigma. </li></ul></ul>
    101. 101. HIV/AIDS: Related Stigma <ul><li>In Conclusion </li></ul><ul><li>Social scientists have identified the three manners in which HIV/AIDS related stigma is displayed in our society: instrumental, symbolic and courtesy stigma. </li></ul><ul><li>Stigmatized attitudes already in existence in society directly impact HIV/AIDS related stigma. </li></ul><ul><li>The MODE model may provide a clue on how individuals process stigmatizing attitudes. </li></ul>
    102. 102. MODULE V THE PROCESS OF COUNTERING HIV/AIDS STIGMA
    103. 103. Objectives <ul><li>Participants will be able to: </li></ul><ul><ul><li>identify potential means of countering HIV/AIDS Stigma through programmatic components. </li></ul></ul><ul><ul><li>learn about individual- and community-level interventions for countering HIV/AIDS stigma. </li></ul></ul><ul><ul><li>learn about interventions addressing women of color, gay/MSM and the community in addressing HIV/AIDS stigma. </li></ul></ul>
    104. 104. COUNTERING HIV/AIDS STIGMA <ul><li>Potential mean to counter HIV/AIDS stigma: </li></ul><ul><li>Multi-level interventions. </li></ul><ul><li>Interventions addressing women of color, gay/MSM of color and the community </li></ul>
    105. 105. COUNTERING HIV/AIDS STIGMA <ul><li>Interventions may be directed at the individual or community level. </li></ul><ul><li>Individual level intervention </li></ul><ul><li>Programs reaching an individual or small group of individuals </li></ul><ul><li>Community level intervention </li></ul><ul><li>Programs reaching a large geographical area </li></ul>
    106. 106. COUNTERING HIV/AIDS STIGMA <ul><li>How do we counter HIV/AIDS stigma? </li></ul><ul><li>Through the use of multi-level intervention strategies targeting population at large and/or PLWH/A. </li></ul><ul><li>Stigma reduction methods include: </li></ul><ul><ul><li>Information dissemination </li></ul></ul><ul><ul><li>Counseling </li></ul></ul><ul><ul><li>Coping Skills Acquisition </li></ul></ul><ul><ul><li>Contact with those affected </li></ul></ul>Source: Brown, L., Trujillo, L., & Macintyre, K. Interventions to reduce HIV/AIDS stigma: What have we learned? August 2001.
    107. 107. COUNTERING HIV/AIDS STIGMA <ul><li>Information dissemination </li></ul><ul><li>The information may be delivered through the use of flyers, advertisement, information packets, and/or presentations to other community based organizations. These include churches, classroom lectures. </li></ul><ul><li>The information presented consist of information about the disease, how the disease is transmitted, and risk reduction methods. </li></ul>Source: Brown, L., Trujillo, L., & Macintyre, K. Interventions to reduce HIV/AIDS stigma: What have we learned? August 2001.
    108. 108. COUNTERING HIV/AIDS STIGMA <ul><li>Counseling </li></ul><ul><li>Strategy designed to assist PLWH/A to increase support and self-efficacy through the use of conflict resolution methods in dealing with family members, spouses and communities in a safe environment. </li></ul><ul><li>Through the use of counseling support interventions, individuals are better able to reduce anxiety and feelings of distress. </li></ul>Source: Brown, L., Trujillo, L., & Macintyre, K. Interventions to reduce HIV/AIDS stigma: What have we learned? August 2001.
    109. 109. COUNTERING HIV/AIDS STIGMA <ul><li>Interventions for Perpetrators </li></ul><ul><li>Coping Skills Acquisition </li></ul><ul><li>Master Imagery- Individuals are presented with hypothetical scenarios where they come in contact with PLWH/A, and are taught to conflict resolution skills and resolve a given situation. </li></ul><ul><li>Group Desensitization- Teaches relaxation at first, then exposes individuals to hypothetical situations exercise newly learned techniques. </li></ul>Source: Brown, L., Trujillo, L., & Macintyre, K. Interventions to reduce HIV/AIDS stigma: What have we learned? August 2001.
    110. 110. COUNTERING HIV/AIDS STIGMA <ul><li>Contact with those affected </li></ul><ul><li>A more personal relationship with a PLWH/A either through the media or face-to-face conversation will demystify information about HIV/AIDS and in the process reduce stigma and prejudice. </li></ul>Source: Brown, L., Trujillo, L., & Macintyre, K. Interventions to reduce HIV/AIDS stigma: What have we learned? August 2001.
    111. 111. COUNTERING HIV/AIDS STIGMA <ul><li>Interventions: Addressing Women of color </li></ul><ul><li>Empowerment of women </li></ul><ul><li>Stress the importance of knowing one’s status, and the status of one’s partner </li></ul><ul><li>The necessity to protect self and family </li></ul><ul><li>Encourage development of self-esteem and self-efficacy </li></ul><ul><ul><ul><ul><li>Address issues of intimate partner violence </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Address patriarchy/Gender norms </li></ul></ul></ul></ul>
    112. 112. COUNTERING HIV/AIDS STIGMA <ul><li>Interventions: Addressing Women of color </li></ul><ul><li>Knowledge of risk that actually exists for all women </li></ul><ul><li>Despite stigma directed toward sex workers and IDUs, they are not the only groups of women who need to protect themselves </li></ul><ul><li>Address risk to lesbian-identified women </li></ul><ul><li>Issues of WSW </li></ul>
    113. 113. COUNTERING HIV/AIDS STIGMA <ul><li>Interventions: Addressing Women of color </li></ul><ul><li>Create a forum for discussion of sexuality </li></ul><ul><li>Create a forum for discussing sexual orientation </li></ul><ul><li>May lessen any homophobia women possess </li></ul><ul><li>Women are not to blame for male partners’ behavior of which they are not aware </li></ul>
    114. 114. COUNTERING HIV/AIDS STIGMA <ul><li>Interventions: Addressing gay/MSM of color </li></ul><ul><li>Work to counter internalized homophobia </li></ul><ul><ul><li>Relationship with HIV/AIDS stigma </li></ul></ul><ul><li>Address identity conflict </li></ul><ul><ul><li>Incongruity between racial and sexual identity </li></ul></ul><ul><li>Informed discussion of sexuality </li></ul><ul><ul><li>Address internalized homophobia </li></ul></ul>
    115. 115. COUNTERING HIV/AIDS STIGMA <ul><li>Community level:Major education campaigns </li></ul><ul><li>Fullilove and Fullilove (1999) </li></ul><ul><li>Importance of involving the church in the struggle </li></ul><ul><ul><li>Address empowerment </li></ul></ul><ul><ul><li>Address threat to community HIV/AIDS presents </li></ul></ul>
    116. 116. COUNTERING HIV/AIDS STIGMA <ul><li>In Conclusion </li></ul><ul><li>HIV/AIDS related stigma can be countered through the use of individual and community level interventions. </li></ul><ul><li>The manner in which HIV/AIDS related stigma is addressed depends on the target population. </li></ul>
    117. 117. MODULE VI COUNTERING THE EFFECTS OF HIV/AIDS STIGMA WITHIN ORGANIZATIONS
    118. 118. Objectives <ul><li>Participants will be able to: </li></ul><ul><ul><li>identify organizational practices that may reduce the effects of HIV/AIDS related stigma. </li></ul></ul><ul><ul><li>identify organizational practices that serve as barriers to women of color and gay men of color deciding to access HIV services. </li></ul></ul>
    119. 119. REDUCING BARRIERS <ul><li>Organizations may impose barriers for those who seek services. </li></ul><ul><li>We will be addressing and identifying: </li></ul><ul><li>Organizational barriers that may increase HIV/AIDS related stigma. </li></ul><ul><li>Organizational practices that serve as barriers to women of color and gay men of color deciding to access HIV services. </li></ul>
    120. 120. <ul><li>“IF YOU BUILD IT, THEY WILL COME” </li></ul><ul><li>AGENCY NAME </li></ul><ul><li>LOCATION </li></ul><ul><li>MARKETING STRATEGY </li></ul><ul><li>FACILITIES </li></ul><ul><li>STAFF ATTITUDES </li></ul>REDUCING BARRIERS
    121. 121. <ul><li>AGENCY NAME Example: The name of the agency might affect access if the name is associated with HIV/AIDS. </li></ul>REDUCING BARRIERS
    122. 122. <ul><li>LOCATION </li></ul><ul><li>Example: If the agency is located within the community it can make consumers reluctant to seek care. </li></ul>REDUCING BARRIERS
    123. 123. <ul><li>MARKETING STRATEGY </li></ul><ul><li>Example: If the agency is perceived to serve a particular ethnic group, gender or sexual orientation, it could cause members of other groups to stay away. </li></ul>REDUCING BARRIERS
    124. 124. REDUCING BARRIERS <ul><li>FACILITIES </li></ul><ul><li>Example: The space of the facility does not accommodate diverse group of individuals. </li></ul>
    125. 125. <ul><li>STAFF ATTITUDES </li></ul><ul><li>Example: The manner in which staff interacts with members of other racial/ethnic group, or sexual minorities may negatively impact the client. </li></ul>REDUCING BARRIERS
    126. 126. <ul><li>Barriers for Women of Color </li></ul><ul><li>Heterosexual or homosexual tailored programs or settings </li></ul><ul><li>Cultural competency of staff </li></ul><ul><ul><li>Cultural competence is defined as the capacity to function effectively as an individual and an organization within the context to the cultural beliefs, behaviors and needs presented by consumers and their communities (HHS, OMH March 2001). </li></ul></ul><ul><li>Male oriented agency </li></ul>REDUCING BARRIERS
    127. 127. <ul><li>Barriers For Gay/MSM of Color </li></ul><ul><li>Assuming that all GMOC’s/MSM are the same </li></ul><ul><li>Sexual history assessment </li></ul><ul><ul><li>Comfort level of staff </li></ul></ul><ul><ul><li>Intrusiveness of Interview </li></ul></ul>REDUCING BARRIERS
    128. 128. <ul><li>Other means of interventions… </li></ul><ul><li>Provide a range of holistic health services </li></ul><ul><li>Provide various types of case management activities </li></ul><ul><li>Implement self-esteem programs </li></ul><ul><li>Increase cultural competency of staff </li></ul><ul><li>Implement HIV/AIDS stigma reduction programs, through the adoption of “zero” tolerance for abusive behavior </li></ul>REDUCING BARRIERS
    129. 129. <ul><li>In Conclusion </li></ul><ul><li>Organizational practices serve as barriers to women of color and gay men of color deciding to access HIV services. </li></ul><ul><li>Organizational practices have the capacity to reduce the effects of HIV/AIDS related stigma at both the individual and community level. </li></ul>REDUCING BARRIERS

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