1. Presenter
Dr M MUNAWAR KHAN
BCC COORDINATOR
SINDH AIDS CONTROL PROGRAM
1

2. 2

3. Stigma: Definition
 Stigma: unfavourable attitudes and
beliefs directed toward someone or
something
 HIV-related stigma: unfavourable
attitudes and beliefs directed toward
people living with HIV, their family and
friends, social groups, and communities
PMTCT Generic Training Package
Module 4, Slide 3

4. Stigma & Discrimination
 UNAIDS
Definition of HIV-related
stigma and discrimination
“…a ‘process of devaluation’ of
people either living with or
associated with HIV and AIDS…

5. HIV-related Stigma
 Stigma particularly pronounced when
behaviour causing disease is perceived to
be under individual’s control, e.g., sex work
or injection drug use
 Certain groups, e.g., poor people, men who
have sex with men, sex workers and
injection drug users, often bear heaviest
burden of HIV-related stigma.
 People who are HIV-infected are often assumed
to be members of these groups, whether they
are or not
PMTCT Generic Training Package
Module 4, Slide 5

6. Examples of Stigma
 Believing HIV is great punishment for moral
misconduct / bad behaviour
 Thinking women are responsible for
transmitting HIV and other STIs in our
community
 A daughter refusing to visit her father once she
finds out he has HIV because she felt
"dirtied“(infected) by contact with him
 A woman with HIV refusing to join support
group or tell people outside the family about
her HIV because she fears being stigmatized
PMTCT Generic Training Package
Module 4, Slide 6

7. Discrimination: Definition
 Discrimination: the treatment of an
individual or group with prejudice
(injustice)
 Discrimination includes the denial
(refusal) of basic human rights such as
health care, employment, legal services
and social welfare benefits
PMTCT Generic Training Package
Module 4, Slide 7

8. Cont…. Stigma & Discrimination
 When a person is labeled by their illness
they are seen as part of a stereotyped /
Stigma group.
 Negative attitudes create injustice
which leads to negative actions and
discrimination.

9. Stigma:
 (Dishonour / Badnami) is when people think that some
people are bad for some reason.
 Self-stigma and fear of a negative community reaction can
hinder efforts to address the AIDS epidemic
 Stigma creates false differences between people. based
on, illogical judgments and results in ‘us-and-them’ type of
thinking
 AIDS stigma and discrimination exist worldwide, although
they marked themselves differently across
countries, communities, religious groups and individuals

10. Cont…
 In the workplace, people living with HIV
may suffer stigma from their co-workers
and employers, such as social isolation
and ridicule, or experience
 Discriminatory practices, such as
termination or refusal of employment.
Fear of an employer’s reaction can
cause a person living with HIV anxiety:

11. What is Discrimination?
 When Stigma is acted upon, the result is
discrimination:
 It includes:
 Arbitrary / illogical actions against the
affected person
 Exclusion
 Restrictions
 Denials

12. What is discrimination?(
Inequity}
Discrimination is when people do act on the
stigma, they have for another person.
It can be say that they do or don’t do, such
as:
 Many countries have laws that restrict the
entry, stay and residence of people living
with HIV.
 Preventing children of PLHIV from going to
school
 Gossiping about or pointing at PLHIV
 Ignoring or staring at family members of
PLHIV
 Other children teasing and making fun of
children of PLHIV

13. Forms of stigma &
discrimination
 Physical:
Physical isolation and violence
 Social:
Social isolation, loss of identity and role
 Verbal:
Insults, taunts, blame, gossip, and rumours
 Institutional:
Loss of livelihood,( employment opportunities,
housing & education)
 Multi-layered stigma:
Among people already socially excluded (MSM,
FSW, IDU)
cont.....

14. Cont…
 Due to Lack of knowledge regarding how
HIV is transmitted, contributes to increase
the discrimination among members of the
general public and health workers.
 HIV positive members of the family can
find themselves stigmatised and
discriminated against within the home.

15. Key points :
about stigma and discrimination are:
 Stigmais based on beliefs / principles
A person is 'stigmatised' when another
person thinks negatively of them
because they belong to a particular
group.
 Discrimination:(unfairness) occurs
when actions are taken (or not taken)
on the basis of a stigmatising belief.
Cont…..

16. Cont……
 HIV/AIDS leads to stigma and discrimination.
 Stigma and discrimination occur in many
settings, including the family, local
community, school and health care facilities.
 There are many negative effects of stigma and
discrimination.
 Stigma and discrimination go against a
patient’s right ,to be treated equally and fairly.

17. Cont….
 Children and young people in other groups may
also experience stigma and discrimination.
These include:
 Orphans,
 Children of women who sell sex,
 Street children,
 Refugees (Immigrant)
 Intravenous drug users,
 Sex workers and prisoners .
 Many of these experience 'double' stigma
because they are also more exposed to HIV.

18. Effects of stigma and
discrimination
 Children and young people experience stigma
and discrimination in different places these
include :
 at home, Withdrawal of caregiving in the
home
 in their local community, Loss of reputation
 in schools
 and at health care facilities. Poor care within
the health sector
This may result in children and young people
being denied access to health care and
education.

19. Effects of stigma and discrimination
include:
 Fear of members of the stigmatised group.
 Verbaland physical abuse of children and
young people.
 Fear of disclosing information, including
results of HIV tests. This may mean that
people do not get the treatment they need.
 Reduced self-Respect and confidence
among children.
cont…

20. cont…
 Stigma brings experiences and feelings of:
 shame
 blame
 hopelessness
 distress
 misrepresentation in the media
 Reluctance to seek and/or accept necessary
help
 Families are also affected by stigma, leading
to a lack of support.

21. Cont….
 Children and young people being isolated
socially. This can mean they are 'excluded'
from society.
 leavingdepression and other psychosocial
problems.
 Children and young people running away
from the place where they are
experiencing stigma and discrimination.
This may involve them moving from rural
to urban areas. This carries the risk of
them ending up living on the street.

22. How stigma and discrimination
contribute to the spread of HIV
 Some people who are HIV positive do
not tell anybody because they are
afraid that the community will blame
them for being infected.
 Some people fear being tested for HIV
because they are worried that they
might be positive and also because
others will treat them badly.

23. Cont….
 People living with HIV sometimes do
not go for treatment because they are
afraid that health care workers will tell
others that they are HIV positive.
 (This is against the law and the
health workers do not have the
right to disclose anyone’s status
to anyone )
Cont….

24. Cont..
 Men and women, because of poverty, will
sometimes necessarily engage in
stigmatized behaviors such as selling sex in
exchange for money or other favors.
 Society and cultural norms tell them they
have to follow their husbands’ commands.
 In many societies women do not have
control of their sex lives.
 They are afraid to ask their partner to use a
condom, even if they know he has had
unprotected sex with other men or women.

25. Stigma, discrimination and
women
 There are many society where women are
wrongly blamed for STIs and HIV.
 However, men are generally responsible for
spreading STIs and HIV to their female partners.
mostly men refuse to use condoms or they have
unprotected sex.
 Sometimes men force women into having sex
against their wish.
 And sometimes men engage in risky behaviors
such as injecting drugs and sharing needles.

26. Vulnerable groups at high risk for
stigma
 People living with HIV and AIDS (PLHIV) and their
families including children
 Injecting drug users and their partners
 Female and male sex workers and their clients
(e.g. truckers), partners, spouses
 Males having sex with males (MSM)
 Migrant workers male migrant workers and their
wives
 Women and young girls
 Street kids, out-of-school youth

27. Stigma and medical
conditions
Disease stigma is greatest when:
 Not well understood / Lake of awareness.
 Supposed as contagious disease.
 HIV infection is often thought to be the result
of personal irresponsibility.
 Condition is severe, degenerative or harming

28. Stigma is a common reaction to
disease
 Many diseases have carried stigma in the
past including STIs, leprosy, TB, cancer
and mental illnesses.
 Some people are afraid because they do
not understand it.
 They may discriminate against people who
have HIV. This makes it difficult for
PLHIV, to talk about HIV and seek help.

29. How stigma and discrimination
contribute to
the bad result of HIV disease:
 people who are at risk of being infected may
avoid seeking HIV testing and counseling.
 unwillingness to individual tested for HIV
among those who are positive, results in late
diagnosis of HIV and delayed initiation of care
and treatment, which can in turn lead to further
transmission of HIV.
Cont…

30. Cont…
 Lessthan 10% of people in the Asia-Pacific
region who are HIV-positive know their
status.
 Accuracyto ART needs to be greater than
95% in order for treatment to be effective.
 Stigma and discrimination against PLHIV
effects on the end result of HIV worse.

31. SUMMARY
 Stigma and discrimination can be very
destructive to people with HIV and their loved
ones.
 We as humans all experience, at some
point, forms of stigma and discrimination. But
some of us may experience more stigma
(Badnami) than others, as with PLHIV.
 If we as HIV care providers work to normalize
HIV in the community and build sympathy for
PLHIV, we can help to reduce HIV-related stigma
and discrimination and improve the quality of life
of our clients

32. Thanks
Have a nice
day