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 communitiesPMTCT Generic Training Package Module 4, Slide 3
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…
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 notPMTCT Generic Training Package Module 4, Slide 5
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 stigmatizedPMTCT Generic Training Package Module 4, Slide 6
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 benefitsPMTCT Generic Training Package Module 4, Slide 7
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.
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
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:
What is Discrimination? When Stigma is acted upon, the result is discrimination: It includes: Arbitrary / illogical actions against the affected person Exclusion Restrictions Denials
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
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.....
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.
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…..
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.
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.
Effects of stigma anddiscrimination 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.
Effects of stigma and discriminationinclude: 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…
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.
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.
How stigma and discriminationcontribute 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.
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….
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.
Stigma, discrimination andwomen 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.
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
Stigma and medicalconditionsDisease 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
Stigma is a common reaction todisease 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.
How stigma and discriminationcontribute 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…
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.
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