Perception of stigma anddiscrimination among PLHIV and related attitudes of MARPs toward PLHIV in Serbia Sladjana Baros, IPH of Serbia / NHAO Tanja Knezevic, MD PhD Prof. Viktorija Cucic, MD PhD
Stigma• Greek – body sign / later – ashamed• Attitude based on prejudices• Marking the difference, discrediting and isolating the persons based on the mark of difference• The Person = 1 characteristic mark of difference
Discrimination• Act, behavior – positive or negative.• Making difference, unequal acting based on: race, ethnicity, citizenship, religion, language, sex, gender, sex orientation, health condition, age etc.• Be free from discrimination – one of the basic human rights• Sigma, discrimination, human rights violation are connected and mutually strengthened
(Bio)BSS among MARPs and PLHIV, 2010 Sample Sample• Carrier: Population Methodology Location size size Ministry of Health 1. IDUs Bio-BSS, RDS Belgrade 371 571 Nis 200 MSM Bio-BSS, Snowball Belgrade 280 480• Implementation: 2. sampling Novi Sad 200 IPH of Serbia 3. SWs Bio-BSS, Snowball sampling Belgrade 250 250 Roma Youth Bio-BSS, RDS Belgrade 270 4. Kragujevac 140 410• Included indicators related 5. Institutionalize BSS, cluster study 14 cities in 269 269 to: d children RS Prisoners BSS, cluster study 14 cities in 599 – Stigma of MARPs 6. RS 599 toward PLHIV PLHIV BSS, quota sampling Belgrade 230 – Experience of 7. Novi Sad 50 296 stigma and Qualitative study Belgrade 16 discrimination Total Number of Respondents 2875 among PLHIV
Stigma toward PLHIV“It’s theirs own fault” “PLHIV should be isolated”
PLHIV: Stigma & Discrimination vs. Self- Stigmatization• Self-Stigmatization: Quilt, Shame, Other
Experience of Stigma & Discrimination in the last 12 months related to HIV status Among those 21.8%: 37.7% - Gossip, ribbing 31.1% - avoided by people 31.1% - denied services in the institution (social, health and/or educational service) 22.9% - family’s inconveniences 18% - social isolation 16.4% - abandoned by partner 14.7% - inconveniences with colleges 11.5% - insults 6.5% - banned from some places 4.9% - violence 4.9% - physical isolation
Experience of the Discrimination in the HC Institutions because of HIV status
Fear of HIV status disclosure in the Community (1)• Medical treatment and follow up as the risk of disclosure• Reasons for not using the services of Clinics for Infective Diseases: – Bureaucracy and social exposure related to request for periodical medical referral Because I didn’t felt quite well, I’ve started with therapy. I was 6 months on therapy and after that I stopped, cause it was very hard for me to come there for… Cause I have to finish to much papers in 555 for coming to doctor NN. See, first, I have to go to my general physician, then to specialist for infective diseases in 555, then on the firs level Commission, and then after all of that I can go at the Clinic. That have taking too much of my time. And it has badgered me. I have the fear that somebody will find out… It’s too many people included in all of that… coming to doctor who actually treat me. I mean, that’s what is actually bothering me. But, as I said, I was have to go cause I was felt bad. However, afterward, probably with therapy, my condition was better and then I decided to stop, cause I didn’t could stand that…
Fear of HIV status disclosure in the Community (2)– Complications at the work place due to medical referral • Free days are needed every months or every three months Did you have problems on the job if you go…? Yes. I have. It’s because I didn’t ever, for the 4 years, I never was sick, I didn’t have any absences from work, except for the vacation and holidays… Now… He (employer) told me something like - that in the past time for 13 days I’ve wasn’t on the work because some health problems that I apparently have. He doesn’t know what’s wrong with me… And… He will take these days from my vacation. Yep. And now, the last time I wasn’t personally go to take my therapy… Instead of me, people from the Organization did go.
Fear of HIV status disclosure in the Community (3)• Perceived lack of discretion on the Clinic: – Other patients, students One Department of one Clinic is working on the problem… on the illness which so many people have. That problem is a serious question… How to everyone provide the privacy… I don’t want… I understand that, so I don’t want to look as stupid and to talk nonsense bat… The fact is that they have very short working time with the patients. The fact is that their range of working hours is from sometimes 8AM, sometimes 9 AM, 10 AM to 12, 1 PM… And, I suppose that is why the big crowd is over there. If they would work from earlier hours to the later hours… then, probably, the crowd wouldn’t be so big and the people would be less in situation to meet each other. But, probably, there have lack of personal… A lot of things are lacking there… I suppose also that not too many people want to work on the 6. Department…
Disclosure of status to others then clinicians
Know there is the Low on Prohibition of Discrimination (2009) 20.7% PLHIV think that the Low will have influence on their social position 41.8% PLHIV think that Low will not change anything 37.5% PLHIV – don’t know will the Low have some influence on their lives or not.Special cases of discrimination (health, labor)Commissioner for Protection of Equality
Conclusions• Stigma and discrimination toward PLHIV is present, as well as auto-stigma among PLHIV.• MARPs are showing the stigmatizing attitudes toward PLHIV.• PLHIV are perceiving stigma in different institutions. – Still, there is uncertainty of perception of discrimination among PLHIV, probably due to lack of familiarity with their rights.• Health consequences of stigma and discrimination can be – direct – refuse to seek health protection, and – indirect – obstacle for social integration of PLHIV and prevention.
Recommendations• development and improvement of programs of psychosocial and legal support focused on strengthening PLHIV;• programs for reducing stigma and discrimination toward PLHIV among MARPs;• programs for social inclusion of PLHIV;• Simplify procedures related to obtaining medical referral• improvement of working conditions at Clinics to be more user friendly;• sensitization and CB of health workers;• campaign for reducing stigma and discrimination in generally.
Sladjana BarošNational HIV/AIDS OfficeInstitute of Public Health of Serbia„Dr Milan Jovanovic Batut“Tel/fax: +381 11 2062 749E-mail:email@example.com