HIV presentation

1. PRESENTATION ON STIGMA AND
DISCRIMINATION AGAINST PLHIV
IN GHANA
Presentation by Mr. Mamudu Aminu.
ART Nurse Weija Gbawe Municipal Hospital.
11th December, 2021
AUCC

2. OBJECTIVES
• To have a fair idea on the HIV/AIDS situation in Ghana.
• To appreciate and understand the forms of stigma and discrimination
• To appreciate the impact of stigma and discrimination of people living
with HIV/AIDS(PLHIV)
• To find out how to end stigma and Discrimination in Ghana.

3. An Overview of HIV and AIDS in Ghana
Current Situation

4. OUTLINE
• Epidemiology of HIV and AIDS
- The Global picture
- The Ghana situation
• The national response

5. Global HIV/AIDS in 2019

6. Globally in 2019
26m PLHIV were accessing ART as at end of June
2019
62% of PLHIV in Africa had access to ART
82% of pregnant women accessed lifelong ART
91% of all pregnant women LHIV live in Africa
4% of PLHIV on treatment are children
67% of all PLHIV were accessing treatment
68% adults had access to treatment
53% of children had access to treatment

7. The Ghana Situation:
Ghana Has a Generalized Epidemic
 HIV prevalence is consistently over 1%
among pregnant women
HIV is firmly established in the general
population.
Although sub-populations at high risk may
continue to contribute disproportionately to the
spread of HIV, sexual networking in the general
population is sufficient to sustain an epidemic
independent of sub-populations at higher risk
for infection.

8. HIV & AIDS in Ghana
• Ghana 1.70%

9. HIV Prevalence by Type 2019
HIV I
98.1%
HIV I & II
1.2%
HIV II
0.7%
HIV I HIV I & II HIV II

10. National Trend Analysis of Median HIV Prevalence
1.8
2.4
2.1
2.4
2
0
0.5
1
1.5
2
2.5
3
2015 2016 2017 2018 2019
Median Prevalence Linear (Median Prevalence)
Five year Trend Analysis (2015-
2019)

11. Mean HIV Prevalence By Age group and Year 2015 - 2019
0.7
1.3
2
2.9
3.4
2.6
1.9
1.1
0.6
1.3
2.1
3.3
3.5
2.6
5.6
1.1
0.9
1.8
2.3
2.4
2.6
3.4
3.2
1.5
0.6
1.5
2.5
2.6
3.2
3.6
1.9
1.2
0
1
2
3
4
5
6
15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-24
Age Groups
2015 2016 2017 2018 2019

12. National Response
1985: Establishment of National Advisory Council on AIDS (NACA) and National Technical Committee
on AIDS (NTCA)
1987: Establishment of National AIDS/STI Control Programme (NACP)
Plans formulated (health sector based)
 West Africa Program to Combat STI and AIDS(WAPCAS) - Implementation
 Christian Health Association of Ghana(CHAG)

13. The National AIDS/STI Control Program
• NACP is a programme under the Disease Control and Prevention
Department of the Public Health Division of the Ghana Health Service
(GHS).
• NACP is mandated to coordinate and implement HIV and AIDS related
activities of the Ghana Health Sector Strategic Framework

14. HIV Testing Coverage by Region- 2020
REGION 2020 Annual
Target
Achieved For
2020
% Coverage per Annual
Target
Ahafo 27,712 43,621 157%
Ashanti 282,726 210,158 74%
Bono 52,731 73,465 139%
Bono East 51,466 116,614 227%
Central 134,852 142,572 106%
Eastern 147,708 150,200 102%
Greater Accra 245,567 243,187 99%
North East 26,435 24,715 93%
Northern 93,299 112,207 120%
Oti 34,993 82,048 234%
Savannah 29,484 30,008 102%
Upper East 54,220 81,642 151%
Upper West 38,683 61,184 158%
Volta 88,072 151,984 173%
Western 92,509 147,700 160%
Western North 39,646 47,299 119%
National 1,440,103 1,718,604 119%

15. HIV TESTING TREND BY GENDER-2016 to 2020
INDICATOR 2016 2017 2018 2019 2020
Period Jan. - Dec Jan. - Dec Jan. - Dec Jan –Dec Jan-Dec
Total Tested 1,023,048 1,271,347 1,695,993 1,926,981 1,718,604
Male Tested 146,076 (14%)
179,677
(14%)
330,989
(20%)
404,585
(21%)
339,508
(20%)
Female Tested
876,972
(86%)
1,091,670
(86%)
1,365,004
(80%)
1,522,396
(79%)
1,379,096
(80%)
Male +Ve
13,518
( 24%)
14,422
(24%)
20,046
(28%)
20,252
(28%)
14,175
(25%)
Female +Ve
43,428
(76%)
44,838
(76%)
51,938
( 72%)
52,697
( 72%)
41,848
(75%)
Total Positive 56,946 59,260 71,984 72,949 56,023
% Positive 5.6% 4.7% 4.2% 3.8% 3.3%

16. Challenges
1. Stigma and Discrimination in some facilities.
2. Low utilization of HIV services across the Treatment Cascade.
3. Low testing yield, Low men coverage, High level of repeat testing.
4. Low VL/ EID testing Coverage.
5. Poor linkage to ART.
6. Lack of ownership of HIV activities at various levels of healthcare delivery.
7. Shortages/expiration of some HIV commodities.
8. Poor data capture at the facility level.
9. Lack of data validation at the facility level.
10.Delayed clearance of GF Financed commodities at the Port.
11.Funding gap for HIV commodities

17. HIV Stigma and Discrimination
•FACTS
•There is a recurrent relationship between stigma and HIV; people who experience
stigma and discrimination are marginalized and made more vulnerable to HIV, while
those living with HIV are more vulnerable to experiencing stigma and discrimination.
•Myths and misinformation increase the stigma and discrimination surrounding HIV
and AIDS.
•Roughly one in eight people living with HIV is being denied health services because
of stigma and discrimination.
•Adopting a human rights approach to HIV and AIDS is in the best interests of public
health and is key to eradicating stigma and discrimination.

18. What is Stigma or stigmatization
HIV-related stigma and discrimination refers to prejudice, negative attitudes and
abuse directed at people living with HIV and AIDS.
In 35% of countries with available data, over 50% of people report having
discriminatory attitudes towards people living with HIV and this includes
Health care workers(HCW)
Those most at risk to HIV (key affected populations) continue to face stigma and
discrimination based on their actual or perceived health status, race,
socioeconomic status, age, sex, sexual orientation or gender identity.

19. HIV Stigma and Discrimination
The fear surrounding the emergence HIV epidemic in the 1980s still persists today. At
that time, very little was known about how HIV is transmitted, which made people
scared of those infected due to fear of getting infected.
This fear, coupled with many other reasons, means that lots of people falsely believe:
• HIV and AIDS are always associated with death.
• HIV is associated with behaviors that some people disapprove of (such as homosexuality, drug use,
sex work or infidelity).
• HIV is only transmitted through sex, which is a taboo subject in some cultures.
• HIV infection is the result of personal irresponsibility or moral fault (such as infidelity) that deserves
to be punished.
• inaccurate information about how HIV is transmitted, which creates irrational behavior and
misperceptions of personal risk.
“My daughter refused to go hospital to receive medicines. My daughter died because of the fear of stigmatization and
discrimination” -Patience Eshun from Ghana, who lost her daughter to an AIDS-related illness

20. Stigma and Discrimination
“Whenever AIDS has won, stigma, shame, distrust, discrimination and apathy was on its side. Every time AIDS has been
defeated, it has been because of trust, openness, dialogue between individuals and communities, family support, human
solidarity, and the human perseverance to find new paths and solutions”. - Michel Sidibé, Executive Director of
UNAIDS
Driver of stigma and discrimination are:
1. Fear
2. Poverty
3. Ignorance or lack of knowledge

21. Forms of Stigma
1. Self-stigma/internalised stigma
Self-stigma affected a person's ability to live positively, limits meaningful self agency, quality of life,
adherence to treatment and access to health services.
Negative self-judgement resulting in shame, worthlessness and blame represents an important but
neglected aspect of living with HIV.
“I am afraid of giving my disease to my family members-
especially my youngest brother who is so small. It would
be so pitiful if he got the disease. I am aware that I have
the disease so I do not touch him. I talk with him only. I
don’t hold him in my arms now” - woman in Vietnam

22. Forms of Stigma
2. Governmental stigma
A country’s discriminatory laws, rules and policies regarding HIV can alienate and exclude people
living with HIV, reinforcing the stigma surrounding HIV and AIDS.
Criminalization of key affected populations remains widespread with 60% of countries reporting
laws, regulations or policies that present obstacles to providing effective HIV prevention,
treatment, care and support.
3. Healthcare stigma
HIV-related discrimination in healthcare remains an issue and is particularly prevalent in some
countries.
It can take many forms, including:
 mandatory HIV testing without consent or appropriate counselling.
 Health providers may minimize contact with, or care of, patients living with HIV.
 Delay or deny treatment.
 Demand additional payment for services and
 isolate people living with HIV from other patients.
 violate a patient’s privacy and confidentiality, including disclosure of a person’s HIV status to
family members or hospital employees without authorization.
These experiences may leave people living with HIV and people from key affected populations too
afraid to seek out healthcare services, or be prevented from accessing them .

23. Forms of Stigma
“When I visited a VCT [voluntary counseling and testing]
clinic, health personnel were not polite and immediately
asked me if I was a sex worker. A doctor asked me
outright, ‘Are you HIV positive?’ This discouraged me from
going to the clinics”. -Payal, 18, Nepal
4. Employment stigma
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.
“It is always in the back of your mind, if I get a job, should I tell my employer about my HIV status?
There is a fear of how they will react to it. It may cost you your job, it may make you so uncomfortable it
changes relationships. Yet you would want to be able to explain about why you are absent, and going to the doctors”
-HIV-positive woman, Ghana.

24. Forms of Stigma
5. Community/social and household level stigma
 Community-level stigma and discrimination towards people living with HIV can force
people to leave their home and change their daily activities.
 In many contexts, women and girls often fear stigma and rejection from their families, not only because they
stand to lose their social place of belonging, but also because they could lose their shelter,
their children, and their ability to survive.
 The isolation that social rejection brings can lead to low self-esteem, depression, and even thoughts or
acts of suicide
“They [my family] were embarrassed and didn’t want to talk to me. My mother essentially said,
‘Good luck, you’re on your own.’” - Shana Cozad from Tulsa, USA, on her family’s reaction after she tested positive for HIV.

25. Consequences of HIV-related stigma
HIV-related stigma and discrimination exists worldwide, although it manifests itself differently across
countries, communities, religious groups and individuals.
In sub-Saharan Africa, for example, heterosexual sex is the main route of infection, which means that HIV-
related stigma in this region is mainly focused on infidelity and sex work
Research by the International Centre for Research on Women (ICRW) outlines the possible consequences of HIV-
related stigma as follows:
•loss of income and livelihood
•loss of marriage and childbearing options
•poor care within the health sector
•withdrawal of caregiving in the home
•loss of hope and feelings of worthlessness
•loss of reputation.

26. Ending HIV stigma and discrimination
The use of specific programs that emphasize the rights of people living with HIV is a well-documented way of
eradicating stigma.
As well as being made aware of their rights, people living with HIV can be empowered in order to take action if
these rights are violated.
The removal of these barriers(Stigma and discrimination) that often blocks access to HIV testing and treatment
services is key to ending the global HIV epidemic.
In March 2016, UNAIDS and WHO’s Global Health Workforce Alliance launched the Agenda for Zero
Discrimination in Healthcare. This works towards a world where everyone, everywhere, is able to receive the
healthcare they need with no discrimination, in line with The UN Political Declaration on Ending AIDS.
As part of this work:
1. Training of health care workers in selected facilities across Ghana, against the act of Stigma and Discrimination
perpetuated towards people living with HIV(PLHIV) who visit those facilities has been very effective.
2.NGO’s such as The West Africa Program to combat STI and AIDS(WAPCAS) and Christian Health Association of
Ghana has trained and employed paralegals and Lay counsellors to assist PLHIV on issues with regards to Stigma
and Discrimination.

27. Ending HIV stigma and discrimination
3. Community sensitization on HIV and AIDS issues and kicking against stigma and discrimination is key to
ending the global HIV epidemic. This is done during community durbars and other social events e.g World AIDS
day celebration.
4. Empowering PLHIV to gain employable skills.
5. Some PLHIV are trained as Models of Hope, Mentor Mothers and Community adolescent treatment
support (CATS), Case managers
5. Stake holder involvement which focuses on addressing discrimination in healthcare, workplace and
education settings.

28. Thank you

29. References
•UNAIDS (2015) ‘On the Fast-Track to end AIDS by 2030: Focus on location and population’[pdf]
•2.UNAIDS (2017) ‘Agenda for zero discrimination in health-care settings’[pdf]
•3.UNAIDS (2017) ‘Agenda for zero discrimination in health-care settings’[pdf]
•4.Stangl, A.L. et al (2013) ‘A systematic review of interventions to reduce HIV-related stigma and
discrimination from 2002 to 2013: how far have we come?’ JIAS 16(Supplement 2):18734
•5.Katz, I.T. et al (2013) ‘Impact of HIV-related stigma on treatment adherence: systematic review and
meta-synthesis’ JIAS 16(Supplement 2):18640
•6.GNP+ (2016) ‘In All Our Diversity: 2015 Highlights’[pdf]
•7.UNAIDS (2017) ‘Make some noise for zero discrimination on 1 March 2017’[pdf]
•8.Huffington Post (5 July, 2012) ‘Giving Power to Couples to End the AIDS Epidemic’ (Accessed
28/3/2017)
•9.Egyptian Anti-Stigma Forum (2012) ‘COMBATING HIV/AIDS RELATED STIGMA IN EGYPT:
Situation Analysis and Advocacy Recommendations’[pdf]
•10.UNAIDS (27 March, 2017) ‘Feature story: Ghana—addressing the barrier of stigma and
discrimination for women’ (Accessed 28/3/2017)
•12.International Center for Research on Women (ICRW) (2005) 'HIV-related stigma across contexts:
common at its core'
•13.ECDC SPECIAL REPORT (2017) ‘The status of the HIV response in the European Union/European
Economic Area, 2016’ [pdf] as referenced by UNAIDS (2017) ‘Make some noise for zero discrimination
on 1 March 2017’[pdf]