HIV/AIDS-Related Stigma in Asia & the Pacific Hawaii AIDS Education & Training Center June 2009.
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Transcript of HIV/AIDS-Related Stigma in Asia & the Pacific Hawaii AIDS Education & Training Center June 2009.
Do the antidiscrimination laws cover:
1. Race
2. Gender
3. Religion
4. Sexual Orientation
5. All of the above
6. Some of the above
7. I don’t know
Does your hospital have a policy of confidentiality of medical
information?
1. Yes
2. No
3. I don’t know
Stereotype
• A list of oversimplified, exaggerated, or demeaning assumptions relating to a group
• Another group of people come to agree with these assumptions regardless of the facts
• Individuals are then prejudged by these erroneous beliefs
Stereotypes of Gay Men
• All gay men are effeminate.
• All gay men listen to show tunes
• All gay men have a lisp
Stereotypes of Lesbians
• All lesbians fall into 1 of 3 groups, – butch, – femme – or lipstick lesbians.
• All lesbians work in construction, the military, law enforcement, or truck driving.
• All feminists are lesbians and hate men
Shame
• Those experiencing it may feel worthless and that there is no redemption
• Shame is delivered by others via judgments ("expose" others’ beliefs or behaviors)
• "To shame“ means to assign shame to another
• Literally saying "Shame!" or "Shame on you!"
Stigma
• Severe social disapproval of minority beliefs or behaviors
• Stigma often leads to marginalization
Stigma Come In Three Forms
First, external deformations, such as:
• scars,
• leprosy,
• physical disability
Stigma Come In Three Forms
Second, differences in personal traits, such as:
•mental illness,
•Drug/alcohol addiction,
•and criminal backgrounds
Are stigmatized in this way.
Stigma Come In Three Forms
Thirdly, “social stigmas" are traits, imagined or real, of
• ethnic groups,
• nationalities,
• or religions
That are considered a deviation from what is perceived the mainstream of society
Basis of Stigma
Stigma is typically based on
• Stereotypes,
• Ignorance,
• Irrational or unfounded fears,
• Or a lack of information pertaining to a particular person or group
Discrimination
• Unfair treatment of a person or group on the basis of prejudice; for example,
• You cannot marry a white person because you are black.
• You cannot join the Boy Scouts because you are gay.
• You cannot be admitted to a nursing home because you have HIV.
HIV/AIDS-Related Stigma
• Definition & Identification of Stigma
• Measuring the Extent of Stigma
• Assessing the Impact of Stigma on the Effectiveness of HIV Prevention & Treatment Programs
• Reducing Stigma
HIV/AIDS-Related Stigma Definition
• Prejudice and discrimination directed at people living with HIV/AIDS (PLWHA)
• It can result in PLWHA being– rejected from their community, – shunned, – neglected– discriminated against – or even physically hurt.
Measuring Stigma
• There are currently no standard measures of individual as well as institutional stigma.
• Questionnaires, reviews of existing policies and laws are some ways of measuring stigma.
• Measuring access to treatment and counseling for HIV patients are markers for HIV related discrimination and therefore stigma.
Measuring Stigma
• Questions on stigma against an individual:– If a member of your family became sick with
AIDS, would you be willing to care for them at home?
– If a food seller you knew had HIV, would you buy food from them?
– If a member of your family had HIV, would you want it to be kept a secret?
Measuring Stigma
• Questions of the Stigmatized Individual:– Are you afraid to take an HIV test because
you fear isolation or rejection?– Do you have trouble disclosing your HIV
status to your family?
Measuring Stigma
• Questions on stigma as a institution or society:– Does your hospital place HIV patients in a
special part of the hospital?– Do healthcare workers refuse to take care of
an HIV patient?
Impact of Stigma on HIV Programs
• Prevents patients from taking the HIV Test
• Decreases resources for treatment programs
• Decreases access to treatment programs
Reducing Stigma
• First recognizing that it exist.
• Baseline Measurement.
• Implement Programs to reduce it with focus on:– Individual– Institution (Society and Culture)– HIV Patients Ability to Cope with it
Reducing Stigma
• The presence of national HIV education campaigns especially focusing on how one acquires HIV and promotion of HIV testing can be measures of a countries efforts to reduce stigma
Reducing Stigma
• HIV Education especially on how HIV is transmitted.
• Increase access to treatment
• Change or Add laws regarding confidentiality and discrimination.
• Improve standard of living, status of women, availability of drug rehabilitation.
Reducing Stigma
• HIV Patients ability to cope with it– Improve access to HIV Testing, make HIV
testing a part of routine care– Treatment and Care to improve the ability to
lead a productive life as well as to improve appearance
– Empowerment: Support Groups– Aggressively treat Anxiety & Depression
Acknowledgements
• Mahajan, A.P., et al, AIDS 2008, 22 (suppl): 567-579, “Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward.”
• UNAIDS, “Developing Indicators for Measuring Stigma and Discrimination and the Impact of Programmes to Reduce it: Summary of Projects and Research to Date.”
• Genberg, B.L., et al, AIDS Behav., (2008) 12:772-780, “Assessing HIV/AIDS Stigma and Discrimination in Developing Countries.”
Panelist
• Raymond Alejo, RN: Patient Perspective
• Dr. Elizabeth Keller: Caregiver Perspective
• Dr. Cho Cho Thien: Healthcare Provider Perspective
• Eleanor Sos, RN: Community Perspective
From The Patient’s Point of View
• Stigma is a Powerful Feeling
• May lead to irrational behaviors
• Huge barrier to care
• Individualize approach to addressing stigma
From the Caregiver’s Point of View
• “Guilt by Association”
• They live in the community and share in the stigma.
• Barrier to care.
• Lossed opportunity to share in a loved ones final journey
From the Healthcare Provider’s Point of View
• HCP are people too!
• Reaction is more from fear
• Increase knowledge and education about disease process
• Address risk to themselves
• HCP need to recognize their own biases
From the Community’s Point of View
• Education is the key
• Use of prominent community leaders (e.g. CPG members), organizations (e.g. churches)
• Local “Poster Person PWA”
• Incorporation into community life (World AIDS Day Activity, Health Fairs)