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HIV AIDS Related Stigma

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					HIV/AIDS-Related Stigma in
     Asia & the Pacific
 Hawaii AIDS Education & Training
             Center
           June 2009
            What do you think?
1.   Wow
2.   Yes
3.   Yuck
4.   No
5.   OMG
            What do you think?
1.   Wow
2.   Yes
3.   Yuck
4.   No
5.   OMG
            What do you think?
1.   Wow
2.   Yes
3.   Yuck
4.   No
5.   OMG
            What do you think?
1.   Wow
2.   Yes
3.   Yuck
4.   No
5.   OMG
            What do you think?
1.   Wow
2.   Yes
3.   Yuck
4.   No
5.   OMG
            What do you think?
1.   Wow
2.   Yes
3.   Yuck
4.   No
5.   OMG
Would you have your hair cut by a
     homosexual person?
1. Yes
2. No
3. I don’t know
   Would you refuse service in a
   restaurant by a homosexual
             person?
1. Yes
2. No
3. I don’t know
Does a feminine acting male make
    you feel uncomfortable?
1. Yes
2. No
3. I don’t know.
      Do you have laws against
           discrimination?

1. Yes
2. No
3. I don’t know.
     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
Would you put an HIV/AIDS patient
      in an isolation room?

1. Yes
2. No
3. I don’t know
                 Definitions
•   Stereotype
•   Shame
•   Stigma
•   Discrimination
              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)
Mahalo

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