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HIV Stigma

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					HIV/AIDS AND STIGMA

 B.J. Caldwell,
 HIV/STI Prevention and Outreach Educator
 AIDS Committee of Guelph
 education@aidsguelph.org
 www.aidsguelph.org / www.qlinks.ca
HIV/AIDS CRISIS IN CANADA
                  AGENDA

Introduction
25+ Years Later…a look at PHAs in Canada
Vulnerability and Stigma
Overview of Current Issues for People with
 HIV/AIDS
SURVEY DEMOGRAPHICS
      SURVEY HOUSEHOLD INCOME




The vast majority of PHAs in Canada live in poverty – or
are dragged their eventually by their disease and our
backwards social assistance policies that don’t meet the
needs of PHAs
SURVEY – SOCIOECONOMIC PROFILE
SURVEY - LIVING WITH HIV
SURVEY - LIVING WITH HIV
SURVEY - IMPACT OF STIGMA
STIGMA PSA
                    HIV/AIDS STIGMA

 HIV/AIDS is not alone among illnesses in being marked by
  stigma
   Epilepsy, mental illness, cancer, TB, and syphilis have been
    stigmatized in both past and present


 What makes HIV dif ferent?
   The multiple dimensions of HIV stigma
              HIV/AIDS STIGMA

Research into HIV/AIDS stigma has found
 that people living with HIV/AIDS (PHAs)
 are stigmatized because:
  It is associated with behaviours that are already
   stigmatized or considered deviant (particularly
   IDU and homosexuality;
  PHAs are thought to be responsible for their
   infection
  HIV/AIDS is a life-threatening disease
  People are afraid of contracting HIV; and
  The religious or moral beliefs of others lead
   them to conclude that having HIV/AIDS is the
   result of moral fault, such as the promiscuous or
   deviant sex, that deserves punishment
                    HIV/AIDS STIGMA

 It is the combination of these stigmas, together with their
  strength, that makes it so dif ficult to overcome HIV/AIDS -
  related stigma.
 Felt vs. Enacted Stigma:
   Felt Stigma: shame associated with the illness and the fear of being
    discriminated against on account of the illness
   Enacted Stigma: the actual experience of discrimination
                 HIV/AIDS STIGMA

 Felt stigma often precedes enacted stigma
 One effect of felt stigma is to reduce the
  possibility of enacted stigma (discrimination)
  since people who feel stigmatized tend to
  conceal their illness in order to protect
  themselves.2


 Upon being given an HIV+ diagnoses, a multitude
  of anxieties and concerns arise that result from
  the fear and uncertainty of how people will react
 These fears prevent people from disclosing to
  family/friends and benefiting from their support,
  from seeking employment, accessing healthcare
  benefits and services, or other services
                  HIV/AIDS STIGMA

 It is clear from the stories told by PHAs from around the
  country (and the world) that PHAs do in fact experience both
  felt and enacted stigma and discrimination.
                        VULNERABILIT Y

 Whether people resist the discriminatory attitudes and
  actions of others, or whether they accept them, those
  attitudes and actions af fect the way people see:
     Themselves
     Their social networks
     Their opportunities, and
     Their rights or entitlements
 It is also important to remember that early life experiences
  (with other forms of internalized oppression, poverty, and the
  other social determinants of health) can have a large impact
  on vulnerability in adulthood.
   Cumulative Effect
         VULNERABILIT Y


How does discrimination make
 people more vulnerable to HIV
 infection?
How does discrimination make PHAs
 more vulnerable to sickness and
 death?
VULNERABILIT Y– SOCIETAL LEVEL

  Economic                               Political
Disadvantages                         Disadvantages




                 Stigma/Discrim.
                  (Race, Gender,
                Sexual Orientation,
                Drug use, Criminal
    Social
                     status, or
Disadvantages     Imprisonment)



                                          Legal
                                      Disadvantages
   VULNERABILIT Y – SOCIETAL LEVEL




All of which increase a person’s
vulnerability to HIV --- The Social
Determinants of Health.
                   VULNERABILIT Y

 Programmatic Level:
   S/D can lead to programs not being available or being
    offered in ways that do not empower, respect the dignity
    of, or meet the needs of PHAs or people vulnerable to HIV
    infection
 Personal Level:
   S/D are experienced directly in day -to-day occurrences
    with family, friends, service providers, and the public, as
    well as indirectly in the conditions created by
    discrimination at the societal level and the limitations
    imposed by discrimination at the programmatic level
ALL THREE MUST BE ADDRESSED TOGETHER.
              VULNERABILIT Y

The history of HIV/AIDS has shown that HIV
 can enter a community or country in many
 different ways
In each country, where and among whom HIV
 enters obviously defines the early history of
 the epidemic
With time, however, it evolves and moves
 along a clear pathway (although different in
 detail in each country) that has one vital,
 common feature:
              VULNERABILIT Y

“ In each society, those people who were
 marginalized, stigmatized and discriminated
 against – before HIV/AIDS arrived – have
 become over time those at highest risk of
 infection.”
       Mann & Tarantola, 1996
                 VULNERABILIT Y

    This underscores the importance of
    recognizing how discrimination at the societal
    and programmatic levels have a profound
    impact on how a given individual can protect
    his/herself from HIV infection or maintain
    his/her health, welfare, and safety while living
    with HIV/AIDS.
   VULNERABILIT Y – INJECTION DRUG /
            DRUG USERS
 The risk of infection among IDUs who inhabit impoverished
  urban centres with a high density of drug users is in part (and,
  arguably, a large part) an ef fect of the criminal status of drug
  use in Cdn law – a legislated form of discrimination against
  IDUs
  VULNERABILIT Y – ABORIGINAL/FIRST
               NATIONS
 The risk of infection experienced by Aboriginal peoples as a
  result of their overrepresentation among drug users and in
  prison populations cannot be understood or addressed without
  recognizing the events and structures (past and present) that
  have contributed to substance use, forced migration,
  unemployment, cultural displacement and despair among the
  Aboriginal people of Canada
      VULNERABILIT Y – QUEER YOUTH

 And an environment that does not acknowledge, and respect
  the sexual and gender identities of gay/bi/trans youth, that
  does not provide support at home or in school for the coming
  out process,provide role models and a sense of history and
  that tolerates high levels of violence and abuse against
  gay/bi/trans people contributes to the many risks to the
  health of gay/bi/trans youth – including the risk of HIV
  infection
           VULNERABILIT Y - POVERT Y

 Lastly, we cannot forget to examine the role of poverty
  (independent of any other risk factors) in leading to HIV
  infection and to sickness and death, and how the structures of
  our economy and our society benefit (discriminate in favour
  of) people with higher incomes or more wealth. 3
      CURRENT PROBLEMS FOR PHAS

 Family and Community
Stigma, Stress, Secrecy, and Isolation
 PHAs must be careful who they tell
 “ I feel it’s stressful cause I have to be careful not to tell
  the family members who can’t be told. They will shun us
  for sure. They are very paranoid about this disease.
  Nothing you tell them will make any difference”
 “Most of my stress is about disclosure and discrimination
  regarding HIV”
 Anticipating such reactions or having experienced them
  can lead to isolation and the toll of keeping secrets can
  weigh heavily on a person
 As a result, PHAs can be fearful of reaching out for
  support from family, friends and service providers which
  can affect disease progression
       CURRENT PROBLEMS FOR PHAS

 Family and Community
   Living in Smaller/Rural Communities
     The need for confidentiality in rural areas can be greater and rural PHAs
      must go to great lengths to protect their confidentiality
     Fear of cashing a cheque from an AIDS organization
     Drive hours to other communities for medical care
     Fewer opportunities for services and a larger reliance on available
      services
   CURRENT PROBLEMS FOR PHAS

            Cultural Communities
 PHAs who identify with a specific ethnic or cultural
  community experience S/D from others within their
  community
     Gay/Bi Men
     Aboriginal people
     Ethnocultural Communities
     Deaf community
 S/D is compounded by the fact that these communities
  are already minorities and often marginalized
 For the PHA there may be no where else to go once
  they have been isolated by their community AND
 For the community it can be hard to address issues
  associated with vulnerability to HIV infection (sex,
  homosexuality, relations between men and women)
  without fear of reprisal from society at large.
         HIV STIGMA AND HIV- GAY MEN

From the website: HIVstigma.com (Gay Men’s Sexual Health Alliance)
     CURRENT PROBLEMS FOR PHAS

Employment and Workplace
  Can be a potentially unsafe environment whether
   they are currently at work, returning to work, or
   looking for work for the first time
  Employers may:
    Breach confidentiality of HIV status
    Fail to accommodate the needs of PHAs (duties, schedule,
     medication side effects, medical appts, or temporary leave
  Employees may fear to claim medical benefits for
   fear of disclosing their status to employers and may
   have to quit work to be covered under disability
   insurance to afford the cost of medicine
       CURRENT PROBLEMS FOR PHAS

 Housing
   Particularly in the private rental market
   Discrimination is rampant as a result of ignorance and stigma
   If a PHA is on disability (they usually are required to disclose their
    source of income on forms) it may be used against them.
     CURRENT PROBLEMS FOR PHAS

Healthcare
  Early on in the epidemic, there were flagrant
   examples of healthcare setting discrimination
   (refusing to provide care, avoiding/neglecting
   patients, making prejudicial remarks)
  These have decreased in number but they are still
   present (although illegal) and are usually not
   addressed because the PHA would have to disclose
   their status publicly to redress the situation (they are
   highly vulnerable)
  Confidentiality is another issue – healthcare workers
   are required to maintain confidentiality (on a need to
   know basis) but do not always do so
       CURRENT PROBLEMS FOR PHAS

 Travel
   Until late 2009, PHAs were not allowed to enter the U.S. for any
    reason unless given a special permit for certain government
    approved events/reasons.
   There are many other countries that discriminate against PHAs at
    various levels
   Medications
                 GAY/BISEXUAL MEN

 Prejudice against homosexuality has resulted in
  predominantly negative legal, social, and cultural
  environment for gay men, lesbians, and bisexuals:
 Queer youth have little support within their families, among
  their peers, at school in recognizing and af firming their sexual
  orientation and in developing relationships with other queer
  youth
   GAY/BISEXUAL/QUEER/TRANS MEN

An overwhelming majority of queers have
 been verbally abused, and many have been
 threatened, chased or followed, assaulted, or
 otherwise abused
Same-sex sexual activity until only relatively
 recently was illegal and the Criminal Code still
 includes provisions that discriminate on the
 basis of sexual orientation
Recent changes to Age of Consent Legislation
Literature and information about same-sex
 relationships have been censored by
 schools/libraries and Canada Customs still
 seize material unfairly at the border.
    GAY/BISEXUAL/QUEER/TRANS MEN

 The early prevalence of HIV among gay/bi men has resulted in
  an enduring association between HIV/AIDS and homosexuality
 The predominantly negative attitudes towards homosexuality
  have influenced peoples attitudes and behaviour towards
  HIV/AIDS in general and gay and bisexual men in particular.
             INJECTION DRUG USERS

 Drug use is a powerful source of stigma and people who
  acquire HIV through drug use (like those who acquire it via
  same-sex activity) live with a double stigma.
 Studies done around the world have shown that people are
  more likely to have sympathy and compassion for people who
  acquire HIV “ through no fault of their own” --- the so called
  innocent victims
            INJECTION DRUG USERS

 The stigma of drug use is reinforced by the illicit
  status of drug use in law and by the application
  of coercive measures, including police
  surveillance, criminal prosecution, and criminal
  penalties against illicit drug users
 Legislation is arguably itself discriminatory and it
  definitely is discriminatory in its effects:
   The prohibition of drugs and the application of criminal
    sanctions, compounded by existing patterns of
    discrimination based on race and income has a
    disproportionate effect on impoverished and minority
    populations --- look at the demographics of our prisons
    and the reason for incarceration
             INJECTION DRUG USERS

 The marginalized status of drug users profoundly af fects the
  way they are treated by others (family, friends, healthcare
  workers, police, landlords)
 Drug users find that they are denied the legal protections,
  health services, and social supports that others enjoy
NFL BREAST CANCER AWARENESS


            For Breast Cancer Awareness Month
            some NFL players wore pink gloves,
            armbands, even shoes to promote
            efforts to fight the disease.

            Players brought their mothers,
            grandmothers, and other women
            who had survived breast cancer
            wearing pink jerseys and
            announcers shared stories of
            survival from their own families.
                  CAN YOU IMAGINE?

 The NFL --- or any sports league – launching a similar
  campaign to address HIV and AIDS?
   Which player would trot out a brother, sister, father who’s HIV+?
   Which TV announcer would proudly point to those living with HIV and
    speak of their “inspirational” battle with HIV?

				
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posted:8/15/2011
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