HIV/AIDS-Related Stigma in Asia & the Pacific

1. HIV/AIDS-Related Stigma in Asia & the Pacific Hawaii AIDS Education & Training Center June 2009

3. What do you think? • Wow • Yes • Yuck • No • OMG

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11. What do you think? • Wow • Yes • Yuck • No • OMG

13. What do you think? • Wow • Yes • Yuck • No • OMG

14. Would you have your hair cut by a homosexual person? • Yes • No • I don’t know

15. Would you refuse service in a restaurant by a homosexual person? • Yes • No • I don’t know

16. Does a feminine acting male make you feel uncomfortable? • Yes • No • I don’t know.

17. Do you have laws against discrimination? • Yes • No • I don’t know.

18. Do the antidiscrimination laws cover: • Race • Gender • Religion • Sexual Orientation • All of the above • Some of the above • I don’t know

19. Does your hospital have a policy of confidentiality of medical information? • Yes • No • I don’t know

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

21. Definitions • Stereotype • Shame • Stigma • Discrimination

22. Stereotype • A list of oversimplified, exaggerated, or demeaning assumptionsrelating 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

23. Stereotypes of Gay Men • All gay men are effeminate. • All gay men listen to show tunes • All gay men have a lisp

24. 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

25. 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!"

26. Stigma • Severe social disapproval of minority beliefs or behaviors • Stigma often leads to marginalization

27. Stigma Come In Three Forms First, external deformations, such as: • scars, • leprosy, • physical disability

28. 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.

29. 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

30. 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

31. 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.

32. 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

33. 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.

34. 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.

35. 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?

36. 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?

37. 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?

38. Impact of Stigma on HIV Programs • Prevents patients from taking the HIV Test • Decreases resources for treatment programs • Decreases access to treatment programs

39. 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

40. 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

41. 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.

42. 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

43. 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.”

44. Panelist • Raymond Alejo, RN: Patient Perspective • Dr. Elizabeth Keller: Caregiver Perspective • Dr. Cho Cho Thien: Healthcare Provider Perspective • Eleanor Sos, RN: Community Perspective

45. 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

46. 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

47. 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

48. 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)

49. Mahalo Questions?