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UNIVERSITY OF NAMIBIA. Contemporary SOCIAL ISSUES. UNIVERSITY OF NAMIBIA COURSE: CONTEMPORARY SOCIAL ISSUES DEPARTMENT OF NURSING (USCI3429) . LECTURER: Mr. Shirungu Michael TEL: 206 3005 Office no. G132 E-MAIL: mshirungu @unam.na. A nnouncements. The course consist of 3 components.

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university of namibia

UNIVERSITY OF NAMIBIA

Contemporary SOCIAL ISSUES

university of namibia course contemporary social issues department of nursing usci3429
UNIVERSITY OF NAMIBIACOURSE: CONTEMPORARY SOCIAL ISSUESDEPARTMENT OF NURSING(USCI3429)
  • LECTURER: Mr.Shirungu Michael
  • TEL: 206 3005
  • Office no. G132
  • E-MAIL: mshirungu@unam.na
a nnouncements
Announcements
  • The course consist of 3 components.
  • HIV, Gender and Ethics
  • Each will run for 4 weeks
  • Two tests will be written
  • See the dates
  • HIV 23 July - 17 August 2012
  • Gender 20 August – 17 September 2012
  • Ethics 17 September – 12 October 2012
  • Gender and HIV test 19, 20 and 21 September 2012
  • Course outline and Reading Materialsavailable on E-Learning and Copy center
  • Class attendance is compulsory
  • Two periods per week
objectives
Objectives
  • Discuss the origin of HIV/AIDS.
  • Discuss the historical background of HIV
  • Explain why HIV knowledge is important
  • Differentiate between HIV and AIDS
  • Discuss the modes of transmission
  • Discuss how HIV cannot be contracted
  • Discuss how HIV invades the CD4 cell
  • Explain the types of HIV
  • Explain window period
  • Life at University
  • Cultural and social factors influencing the spread of HIV/AIDS in Namibia
male circumcision
Male circumcision
  • Define male circumcision
  • Explain the current situation of MC in Namibia
  • Explain the biological effectiveness of circumcision against HIV”
  • Explain the additional health benefits of MC for both men and women”
  • Explain how long does it take to heal after circumcision?”
  • To explain why must circumcised men still wear condoms?”
arv therapy
ARV therapy
  • Define ARV
  • Explain how HAART works
  • Discuss the classes of HIV medication
  • Explain the clinical and social criteria to start with HIV medication
sexually transmitted diseases
Sexually transmitted diseases
  • Define Sexual Transmitted Diseases (STDs)
  • Outline the types of STIs
  • Name the signs and symptoms of STD’s
  • Discuss the complications of untreated STIs
  • Discuss the prevention of STDs
  • Discuss prevention of STIs infection
stigma and discrimination in hiv and aids
Stigma and discrimination in HIV and AIDS
  • Define stigma
  • Explain the types of stigma
  • Discuss the drivers of stigma
  • Explain the impact HIV related stigma to families, communities and society
  • Discuss the long effect of stigma
origin
ORIGIN
  • Unknown
  • Speculations
  • Myths
  • beliefs
historical background
HISTORICAL BACKGROUND
  • Several researchers believe that by 1970’s HIV/AIDS around unnoticed.
  • First described in 1981 in US (Los Angeles)
  • Among gay men- Kaposi’s Sarcoma & Pneumocystis Carinii Pneumonia (PCP)
  • In Central Africa soon afterwards weight loss, diarrhoea in some patients
  • Luc Montagnet discovered the virus in France in 1984
  • WHO collected statistics/prevalence, incidence worldwide
  • First case in SA in 1982
  • 1985 BTS started screening of all donated blood
  • 1986 first 4 cases in Namibia
introduction to hiv and aids
INTRODUCTION TO HIV AND AIDS
  • Terrifying, devastating disease
  • Fear, guilt, hysteria, accusations
  • Public health concern
  • Statistics claiming by minute
  • Global unification
  • Sub-Saharan hardest hit
  • Namibia ranking amongst top five
  • Namibian Government commitment
why hiv and aids knowledge is so important
WHY HIV AND AIDS KNOWLEDGE IS SO IMPORTANT
  • All sectors of the nation affected
  • Prevention and control measures
  • Develop coping mechanisms
  • Mobilize resources to curb the epidemic
  • National objectives protection (NDPII, Millennium Development Goals, Vision 2030 etc.)
  • Develop strategies & interventions
  • Monitoring of the epidemic
hiv and aids
HIV AND AIDS

HIV Stands for;

H – Human

  • I – Immuno-Deficiency
  • V – Virus

AIDS stands for;

A – Acquired

  • I – Immune
  • D – Deficiency
  • S – Syndrome
  • Attacks immune system
  • Reproductive in the system (bloodstream & bodily fluids)
define hiv
DEFINE HIV

The HI Virus

  • A virus called HIV causes AIDS
  • HIV stands for the;
  • Human Immuno-Deficiency Virus
  • Shape –circular, consists of an inner matrix of protein
continue
CONTINUE
  • Reproductive inside the cell
  • Only in human cells
  • Attacks directly defensive cells
  • CD4 cells & T-helper cells
  • Attacks immune system
  • Lead to immuno deficiency
  • Multiplies in blood
  • Even cross blood brain barrier & blood cells & causes diseases or infection
definition of aids
DEFINITION OF AIDS

Stands for;

  • A - Acquired
  • I - Immune
  • D - Deficiency
  • S - Syndrome
  • Acquired, not inherited
  • HIV causes AIDS
  • Immunity refers to body’s natural defence
  • Deficiency – how immune system weakens by virus
continue1
CONTINUE
  • Syndrome, a medical name for set of collection of signs and symptoms
  • Opportunistic infections occur
  • Can be treated, person becomes ill - AIDS
  • Moves through number of stages 1 – 4
  • Until Aids develops
hiv transmission
HIV TRANSMISSION

Through;

  • Body fluids
  • Sexual fluids (vaginal & semen)
  • Blood
  • Breast milk
  • Also present in saliva, tears, sweat and urine
  • Concentration of HIV low infection
  • Skin a barrier if intact
  • Broken skin allows penetration of virus
exchange of bodily fluids 3 ways
EXCHANGE OF BODILY FLUIDS, 3 WAYS
  • Sexual transmission
  • 90% of transmission
  • Unprotected sex
  • Semen, vaginal fluid
  • Mucus membrane
  • Infect other person
slide20

2. BLOOD TRANSMISSION

  • Needle sticks
  • Skin piercing instruments
  • Unsterile syringe sharing
  • Mother to child transmission:

3. Mother to baby

  • Placenta (unborn baby)
  • Birth (during birth)
  • Breast milk (after birth)
hiv cannot be transmitted via
HIV CANNOT BE TRANSMITTED VIA;
  • Touch pets
  • Coughing mosquito
  • Sneezing baths
  • Cutlery showers
  • Glasses other insects
  • Toilet seats hugging
  • Swimming pools kissing etc.
  • clothes
steps
STEPS
  • The projections on the virus’s outer layer attach themselves firmly to the outer layer of the CD4 cell.
  • The cell and the virus now join membranes.
  • The virus then sheds its outer layer and the genetic material (viral RNA) of the virus enters the CD4 cell
  • The virus transforms its own RNA into viral DNA so that it can manufacture more viruses.
  • The viral DNA then fuses with the CD4 cell DNA and makes numerous copies of viral DNA
continue steps
Continue steps
  • These new viruses become fully functional HIV viruses.

7. In the process of budding they kill the host cell and move out into the blood stream and infect new cells repeating the whole process all over again.

hiv types
HIV TYPES
  • HIV – 1 (Central, East, Southern Africa, North & South America & other parts of the world (aggressive)
  • HIV – 2 -West Africa this virus acts slowly, takes longer before symptoms develop

THEORIES

  • Biological warfare instrument (racial aspects)
  • Witchcraft connected to ancestors
  • Chimpanzees
  • African green monkeys
3 types of hiv test
3 TYPES of HIV test

(1)ELISA (Enzyme Linked Immunosorbent Assay

  • Sensitive test simply inexpensive
  • Can pick up other virus infections
  • Confirmatory is used to confirm
  • Also other variations of ELISA test can also be used for confirmation
2 dna pcr test
(2) DNA (PCR) test
  • Polymerase Chain Reaction (PCR) tests, is mainly used in infant.
  • Since maternal HIV antibodies can pass through the placenta.
  • Children born to HIV-positive mother may have HIV antibodies up to 18 months.
  • Therefore, DNA, PCR test, which detect viral RNA or DNA rather maternal antibodies.
  • In Namibia the test is done at six weeks after birth.

(3) WESTERN BLOT

  • Confirmatory test
  • More specific
  • Requires well-trained professionals
  • Drop of blood from fingerprick
  • Results in 10-30 minutes
4 rapid test
(4)RAPID TEST
  • Clients counseled
  • Test results in a single visit
  • Useful in rural areas
  • If positive, confirmatory test needed
  • Ethical standard to be applied
  • Pre and post test counseling pre-requisite
possible results
POSSIBLE RESULTS

Negative results

  • No contact with HIV
  • No antibodies yet (though infected)

NB: May still contract the HIV infection

the window period
THE WINDOW PERIOD
  • HIV test to detect antibodies
  • 6-12 weeks before body produces antibodies
  • May test negative – repeat after three months
  • NB * incubation period – time/infection –first signs of symptoms
  • There is a difference between the two
positive results
POSITIVE RESULTS

IN ADULTS

  • Antibodies present
  • Capable of passing the virus to others
  • Will remain infectious

IN INFANTS

  • Mother infected with the virus
  • Antibodies of the child will only be detected at 18 months of age
  • Baby has 1/3 chance of being infected
  • Needs further evaluation
  • If positive at 18 months infected
hiv testing
HIV TESTING
  • Blood test to detect antibodies
  • Presence of antibodies in blood system means HIV positive
  • HIV Infection took place
  • Can infect others
  • Infection lifelong unless cure is found
  • Test cannot tell: -
      • when infected?
      • who infected you?
      • how infected?
      • whether you have Aids?
      • how long you will live?
topics to be discussed
Topics to be discussed
  • 1.Life at University
  • Drivers of the epidemic in Namibia identified by the MOHSS/.Factors influencing the spread of HIV/AIDS in Namibia
  • 3.Social conditions
  • 4. Influences from a broader society
  • 5. Attitudes
  • 6. Cultural influences
  • 7. Myths
  • 8. Behavior change
slide34
Cont..
  • HIV/AIDS intervention strategies at UNAM
life at the university of namibia
LIFE AT THE UNIVERSITY OF NAMIBIA
  • Different ways of coping
  • *The shy student
  • *The assertive student
  • *The exploring student
  • *The confused student
drivers of the epidemics
Drivers of the epidemics
  • Multiple concurrent partnership
  • Transactional sex
  • Cross generational sex
  • Alcohol abuse
  • Low and inconsistent condom use
  • Male circumciscion
factors influencing the spread of hiv aids in namibia
FACTORS INFLUENCING THE SPREAD OF HIV/AIDS IN NAMIBIA
  • Relationships

*Self –concept

*Low self esteem

*Need for emotional gratification

*Fighting Loneliness

*Fighting false accusations

*Peer pressure

*Role models

social conditions
SOCIAL CONDITIONS

*Poverty

*Alcohol and drugs

*Inadequate health and birth control

*Rape and sexual violence

*Prostitution

*Lack of financial assistance for needy people

influence from a broader society
INFLUENCE FROM A BROADER SOCIETY

*Pornography and the mass media

*Tourism

*Rural-urban migration

*Lack of friendly entertainment

*The sex pool and polygamy

attitudes
ATTITUDES

*Influence his/her behavior

*Way of feeling about a topic or a person

*Attitudes/ condom and gender

*Ideas about condoms/myths

*Gender attitude

cultural influences
CULTURAL INFLUENCES
  • Influence of culture on HIV/AIDS

*Obligatory sex

*Marital rape

*Widow inheritance

*Ceremonial cleansing

*Traditional healers

myths
MYTHS

*Aids can be cured

*Nobody dies of Aids

*Women who carry condoms are loose women

*Condoms has come to destroy relationships

*Men should have multiple sexual relationships

*A person is bewitched if he/she has Aids

behaviour change
BEHAVIOUR CHANGE
  • *Boys need new values
  • *Girls need empowerment
  • * Live with confidence
  • *Work on a good self-esteem
  • Communication skills to talk about sex, your dreams for the future, and what you like and dislike
hiv aids intervention strategies at unam
HIV/AIDS INTERVENTION STRATEGIES AT UNAM
  • *Support groups
  • *Counseling services
  • *Peer education
  • *Secrecy of the existence of Aids on the UNAM campus
  • *Ownership for their sexual behaviour
arv therapy1

ARV THERAPY

DEFENITION

definition art or arv
DEFINITION ART OR ARV
  • Antiretroviral Therapy. A treatment that uses antiretroviral medicines to suppress viral replication and improve symptoms of HIV.
what is haart
What is HAART
  • HAART-Highly active antiretroviral therapy

with three or more antiretroviral medication

  • Once a patient is on HAART, it is a lifetime commitment
how haart works
HOW HAART WORKS
  • HIV is a type of retrovirus that’s why it requires host cell to replicate
  • It specifically targets the body’s CD4 cell over time
  • HAART works to control HIV infection by reducing the ability of the virus to replicate.
  • Therefore successful HAART therapy include immune reconstitution, an increase in CD4 and a decrease in HIV viral load
classes of hiv medication
Classes of HIV Medication
  • There are three ARV classes mostly available in Namibia
  • NRTI’s- Nucleoside Reverse Transcriptase
  • NNRTI’s-Non-Nucleoside Reverse Transcriptase
  • PI- Protease Inhibitors
nrti s
NRTI’s
  • Zidovudine – AZT
  • Lamivudine – 3TC
  • Stavudine – D4t
  • Didanosine – DDI
  • Abacavir – ABC
  • Emtrivitabine – FTC
  • Tenofovir – DTF

The NRT’s block the( reverse transcriptase), an enzyme required by the virus to make DNA copies of the viral RNA (stage four)

nnrti s
NNRTI’s
  • Nevirapine – NVP
  • EFavirenz – EFV
  • This medicines work by inhibiting the transcription of the viral RNA into DNA (stage two)
slide52
PI’s
  • Lopinavir– LPV/r
  • Nelfinavir – NFV
  • Ritonavir – RTV
  • Indinavir – IDV
  • Sequinavir – SQV
  • Pi’s work by blocking the protease enzyme which cuts the long chain of virally produce amino acids into smaller proteins during the HIV lifecycle.(Stage three)
other classes
Other Classes
  • Fusion Inhibitors – Enfuvirtide (t-20)

This medication has a role currently in the salvage therapy regime. Fusion inhibitors block the virus from being able to merge with the host cell.( Stage one)

  • Other new classes exist and may be available in the private sector or other countries. Some of these classes include Maturation inhibitors, Entry inhibitors and Integrase inhibitors.
when to start haart
When to start HAART
  • ART is not started if patient tested positive although some studies suggest that it can be started when a patient is asymptomatic to prolong life.
  • It is very costly.
  • Resistance
  • Due to the complexities of taking ARV’s
  • If not yet sick the adherence will be poor.
  • Starting HAART is not an emergency.
slide55
CONT………
  • Clinical assessment is done prior to HAART
  • Patients are staged according to WHO, based on the medical manifestation. They are stages 1,2,3,4. Where as stages 1,2 are not eligible and stages 3,4 are eligible for HAART
  • CD4 Cell count is considered as well.
criteria for starting haart
Criteria for starting HAART
  • WHO clinical stages 3,4 disease irrespective of CD4 count, or
  • CD4 cell count less than <250 cells/mm (for pregnant women will be more than that)
  • Social eligibility criteria (MoH) should be followed
baseline laboratory assessment for haart
Baseline laboratory assessment for HAART
  • Confirmed Elisa or rapid test
  • CD4 cell
  • FBC (HB)
  • Creatinine
  • ALT
  • RPR
  • HBsAG
  • Pregnancy test
  • Viral load if indicated
social criteria
Social criteria
  • Have lived at a fixed address for the pass 3 months
  • Have access to a designated treatment centre for treatment.
  • Not abuse alcohol
  • Be committed to:

- lifelong treatment with HAART

- strict adherence to treatment

- practicing safe sex

- allowing home visits if indicated

adherence to medication
Adherence to Medication

Adherence means taking the right medication, at the right time, in the right way.

Compliance different from adherence, this actually refers to the command given by the doctor or nurse.

Adherence is a very important factor in ART because evidence suggest that 95% adherence or greater is required for successful viral suppression of HIV via combination therapy

adherence cont
Adherence cont
  • If person misses her/his meds for more than 3 months they are called defaulters and their HAART should be discontinued
  • social work should be implemented
  • trail period of 3 months is given to the patient.
  • Once the social worker is satisfied, then HAART can be recommenced again.
haart regimes
HAART regimes
  • HAART regimes should consist of 3 or more antiretrovirals
  • Recommended are:
  • - 2 NRTI’s +1 NNRTI’s or

- 2 NRTI’s +1 Boosted PI

- 3 NRTI’s(only recommended for special situations)

first line regime
First line Regime
  • For adults :

- AZT/3TC/NVP and alternation based on the LAB results

For children:

- D4T/3TC/NVP, alternation thereafter depending on the LAB results

clinical evaluation of patient haart
Clinical Evaluation of patient HAART
  • Changes in the body weight over course of treatment
  • Changes in frequency of HIV-related symptoms, such as fevers and diarrhea
  • Pertinent physical findings: signs of IRIS(lymph node swelling) ,
  • Signs of improvement, such as the regression of the KS lesions
  • Therefore after HAART is commence patients are seen in 2/52, 1/12 and thereafter every 3/12.
monitoring
Monitoring

During those visits the following are done :

  • Patients history reviewed and physical examination
  • Basic Lab test are done :(Hb, ALT, Creatinine, pregnancy test and CD4 at every 6/12 and Viral load is optional)
  • Check for side effects of medications
  • Adherence evaluation
  • Exam for some OI’s
haart side effects
HAART Side effects
  • Some patients may not experience side effects as for others, they may
  • Side effects could be mild, severe of even life threatening
  • Pre-HAART counseling patients therefore are well educated on the potential side effects.
  • Most common side effects are:

- Anemia, headaches, hypersensitivity, rashes, nausea, vomiting, diarrhea,

lactic acidosis, pancreatitis.

1 hematological toxicity
(1)Hematological Toxicity
  • In case AZT-if found that the Hb less than the 7.0gm do not start the patient on AZT.
  • So starting patient on AZT you should monitor the Hb frequency.
  • If you find that after starting patients in AZT HB drops with 25% from the baseline value then stop AZT, and use another alternative.
2 hepatoxicity
(2) Hepatoxicity
  • Caused by NVP
  • Therefore ALT test should be done
  • If found that ALT is 5 times higher than the normal value then stop NVP and use a alternative.
  • If severe then stop HAART and recommence after the ALT results has normalized.
lactic acidosis
Lactic acidosis
  • Lactic acidosis is a physiological condition characterized by low pH in body tissues and blood (acidosis) accompanied by the buildup of lactate.
  • D4T30, DDI

-caused by mitochondrial dysfunction, disruption of normal cellular metabolism.

-symptoms: - Abnormal pain

- Weight loss

- Malaises

- Hyperventilation

- Nausea, Vomiting

objectives1
Objectives
  • Define male circumcision
  • Explain the current situation of MC in Namibia
  • Explain the biological effectiveness of circumcision against HIV”
  • Explain the additional health benefits of MC for both men and women”
  • Explain how long does it take to heal after circumcision?”
  • Explain why must circumcised men still wear condoms?”
what is male circumcision
What is male circumcision
  • Male circumcision is the removal of the foreskin of the penis.”
  • It is very common all over the world,
  • Religion, culture or health reasons.
  • Limiting the spread of HIV.
  • Studies show MC significantly reduce men’s chances of getting HIV.
  • Global health organizations recommended it to be included in national HIV prevention programmes.
  • Applies in countries with high rates of HIV infection and low rates of male circumcision, like Namibia.
male circumcision in namibia
Male circumcision in Namibia

A national assessment of male circumcision in Namibia has recently been conducted.

  • About 20 percent of adult men between 15-49 years in Namibia are circumcised.
  • The rate is highest in Kunene and Omaheke regions (50% and 57% respectively).
  • 52% of male circumcisions are done by traditional methods.
  • Regions in the north, for example Omusati, Ohangwena, Oshana and Caprivi, have low prevalence of male circumcision (less than 10%).
biological explanations for the effectiveness of circumcision against hiv
Biological explanations for the effectiveness of circumcision against HIV”
  • higher levels of sexually transmitted include HIV infectioncommon among uncircumcised men.
  • inner mucosal surface of the foreskin is fragile and is susceptible to minor trauma and sores which facilitate entry of pathogens (germs) including HIV.
  • The area under the foreskin is a warm, moist environment which may enable germs to multiply, especially when hygiene of the penis is poor.
  • there are cells under the foreskin that are susceptible to HIV infection.
  • These cells (Langerhans cells), are removed during the process.
male circumcision has additional health benefits for both men and women
Male circumcision has additional health benefits for both men and women”
  • Circumcised men have a lower risk of contracting some sexually transmitted infections, especially those that cause ulcers on the genitals, like chancroid (symptoms of which include sores and swelling) and syphilis.
  • Studies have found lower rates of infections of the urinary system in male infants who are circumcised.
  • Circumcision prevents swelling of the head of the penis (balanitis of the glans) and of the foreskin (posthitis).
  • Men who are circumcised do not suffer health problems associated with the foreskin such as phimosis (an inability to pull back the foreskin) or paraphimosis (swelling of the foreskin when pulled back, causing inability to return it to its normal position).
  • Circumcised men do not have to clean under their foreskin, so they may find it easier to maintain cleanliness of the penis.
  • Studies show that female partners of circumcised men have a lower risk of cancer of the cervix.
  • Circumcision is associated with a lower risk of cancer of the penis.
how long does it take to heal after circumcision
How long does it take to heal after circumcision?”
  • The dressings can be removed after a couple of days,
  • full recovery takes six weeks.
  • Clients need to abstain from sex and masturbation during this period, so the wound can heal completely.
why must circumcised men still wear condoms
Why must circumcised men still wear condoms?”
  • Circumcision only offers partial protection against HIV, something in the region of 60% protection.
  • This is a great benefit for the individual and also in terms of the overall Namibian HIV epidemic.
  • However, even circumcised men can contract HIV
  • and are far from being completely protected.
  • Only abstinence or safe sex can offer effective HIV protection.
  • Circumcised man should continue to practice safe sex to be safe from HIV.
sexually transmitted diseases stds
SEXUALLY TRANSMITTED DISEASES (STDs)

WHAT ARE STD’s

  • These are infections that are transmitted by any type of genital, oral or anal intimate contact with an infected person
  • 30 types of infections known caused by different micro organisms.
  • STD’s highest amongst age group of 15-29.
  • Knowledge of reproductive health imperative
continue2
Continue

Show transparency on RH System (Male &

Female)

  • STD’s – negative impact on women, men and children
  • Causes morbidity in adults
complications
COMPLICATIONS
  • Infertility
  • Ectopic pregnancy
  • Cervical cancer
  • Congenital syphilis
  • Low birth weight
  • Prematurity
  • Blindness
  • People with severe STD’s treatment less effective
types of std s
TYPES OF STD’s
  • Gonorrhoea
  • Syphilis
  • Lower abdominal pain
  • Genital ulcer
  • Scrotal swelling
  • Inguinal Bubo (swelling lymph glands)
  • Conjunctivitis (neonatal)
  • Trichomoniasis

U

signs symptoms
SIGNS & SYMPTOMS
  • Dripping discharge from penis
  • Cloudy discharge from penis
  • Burning feeling when urinates
  • Pus from anterior part of urethra
  • Anal irritation
  • Inflammation of cervix
  • Pain during sexual intercourse
continue3
Continue
  • Pain during sexual intercourse
  • Redness of vulva
  • Lower abdominal pain
  • Fever
  • Painful ulcer/painless
  • Swelling of scrotum
  • Pus from eyes of neonates
prevention treatment of std s
PREVENTION & TREATMENT OF STD’s
  • STD’s are curable, except for Herpes, which burns itself out in the end.
  • If not treated – can cause damage (both man and woman)
  • Treatment should be immediately
  • Also occur when both partners are faithful – (has stayed dormant for a long time)
  • Symptoms may occur (discussed) for sometimes not.
  • If you always use condom – chance of contracting STD’s including HIV will be reduced.
continue4
CONTINUE
  • More than one partner, use condom (faithful to your partner).
  • STD’s must be treated medically
  • Do not ignore the signs and symptoms of STD’s
prevention is the key to a healthy life
PREVENTION IS THE KEY TO A HEALTHY LIFE
  • Abstain from sexual intercourse
  • Be faithful: (stick to one uninfected partner)
  • Condomise
  • Delay the first sexual intercourse

No risk

  • Masturbation (alone)
  • Hugging, kissing, touching
  • Talking, net sex,

THERE IS NO CURE FOR AIDS

definition
Definition
  • Stigma can be defined as:
  • Deep feelings disrespect and being unloved
  • Results from reducing of individual as a whole
  • Dynamic process to consider those ‘different’ to be as a non-person
  • Often unconscious act on the part of the ‘stigmatizer’
definition1
Definition
  • Resulting treating others in a negative way
  • Cause people living with HIV and AIDS feeling ashamed because of their status
  • In HIV leads to non-disclosure
types of stigma
Types of Stigma
  • Self-stigma – Self-hatred, shame, and/or blame due to judgment upon them
  • Felt or perceived stigma – Real or imagined fear of societal attitudes and potential discrimination arising from a particular undesirable attribute, disease or association with a particular group
  • Enacted stigma – stigma leading to active discrimination and negative behaviour towards PLWHA
stigma and hiv
Stigma and HIV

Self-stigma

  • Feeling of judgment because of being infected with HIV

Felt-stigma

  • They are blamed for their illnesses
  • Condition is sealed and are destined to die from HIV and AIDS very soon
  • Dangerous to associate with HIV infected person closely
stigma and hiv1
Stigma and HIV
  • Felt stigma cont.
  • Feelings of embarrassment to their families, friends, clans and communities and no association
  • Illness is caused by sinful and promiscuous behaviour
  • Result is shunning, isolation and rejection
drivers of stigma
Drivers of Stigma
  • Misinterpretation of an individual’s HIV identity.
  • Associations of inferiority
  • Struggle of power and domination throughout society as a whole
  • Reinforced by social inequality
  • Stimulated by norms and values of everyday life
negative thoughts and attitudes
Negative Thoughts and Attitudes
  • Fear to disclose HIV status; fear of treatment
  • Being stigmatized at the workplace
  • Being denied treatment
  • Fear of rejection or being ostracized
  • Fear of being expelled as a student from institution
discussion
Discussion
  • Which of the 3 stigma types is most damaging

and why?

  • How can the issue of stigma be addressed at the individual, family, community and societal levels
  • List some of the fear and concerns of individuals in your community who are living with HIV
root causes of stigma
Root causes of stigma

Culture

  • Common heritage, or set of beliefs, norms and values
  • A set of shared attributes of one group or shared systems of meaning
root causes of stigma1
Root causes of stigma
  • Sexuality
  • HIV is mainly transmitted through sexual activities
  • Association with homosexuality, promiscuity, prostitution.
root causes of stigma2
Root causes of stigma
  • Gender
  • In a dominant heterosexual transmission environment, HIV is to be blamed on women
  • Sex workers are seen to be female practices
  • In heterosexual circles men are blamed for the spread due to multi partner preference
root causes of stigma3
Root causes of stigma
  • Gender cont.
  • Lack of control amongst women over sexual decision-making e.g. Condom use
  • Race and ethnicity
  • HIV and AIDS is perceived as an African disease
  • Assumptions about those most infected
  • Certain ethnic groups are seen more promiscuous and there blamed for the spread of HIV
root causes of stigma4
Root causes of stigma
  • Class
  • HIV and AIDS developed during a period of rapid globalisation and gap widening between the rich and poor
  • New forms of social exclusion: poor, homeless, landless and jobless
  • Poverty exacerbates the epidemic
  • In some cases the epidemic affected the rich more due to economic ability to purchase commodities such as drugs and sex workers
impact of hiv aids stigma on families and communities
Impact of HIV/AIDS stigma on families and communities
  • Shock; anger; disappointment; worry; grief; sorrow; fear of caring for PLWHA; being asked to leave the family home; burden and fear of infection; isolation; fear of neighbours finding out.
  • Discuss others
impact on the stigmatized family
Impact on the stigmatized family
  • Family denial – refuse to accept results
  • Family inaction – don’t know what to do
  • Hatred within family
  • Blaming and shaming – I told him-her not to go out with other women/men
long term effects on the family
Long term effects on the family
  • Conflict within the family
  • Divorce or separation
  • Heavy burden on the caregivers
  • Loss of income and money problems
  • Children drop out of school and may become orphans
  • Property grabbing
  • Disinheritance
strategic health communication
Strategic Health Communication
  • Interactive processes involves working with target audience to deliver a health message
  • Before behaviour can be change it is necessary to understand basic facts of health issue
  • They must adopt key issues towards the health issue
  • Increase in knowledge challenges stigma and discrimination and promotes change in attitudes
strategic communication
Strategic Communication
  • Develop programmes from the audience point of view
  • Basic strategy on a model that will describe how your communication will influence behaviour change
  • Drawing on behaviour theory to develop communication models
  • Pay attention to social norms and individual factors
three strategic communication levels
Three strategic communication levels
  • National levels (Education and communication strategy with a long time vision)
  • Campaign or project level (specific intended audiences with medium time)
  • The activity level ( specific events with short to medium time.
evaluation of hiv and aids stigma
Evaluation of HIV and AIDS stigma
  • Gain insight
  • Assess needs, desires and assets of community members
  • Identify barriers and facilitators to service use
  • Learn how to describe and measure the programme activities and effects
evaluation of hiv and aids stigma1
Evaluation of HIV and AIDS stigma
  • Change Practice
  • Refine plans for introducing a new service
  • Improve content educational materials
  • Enhance programmes of cultural competence
  • Mobilise community support for the programme
assess effects
Assess Effects
  • Assess skills development by programme participants
  • Compare changes in provider behaviour over time
  • Compare cost with benefits
  • Find out which participants are doing well in the programme
  • Decide where to allocate new resources
affect participants
Affect participants
  • Reinforce intervention messages
  • Stimulate dialogue and raise awareness regarding health issues
  • Broaden consensus among coalition members regarding program goals
  • Teach evaluation skills to staff and others