Transcript Partners incare Stigma and Me Slides 11.08.12

HIV, Stigma
and Me
November 8, 2012
For Audio: Dial-in#: 866.394.2346
Participant Code: 397 154 6368#
Agenda
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
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Welcome & Overview- 5 mins
The Stigma of HIV/AIDS – 30 mins
Panel Discussion on Stigma, 20 mins
Wrap-up & Evaluation, 5 mins
Michael Hager
in+care Campaign Manager
National Quality Center
New York, NY
[email protected]
Conversation opportunities throughout webinar
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Welcome & Overview
 This Partners in+care webinar is offered as part of the
in+care Campaign.
 The in+care Campaign is a national effort to improve
retention in HIV care.
 Webinars are one of many Partners in+care activities
designed to engage people living with HIV/AIDS and their
allies in the in+care Campaign.
For more information: www.incarecampaign.org
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Participation Guidelines
 This is a “public event.” If you have confidentiality
concerns:
 Your names appear on-line in the list of webinar registrants
-consider just listening to the audio or to viewing the webinar at a
later time, after it is posted at www.incarecampaign.org
 All webinars are recorded - do not use identifying information
when asking questions
For Audio: Dial-in#: 866.394.2346
4
Participant Code: 397 154 6368#
Participation Guidelines
 Actively participate and write your questions into the chat
area during the presentation; we will also have a “pop up”
question exercise, and will pause for conversation during
the webinar
 Do not put us on hold
 Mute your line if you are not speaking (press *6, to
unmute your line press #6)
 The slides and recording of this and other Partners in+care
webinars are available for playback and group
presentations at www.incarecampaign.org – “Resources” tab
For Audio: Dial-in#: 866.394.2346
5
Participant Code: 397 154 6368#
Learning Objectives
At the end of this webinar you will know:
 What is stigma
 Characteristics of different types of
stigma
 Examples of how stigma affects Persons
Living with HIV
 How to combat stigma-related barriers
in HIV care
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How great a factor is
stigma in HIV care?
Pop-up Question
Has stigma ever kept you
from accessing your clinical
HIV services?
Yes
No
I am not HIV+
Visit www.incarecampaign.org
7
HIV Stigma and Me - Our Goal
Pop-up Question
Do you think that we can
overcome stigma even if we
can’t eliminate it?
Yes
No
I don’t know
Visit www.incarecampaign.org
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The Stigma of HIV/AIDS
• What is stigma? A theoretical analysis of
four manifestations of stigma
• Applying this theory to HIV-related
stigma:
•
•
•
•
John B. Pryor, PhD
Distinguished Professor of Psychology
Illinois State University
Normal, IL
[email protected]
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Public Stigma
Self-Stigma
Stigma by Association
Structural Stigma
• Common elements of effective
interventions – what works?
What is Stigma?
• The term stigma can be traced to the Ancient Greeks who used
tattoos, scars, or brands to mark slaves, deserters, or criminals as
people of reproach and disgrace.
• Goffman (1963) described stigma as a sign or mark designating
the bearer as spoiled, flawed, or compromised—someone less
than fully human.
• More recently, Dovidio, Major, & Crocker (2000) defined stigma
as "a social construction that involves at least two fundamental
components: (1) the recognition of difference based on some
distinguishing characteristic, or 'mark'; and (2) a consequent
devaluation of the person” (p. 3).
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Three Social Psychological Functions of Stigma
(Phelan, Link, & Dovidio, 2008)
• To keep people down – stigmas help to legitimize and perpetuate
social inequities (i.e., provide justification for the exploitation
and dominance of lower status groups)
• To make people conform - stigmas help to enforce social norms
by serving as a punishment to those who choose non-conformity
• To keep people away – stigmas trigger avoidance responses to a
broad class of deviant human characteristics that potentially
signal risk of infection
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Four Manifestations of Stigma
(Pryor & Reeder, 2011)
1) Public stigma – people’s social and psychological reactions to
someone with a perceived stigma
2) Self-stigma – how one reacts to the possession of a stigma
3) Stigma by association – social and psychological reactions to people
who are somehow associated with a stigmatized person or how
people react to being associated with a stigmatized person
4) Structural stigma – the legitimatization and perpetuation of a
stigmatized status by society’s institutions and ideological systems
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A Dynamic Model of the Four Manifestations of Stigma
Structural
Stigma
Public
Stigma
Stigma by
Association
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SelfStigma
Applying the Stigma Model to HIV
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Public Stigma
• Social psychologists view negative reactions to a perceived
stigma as a form of prejudice.
• Prejudice is essentially a negative attitude toward people perceived
to be members of an out-group.
• Stigmatized out-groups often have less social power than ingroups.
US
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THEM
Tri-Part Conceptual Model of Public Stigma
Cognitive
Component
Behavioral
Component
Affective
Component
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Cognitive Components of Reactions to Perceived
HIV-Related Stigma
Stereotypes about PLWHA
• Connections to sexual orientation and drug use
Beliefs about blame
• Belief that bad things happen to bad people
Conceptions of risk and transmission
• Risks associated with casual contact
Beliefs about prejudice
• Are negative reactions to PLWHA seen as a form of
prejudice?
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Affective (emotional) components of reactions to
perceived HIV-related Stigma
• Affective reactions can be positive (e.g., compassion, empathy)
or negative (e.g., fear, disgust, anger, etc.)
• Affective reactions can be automatic (spontaneous or reflexive)
or derived from conscious deliberation
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Behavioral components of reactions to perceived
HIV-related stigma
• Avoidance (or approach) – a general behavioral tendency
• Harassment, ridicule, & ostracism
• Discrimination
• Employment
• Housing
• Educational opportunities
• Access to medical care
• Insurance
• Pro-social behavior – the flip side of discrimination – social support
• Support for public policies
• Coercive policies
• Anti-discrimination policies
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What is
selfstigma?
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Self-stigma – derived from enacted (actual) or perceived
(anticipated) social experiences
• Related to knowledge of public reactions to stigma – reflected appraisals of
others
• Label avoidance
•
•
•
•
Avoiding HIV testing
Avoiding disclosure of HIV status
Avoiding treatment
Avoiding safer sex
• Withdrawal from situations where ill treatment might occur – social
isolation
• Internalization of the negative label
• Reduction of self-esteem & self-efficacy
• Hopelessness and depression
• Reduced Immune functioning
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Stigma by Association
Goffman called this courtesy stigma
• To some degree all of the public stigma reactions to PLWHA are
also experienced by uninfected people who are somehow
associated with PLWHA
• HIV-related stigma affects families – shame & disclosure
concerns
• Stigma-by-Association contributes to burnout among care-givers
and health care providers
• Being associated with a PLWHA may contribute to
psychological distress
• Concern about stigma by association contributes to social
avoidance
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Structural Stigma
Examples of stigmatizing government laws and policies in the U.S.
• Until recently the U.S. government banned individuals with
HIV from entering the United States as tourists, workers or
immigrants
• The U.S. Foreign Service still refuses to hire applicants with
HIV.
• The Transportation Security Administration has refused to hire
applicants who are HIV+.
• 34 states and 2 U.S. territories have criminal statutes based on
perceived exposure to HIV, and prosecutions for alleged
exposure to HIV have occurred in at least 39 states.
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Structural Stigma
Examples of stigmatizing government laws and policies in the U.S.
• Public stigma toward persons living with HIV/AIDS is related
to the perceived connections of HIV/AIDS to other stigmas
(e.g., homosexuality)
• Policies of private and governmental institutions that have a
negative impact people with these related stigmas also serve to
legitimize and perpetuate HIV-related stigma
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Stigmas Related to HIV in the US
African
Americans
MSM
IV Drug
Users
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Societal Responses to Related Stigmas in the US
Sexual
Prejudice
Racism
African
Americans
MSM
IV Drug
Users
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Criminalization
of drug addiction
Related Structural Stigma
in the United States
• Sexual prejudice – state laws in the US banning gay marriage,
Federal Defense of Marriage Act
• Institutional racism – 1 in 7 US Black men between ages 25 &
29 are in prison
• Criminalization of Drug Addiction – Although the Federal
funding ban on syringe exchange was rescinded recently, syringe
exchange remains illegal in 15 states
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Is it possible?
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Some Common Sense steps in Conducting a Stigma
Reduction Intervention
1)
2)
3)
4)
5)
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Identify the manifestations you want to target
Specify how you will measure stigma reduction
Identify some effective components of past interventions
Taylor intervention components to your audience
Evaluate your intervention’s outcomes and be prepared to
adjust your ongoing plan
Components of Effective Interventions
• Education – just the facts…“HIV 101”…still important in 2012
(for all manifestations)
• Counseling – one-on-one & support groups, helping people
cope with HIV as a disease and as a stigma (self-stigma &
stigma-by-association)
• Coping Skills Acquisition – master imagery and group
desensitization are two techniques for acquiring coping skills
(public stigma)
• Contact with PLWHA – one-on-one, with a public speaker, or
through media (public stigma)
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Take Home Messages of Today’s Talk
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1.
Stigma is a multi-dimensional concept. Public stigma, selfstigma, stigma by association, and structural stigma represent
different, but inter-related manifestations of stigma.
2.
While public stigma is theorized to be pivotal to the other
manifestations of stigma more research is needed that
examines the inter-relationships empirically.
3.
Stigma reduction interventions should identify specific
manifestions of stigma for potential change and include
evaluation measures that are appropriate
Stigma and Retention in Care
Panel Discussion - Introduction
John B. Pryor, PhD
Distinguished Professor of Psychology
Illinois State University
Normal, IL
[email protected]
Kathleen Clanon, MD
Medical Director
Health Program of Alameda County
Long time HIV Specialist Physician
Oakland, CA
[email protected]
Adam Thompson
Peer Consultant
National Quality Center
PLWH
Charlottesville, VA
[email protected]
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Speaking from Experience:
Stigma in HIV/AIDS Care
What is one way we can reduce
the impact of HIV-related
stigma in ourselves, and our
clinics and communities?
Let us know your experiences in the chat room!
33
Speaking from Experience:
Stigma in HIV/AIDS Care
What change is needed to
ensure that HIV-related stigma
does not keep persons from
accessing clinical care?
Let us know your experiences in the chat room!
34
Working in a Stigmatizing
World
Pop-up Question
How likely are you to
reevaluate the way you combat
stigma in your life and clinic?
More likely than before I watched this program
No more or less likely than before I watched this program
Less likely than before I watched this program
Visit www.incarecampaign.org
35
Partners in+care Resources
Visit Web / Open the Toolkit
www.incarecampaign.org - “Partners” tab
Sign up for Partners in+care Network
www.incarecampaign.org – “Partners” tab
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Send email to
[email protected] –
“Facebook” in subject line
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Campaign Headquarters:
National Quality Center (NQC)
90 Church Street, 13th floor
New York, NY 10007
Phone 212-417-4730