Transcript h_PB_Mod_5_Slides.

Module 5
Stigma and Discrimination
Associated with HIV
Module Objectives
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Define correctly HIV-related stigma.
Define correctly HIV-related discrimination.
Describe current international rights related to HIV.
Discuss stigma and discrimination against women
in the context of HIV.
 Discuss examples of how stigma is expressed in
professional and social settings.
 Discuss the consequences of stigma in PMTCT
services.
 Discuss strategies to address stigma and
discrimination.
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Exercise 5.1
Labels Interactive Game
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Unit 1
Introduction to the Concepts of
Stigma and Discrimination and
International Human Rights
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Unit 1 Objectives
 Define correctly HIV-related stigma.
 Define correctly HIV-related
discrimination.
 Describe current international rights
related to HIV.
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Introduction to Stigma &
Discrimination
 HIV poses human rights challenges
 HIV-related stigma is the single greatest challenge
to slowing spread of the disease at global, national,
and community level.
 HIV-related stigma can prevent a woman from
seeking ANC services and HIV testing; discourage
her from disclosing her test results and agreeing to
antiretroviral treatment and prophylaxis; and keep
her from adopting safer infant-feeding practices.
 Women may feel compelled to keep their HIV
status secret.
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What is stigma?
Stigma refers to unfavourable attitudes
and beliefs directed toward someone
or something.
 Socially marginalized people bear
heaviest burden of HIV-related stigma and
discrimination.
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What is stigma?
(continued)
HIV-related stigma
 Unfavourable attitudes and beliefs toward
people living with HIV, those perceived to be
infected, and their families, friends, social
groups, and communities
 Stigma is greater when risk of contracting the
disease is thought to be under the individual’s
control (e.g., commercial sex workers)
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What is discrimination?
Discrimination is the treatment of an
individual or group with partiality or
prejudice.
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Examples of Discrimination
 HCW denies services to person with HIV
 Wife and children of a man who died of AIDS
ostracized by community
 Individual loses his job when it is known he/she
is HIV-infected
 Individual has difficulty getting a job when
revealed he/she is HIV-infected
 Community ostracizes a woman who decides
not to breastfeed because it is assumed she is
HIV-infected
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Stigmatization versus
Discrimination
Stigmatization reflects an attitude.
Discrimination is an act or behaviour.
 Discrimination is a way of expressing
stigmatizing thoughts, either on purpose
or by accident.
 Stigmatized individuals may suffer
discrimination and other human rights
violations.
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Stigma, HIV, and Women
 HIV epidemic spreading more rapidly among
women than men.
 Women more vulnerable to HIV.
 Woman often first in a couple to be tested for HIV
 These reasons may compel a woman either not to be
tested or to keep her HIV status a secret.
 Stigma and discrimination handicaps successful
prevention, care, and support activities.
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Human Rights &
HIV-related Stigma and Discrimination
 Freedom from discrimination is a
fundamental human right founded on the
principles of natural justice.
 Discrimination against people living with
HIV or people thought to be infected is a
clear violation of human rights.
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Human Rights &
HIV-related Stigma and Discrimination
Against Women
Research in India and Uganda showed that women
with HIV face stigma on many levels:
 As women
 As people living with HIV
 As the spouse of an HIV-infected person
 As the widow of a person who died of AIDS
 Or as a woman who is HIV-infected and
pregnant.
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Protect, Respect, & Fulfill Human
Rights in Relation to HIV
 Women and men have a right to determine
the course of their sexual and reproductive
lives.
 Children have a right to survival,
development, and health.
 Women and girls have a right to
information about HIV and access to a
means of protecting themselves.
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Protect, Respect, & Fulfill Human
Rights in Relation to HIV (continued)
 Women have the right to access HIV testing and
counselling and to know their HIV status.
 Women have a right to choose not to be tested or
choose not to be told the result of an HIV test.
 Women have a right to make decisions about
infant feeding and to receive support for the
infant feeding method they choose.
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Unit 2
Social Context and the Impact of Stigma
and Discrimination
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Unit 2 Objectives
 Discuss examples of how stigma is
expressed in professional and social
settings.
 Discuss the consequences of stigma in
PMTCT services.
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The Face of Stigma
 People living with HIV, orphans and
families affected by HIV, are highly
stigmatized in many countries.
 Fear of stigmatization often the main
reason why a person does not get tested.
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How Stigma Can be Expressed
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Attitudes and actions are stigmatizing
Choice of language may express stigma
Fear and lack of knowledge foster stigma
Shame and blame are associated with HIV
Stigma makes disclosure more difficult
Stigma can exist even in typically supportive or
caring environments
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Exercise 5.2
Examples of
Stigma & Discrimination:
Large Group Discussion
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Examples of Stigmatization and
Discrimination
In the media
 Suggestions that specific groups of people with
HIV are at fault whereas others are innocent
 Depicting HIV/AIDS as a death sentence rather
than a chronic disease that can be managed.
 Using stereotypical gender roles, which may
perpetuate women's vulnerability to sexual
coercion and HIV infection.
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Examples of Stigmatization and
Discrimination
(continued)
In health services
 Violating patient confidentiality
 Providing HIV care in stand-alone settings (such
as clinics for sexually transmitted infections)
that further stigmatize and segregate PLHIV
 Requiring HIV test before surgery
 Using infection-control procedures (such as
gloves) only with patients thought to be HIVpositive, rather than with all patients
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Examples of Stigmatization and
Discrimination
(continued)
In the workplace
 Refusing to hire HIV-infected persons
 Violating confidentiality
In the context of religion
 Denying participation in rituals (such as
funerals) for PLHIV
 References to HIV as a punishment or test
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Examples of Stigmatization and
Discrimination
(continued)
In the family and local community
 Discriminating against partners and
children of PLHIV
 Using violence against an HIV-positive
spouse or partner
 Denying support for bereaved family
members
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Effects of Stigma
Stigma is disruptive and harmful at every stage of
HIV care.
 People who fear stigma and discrimination are
less likely to seek HIV testing.
 Persons testing HIV-positive may be afraid to
seek necessary care and treatment.
 PLHIV may receive suboptimal care from
discriminatory HCWs.
 Stigma may discourage those who are HIVinfected from discussing their HIV status with
their sex partners.
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Secondary Stigma
Secondary stigma (stigma by association)
 Effects of stigma often extend beyond the
infected individual to stigma by
association.
 Women whose husbands died of AIDS
can be stigmatized by their community.
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Stigma & PMTCT Services
Consequences of stigma in PMTCT services
 Discourages women from accessing ANC
 Prevents people from receiving HIV testing
 Discourages women from discussing their HIV test
results and disclosing results to partner(s)
 Prevents women from accepting PMTCT interventions
 Discourages women from accepting referrals to ARV
Clinic
 Discourages safer infant-feeding practices (replacement
feeding or early cessation of breastfeeding)
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Unit 3
Dealing with Stigma &
Discrimination in Healthcare
Settings and Communities
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Unit 3 Objective
 Discuss strategies to address stigma and
discrimination.
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Addressing Stigma in
PMTCT Services
 To increase participation in PMTCT
services, implement interventions that
address HIV-related stigma.
 These efforts should occur at all levels:
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National
Community, social, and cultural
PMTCT service
Individual, HCW
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National Level
Examples of national initiatives and policies that HCWs
can advocate:
 Legislation that protects rights of PLHIV
 Legislation that protects legal rights of women in health
care, education, and employment.
 Anti-discrimination policies
 Scale-up treatment of HIV with antiretroviral (ARV)
medication.
 Quality treatment programmes for people with
addictions.
 Involve consumers in national advocacy and programme
and policy development.
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National Level
(continued)
 Advocate for sufficient funding for
PMTCT services.
 Educate national leaders about the
importance of PMTCT services
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National Level
(continued)
 Encourage national leaders to serve as role
models in their professional and personal lives
 Encourage leaders to hire staff that are HIV-infected.
 Encourage leaders to praise the good work of
PMTCT HCWs.
 Encourage leaders to speak out against emotional,
verbal, and physical abuse directed at women
infected with HIV.
 Remind leaders to promote funding of HIV care and
treatment services.
 Suggest that leaders be tested for HIV.
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Community Level
 Stigmatization is a social process that
must be addressed on the community
level.
 PMTCT service managers should
collaborate with the community to address
HIV-related stigma and discrimination.
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HIV Education & Training
HCWs should participate in
educational programmes that:
 Increase knowledge about HIV
 Increase awareness of issues faced by
PLHIV
 Increase awareness of domestic violence
faced by some newly diagnosed women
 Include content that violence against
women or men is not acceptable
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HIV Education & Training
(continued)
HCWs should participate in educational
programmes that:
 Encourage leaders to make workplaces HIVfriendly.
 Promote PMTCT activities as routine part of
healthcare and HIV prevention/treatment
 Educate community about PMTCT interventions
 Increase referrals to/from PMTCT services
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Community Awareness of PMTCT
Interventions
 Community education and mobilization
activities increase community awareness
of PMTCT interventions
 Greater community awareness should
strengthen social support for the partner,
extended family, and community.
 People with social and family support
cope with their HIV infection better.
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Community Partnerships
 PMTCT HCWs and managers should build
partnerships with churches, schools, and social
or civic organizations when developing PMTCT
services.
 Promoting PMTCT services among community
organizations enhances sustainability
 Faith-based organizations (FBOs) and religious
communities are important partners in efforts to
eliminate stigma.
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Ways to Facilitate Building of
Community Partnerships
 Maintain awareness of community health and
development activities that benefit PMTCT
clients.
 Understand the HCW’s role as a liaison between
community and the PMTCT service.
 Work to incorporate PMTCT messages and
activities into existing MCH and BCI initiatives.
 Participate in community meetings with
influential leaders to discuss HIV and PMTCT
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Involve People Living with HIV
(PLHIV)
Invite PLHIV to become involved in national and
local initiatives, as this will help them:
 Gain and practise life skills to challenge HIVrelated stigma and discrimination.
 Become actively involved in national and local
activities to foster positive perceptions of
PLHIV.
 Support establishment of organizations and
networks for PLHIV.
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Training Programmes for PLHIV
 Develop and implement training
programmes for PLHIV to:
 Advocate for their rights and take an active
role in their own health care.
 Participate in interventions (such as PMTCT
services or HIV prevention and care
education) as volunteers, advisors, board
members, or paid employees to demonstrate
their ability to remain productive members of
the community.
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PMTCT Service Level
 Ensure that PMTCT services are
integrated into existing health and social
services
 Suggestions on how to do this follow in
the next few slides
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Integrate PMTCT Interventions
into (ANC) services
 Offer routine HIV testing and education to
all clinic attendees, regardless of HIV
risk.
 Mainstream HIV services with routine
ANC services helps normalize HIV.
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Increase Participation of
Partners
 Educate partners about PMTCT interventions
and stress importance of partner testing and
support for PMTCT.
 Examples where men were invited to visit
reproductive clinics for testing, counselling and
PMTCT education designed for a male audience
have shown:
 Improved spousal communication about PMTCT
 Increased HIV testing among male partners of
PMTCT patients
 Increased rates of disclosure of HIV test results for
both partners
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Implement Educational
Sessions
 Group or individual education sessions can draw
attention to role of partners in HIV transmission
and reduce stigmatization of women.
 Reach out to men in male-friendly settings, such
as sports stadiums, taxi stands, and markets to
increase awareness of PMTCT and encourage
them to attend ANC with their pregnant
partners.
 Couples counselling offers opportunity to
reduce blame directed at women and emphasize
couple's shared responsibility for PMTCT
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Educate & Train HCWs
 Success or failure of PMTCT service
depends on attitudes, skills, and
experience of its employees.
 Train HCWs and clinic staff at all levels
 Employee training should include:
 Complete and accurate information about
transmission of HIV and risk factors for
infection
 Ongoing activities that address HIV-related
stigma
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Understand the Perspectives of PLHIV
 Training HCWs to reduce stigmatizing
behaviour will address assumptions about the
educational, social, economic, and class status
of people living with HIV.
 During training activities, strive to increase
awareness of language used to describe HIV and
PLHIV.
 The training should include:
 Exercises to encourage participants to explore
personal attitudes and prejudices
 Summaries of confidentiality, anti-discrimination,
and infection control policies as well as
consequences of policy breaches
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Adhere to Infection Control &
Patient Confidentiality
Infection control
 Provide all HCWs with the equipment and supplies
needed to adhere to infection control policies
Patient confidentiality
Safeguard patient confidentiality by developing policies
and procedures on:
 Recording and storing patient information
 Ensuring patient interactions are private
 Disclosure of medical information and informed consent
 Disciplining workers who breach confidentiality
 Requirements for staff confidentiality training
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Encourage PMTCT Staff to Serve
as Role Models
 Encourage PMTCT staff to treat PLHIV
the same as patients assumed to be HIVnegative.
 HCWs are role models, and their attitudes
toward PLHIV are often imitated in the
community.
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Know the Local Community
 PMTCT staff should get to know people
in the community.
 This will help them identify local HIVrelated stereotypes.
 Staff can address stereotypes and correct
misconceptions during PMTCT services.
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Role of PMTCT Service Managers
Ensure policies and procedures in place to protect
individuals from discrimination and
stigmatization
 Maintain policies against discriminatory
recruitment and employment practices
 Support workers who are HIV-infected.
 Establish policies that all patients must receive
equal treatment regardless of HIV status.
 Establish procedures and protocols for reporting
discrimination and disciplining staff.
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Role of PMTCT Service Managers
(continued)
Ensure that all staff follow standard precautions:
 Update facility's infection control policy
 Ensure access to infection control supplies &
equipment
 Ensure staff members apply standard
precautions
 Discipline employees who knowingly breach
standard precautions policy
 Ensure post-exposure prophylaxis (PEP)
accessible to staff
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Exercise 5.3
People Living with HIV Panel
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Exercise 5.4
Stigma and Discrimination:
Case Study
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Module 5: Key Points
 While stigmatization reflects an attitude,
discrimination is an act or behaviour.
 Stigma and discrimination are interconnected.
Stigmatizing thoughts can lead to discriminating
behaviours.
 PMTCT service staff have a responsibility to
respect the rights of all women and men,
regardless of their HIV status.
 Discrimination against people living with HIV is
illegal in Malawi
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Module 5: Key Points (continued)
 HIV/AIDS-related stigmatization and
discrimination may discourage people living
with HIV from accessing key HIV services.
Stigma and discrimination may also:
 Discourage disclosure of HIV status
 Reduce acceptance of safer infant-feeding practices
 Limit access to education, counselling, and treatment
for people infected with HIV even when services are
available and affordable
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Module 5: Key Points (continued)
 PMTCT service staff can help reduce stigma and
discrimination in the healthcare setting, in the
community, and on the national level.
 Encourage PMTCT staff to serve as role models
by treating people living with HIV as they
would treat clients assumed to be HIV-negative.
 It is important for HCWs and staff to explore
attitudes and behaviours that could be
stigmatizing and discriminatory.
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