Transcript Chapter 6: Time Value of Money Concepts

Significance of multisectoral response
in breaking stigma in MAP
MAP Workshop, Kigali, June 2007
Jean Delion
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Stigma, mark of infamy or disgrace
 Stigma: “a mark made with a burning iron” or
“any mark of infamy or disgrace; sign of moral
blemish; stain or reproach caused by dishonorable
conduct” (Webster Dictionary)
 The public’s attitude toward a person who
possesses an attribute that falls short of societal
expectations. The person with the attribute is
“reduced in our minds from a whole and usual
person to a tainted, discounted one (E Goffman)
(Ref. detailed in 2 docs from H Binswanger available to participants)
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Stigma = shame and fears
• Stigma is an expression of social norms set up by
people in power (meiji and Heijnders)
• People afraid of HIV-AIDS “mark” infected
people, contrasting them with other people,
pointing at them as being different and
“dangerous” (Parker and Aggleton, Bos)
• Stigma builds upon, and reinforces, existing
prejudices. It plays into and strengthens existing
social inequalities – especially of gender, sexuality
and race (Brown et al.; Nyblade, Heijnders)
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Stigma can kill, directly or indirectly
• Stigma on HIV-AIDS deeply rooted in individual and
societal attitudes: eg. on sexual relations, on death.
• Famous example: M. Mead – “Sex and Temperament in
Three Primitive Societies” – 1935 - Trobriand Islands • It is reflected in behaviours seriously undermining the
rights and dignity of infected and affected
• Stigmatized people face resentment, isolation, ridicule;
they are denied participation in family/ social life, access
to their rights and basic services
• Example Togo 2002: mother LWHA isolated in a piggery
outside the village and left to die, marked as a witch
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HIV infection carries a high level of
stigmatization
• People infected with HIV are often blamed for their
condition and many people believe HIV could be avoided
if individuals made better moral decisions
• Although HIV is treatable, it is nevertheless a progressive,
incurable disease
• HIV transmission is not fully understood by some people
who feel threatened by the mere presence of the disease
• HIV-related symptoms may be considered repulsive, ugly,
and disruptive to social interaction
• In the case of PLWHA, stigma is a strong disincentive to
use existing services for fear of being “marked”
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Examples of people often stigmatized
• Commercial sex workers seen as morally decadent people
• Although HIV is treatable, it is nevertheless a progressive,
incurable disease
• HIV transmission is not fully understood by some people
who feel threatened by the mere presence of the disease
• HIV-related symptoms may be considered repulsive, ugly,
and disruptive to social interaction
• In the case of PLWHA, stigma is a strong disincentive to
use existing services for fear of being “marked”
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Social groups produce stigma - with
LR/BCC support they can reduce it.
• Stigma is one of the social dimensions of the fight
against HIV-AIDS. Other social aspects include
culture, values, norms, power relations, gender.
• Need to go behind IEC, to guide societies,
communities, small groups to adjust values,
norms, regulations, to reduce stigma.
• Communities and small groups are very influential
to shape behaviors and enforce social norms
• LR grants and BCC in MAP can be powerful
incentives stimulate effective social responses.
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What can NAC do to reduce stigma on
PLWHA?
• Act on the image associated with HIV-AIDS
reducing negative connotations (using media, role
models, supporting PLWHA inclusion)
• Assist communities to identify social factors on
which they can act, use LR grants as incentives to
change norms and support behavioral changes.
• Assist PLWHA to rebuild social capital: to get
positive social signals, to be useful to society
(prevention, counseling). To get support
• Train services providers to be aware of stigma
inside and around them and overcome them.
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Examples of actions to reduce risky
behaviors and access services
• Proximity groups (family, peer groups, friends,
community) the most effective to bring people to
take precautions, do a test, to visit doctor
• Intensive actions with target groups: home visits to
seropositive pregnant women to try and bring
husband, to accept test/ treatment
• Intensive actions (peer pressure) among youth, sex
workers, soldiers, truck drivers
• Bring tests and services close to people (free as
much as possible) and reduce fears to use them
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Yes, NAC can measure stigma
reduction
• Stigma reduction translates into improved MAP
scorecards indicators on prevention, access to test,
treatment, support services
• Stigma level can also be rated based on data such
as : Nb of people who collect and discuss tests
results, nb of partners of pregnant women who
take tests and results, nb of PLWHA satisfied with
the way they are treated in their communities, nb
of PLWHA testifying in public
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Qualitative studies can assess stigma
• Beneficiary Assessments are effective tools to
shade light on stigma and other social factors: SD
specialists take time to build trust with people and
ask their deep feelings
• Focus groups with PLWHA and groups
representing various segments of society allow to
ponder individual opinions
• Open questions to religious and traditional leaders
can capture evolution of values and norms
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Who can help the NAC to address
stigma?
• Anthropologists, sociologists, faith based
organizations and leaders of PLWHA
• BCC (not just IEC) specialists, social workers in
NGOS, with PLWHA, youth organizations
• NAC, UN agencies, International and National
NGOs, the WB can organize exchanges among
practitioners at sub-regional level.
• The WB as “Knowledge bank” will train its SD
specialists, will disseminate publications, best
practices, manuals, evaluation methodologies.
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