2HIV and stigma

REDUCING HIV STIGMA AND DISCRIMINATION THROUGH EDUCATION: ICAAP 2007: 

REDUCING HIV STIGMA AND DISCRIMINATION THROUGH EDUCATION: ICAAP 2007 The nature of stigma

Objectives for this presentation: 

Objectives for this presentation Define and discuss stigma: its antecedents and social mechanisms Address the specific features of HIV that lead to stigma Consider specific factors that should be addressed in education

Slide3: 

What is stigma?

Stigma: definitions: 

Stigma: definitions Stigma marks an individual as being unacceptably different from ‘normal’ people with whom s/he interacts (Goffman 1963) …an attribute that discredits or disqualifies an individual from full social acceptance (Goffman 1963) Stigma is a social process; a feature of social relations reflecting the tension, conflict, silence, subterfuge and hypocrisy found in every human society and culture (Barnett and Whiteside 2002)… …‘All societies need to have one illness which becomes identified with evil, and attaches blame to its victims’ (Sontag 1991) …AND it is more than just the way a person is seen. structural, social and cultural – it is about power…

Knowledge, power, truth and stigma:Michel Foucault: 

Knowledge, power, truth and stigma: Michel Foucault Knowledge, linked to power, assumes the authority of truth, AND has the power to make itself true creating a regime of truth that is maintained in discourse Knowledge and truth are both socially situated, shaped by context: essentially, who is stigmatised is decided by who are the most influential Example? The language of epidemiology (e.g. the identification of ‘risk’ groups)

Slide6: 

EXERCISE: ‘Our experience as stigmatised and stigmatiser’

Our experience of stigmatised and stigmatiser: 

Our experience of stigmatised and stigmatiser PART ONE: think about a time in your life when you felt isolated or rejected for being seen to be different from others, or when you saw other people treated this way. What happened? What impact did it have on you? [individual, then share: 5 mins] PART TWO: Think about a time in your life when you isolated or rejected someone else because they were different. What happened?? How did you feel? What was your attitude? How did you behave? [individual, then share: 5 mins]

Stigma is complex: 

Stigma is complex STIGMA: is an idea or thought, based (usually) on prejudice It is an attribute and discredits a person in the eyes of other Two main types of stigma are: External stigma [the experience of being treated differently to other people] Internal stigma [the way a person feels about themselves [e.g. shame, fear of rejection, discrimination]

Examples of EXTERNAL stigma: 

Examples of EXTERNAL stigma Avoidance Rejection Moral judgement Stigma by association Discrimination (the ACT associated with stigma) Abuse Victimisation Abuse of human rights

Examples of INTERNAL stigma: 

Examples of INTERNAL stigma Self-exclusion from services or opportunities Perceptions of self: low self esteem Social withdrawal Overcompensation Fear of disclosure

The impact of stigma: 

The impact of stigma It creates ‘excluding behaviours’ It isolates and divides communities Causes people to withdraw, putting them beyond the reach of support services It generates a strong ‘us and them’ phenomenon

Slide12: 

HIV stigma

Slide13: 

‘Many people suffering from AIDS and not killed by the disease itself are killed by the stigma.’ Nelson Mandela, 14th International AIDS Conference, Barcelona July 2002

Slide14: 

‘HIV-related stigma is exceptional in its scale, its context, and its causes.’ Mary Robinson, 16th International AIDS Conference, Toronto, 2006

The engines driving HIV & Aids stigma: 

The engines driving HIV & Aids stigma HIV infection is a mystery for most people: it is invisible, incurable and infectious…blaming has always been a way of making mysterious and devastating diseases comprehensible’ (Nelkin and Gilman 1988) Fear of infection… People with HIV are seen as the cause of their condition (a perception strongest in developed countries) Stigma formalises exclusion rules against groups that are already unpopular, and therefore becomes a form of social control (and eventually a part of ‘structural violence’) (Douglas, 1996; Farmer 1992) Stigma can be covert, institutionalised, and is often about POWER (e.g. enforced testing for HIV; screening of ‘at risk’ groups)

HIV stigma and culture…: 

HIV stigma and culture… Stigma is ‘written’ by powerful cultural forces: and as a social product, exists at the intersection between power, difference and culture… Stigma Power Difference Culture

HIV stigma and place: 

HIV stigma and place PLHIV experience significant stigma in the workplace, healthcare setting, and in the religious sector - stigma exists even in institutions purporting to offer a ‘safe haven’ “Fear of contagion seems to be a powerful factor in explaining…stigma among health workers, especially in countries with weak health care infrastructure” [India] Source: ‘Living on the outside’ (HDN, 2005)

Stigma and the person: 

Stigma and the person Self stigma: “More deadly than the HIV living within our bodies: it infects your mental state resulting in behaviours beyond your ability to comprehend” [Thailand] IDUs: experience additional barriers to care, and exclusion from ARVs - stigma is amplified because of the double diagnosis Disclosure: “Everyone seems to care and is very sorry about what has happened, but no one comes within touching distance and no one is willing to touch or be touched. Your whole world disintegrates within one day” [Sri Lanka] Source: ‘Living on the outside’ (HDN, 2005)

HIV stigma and the media: 

HIV stigma and the media “The media wants to sensationalise issues…and this becomes even more dangerous when media personnel are not knowledgeable to start with” [Ethiopia] “The media is a direct reflection of the development and consciousness of a society” [Ethiopia] Source: ‘Living on the outside’ (HDN, 2005)

The language of stigma…One day in June 2006: 

The language of stigma… One day in June 2006 “Woman jailed for giving boyfriend HIV” “Woman is jailed for infecting lover with HIV” “Woman jailed for deliberately infecting lover with HIV” [Headline: Pure Evil] “Ex tells of HIV nightmare” [caption on photo: AIDS Avenger] [1. Guardian; 2. Independent; 3. Daily Mail; 4. Sun] Broadsheet Tabloid

…the ‘use’ of stigma: 

…the ‘use’ of stigma Beliefs about danger and pollution are often used as a form of social control (Douglas, 1984) ‘ideas about sexual dangers are better interpreted as symbols of the relationship between parts of society’ (Douglas, 1996)

Any questions?: 

Any questions?