ProfD D Reidpath

Slide1: 

Stigma, Discrimination and Counselling Daniel D Reidpath Centre for Public Health Research Brunel University 13 November, 2006

Acknowledgment: 

Acknowledgment Kit Yee Chan (Australia) Joy Elamon (India) Dang Van Khoat (Vietnam) Tuti Merati (Indonesia) Nenet Ortega (Philippines) Luechai Sringernyuang (Thailand) Yang Yi & Zhang Kong Lai (China) Ford Foundation supported

Stigma: 

Stigma A deeply discrediting attribute that devalues the person in the eyes of others

Discrimination: 

Discrimination Any form of distinction, exclusion or restriction affecting a person, usually, but not only, by virtue of an inherent personal characteristic (UNAIDS, 2000, p. 7)

Stigma & Discrimination: 

Stigma & Discrimination Discrimination as the “action arm” of stigma Stigma Discrimination

For HIV…: 

For HIV… HIV/AIDS-Related Stigma: “a ‘process of devaluation’ of people either living with or associated with HIV/AIDS”. (UNAIDS) HIV/AIDS-related Discrimination: “Discrimination follows stigma and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status”. (UNAIDS)

Slide7: 

“Stigma and discrimination associated with HIV and AIDS are the greatest barriers to preventing further infections, providing adequate care, support and treatment and alleviating impact.” Aggleton & Parker (2002, p.5)

Slide8: 

“Stigma and discrimination associated with HIV and AIDS are the greatest barriers to preventing further infections, providing adequate care, support and treatment and alleviating impact.” Aggleton & Parker (2002, p.5)

Slide9: 

“Stigma and discrimination associated with HIV and AIDS are the greatest barriers to preventing further infections, providing adequate care, support and treatment and alleviating impact.” Aggleton & Parker (2002, p.5)

Two Contentions about Stigma: 

Two Contentions about Stigma Greatest barrier to preventing further infections Negative impact on treatment care and support

So, I’m going to focus on the negative impact for PLWHA…: 

So, I’m going to focus on the negative impact for PLWHA…

A six country study of HIV relate discrimination: 

A six country study of HIV relate discrimination Institutional Discrimination China India Indonesia Philippines Thailand Vietnam AIDS Care, 2005; Vol 17(Suppl 2)

For PLWHA “HIV Stigma” Can Affect Everything: 

For PLWHA “HIV Stigma” Can Affect Everything Housing Education Employment Healthcare

“HIV Stigma” and Healthcare: 

“HIV Stigma” and Healthcare Reduced access Specialist hospitals (China) Refusal to treat (Indonesia) Results in poorer treatment Hospital nurses and orderlies (Thailand) Testing without consent without counselling

But…: 

But… What do we mean by “HIV Stigma” (or Discrimination)? It is talked of as a singular thing And interventions target that thing

Slide16: 

HIV Stigma

Aims: 

Aims To disentangle the layering of “HIV/AIDS related stigma” in the health care context; specifically: How much of the “HIV stigma” is actually attributable to co-stigmas? What are the strength of the co-stigmas? Can stigma be reduced with knowledge about modes disease transmission?

The Research: 

The Research Based in Guangzhou 360 medical students A survey Repeated in Thailand with nurses and nursing students Substantially similar results

Vignettes: 

Vignettes Wang is a bright young man with many talents. He was considered to be a dutiful son to his parents, and a kind, selfless and responsible person by everyone who knew him. Over the past six months, Wang developed a range of health problems including fatigue, physical decline and recurrent infections. He learned from his doctor that he was seriously ill, and his family and friends were said to have difficulty adjusting to his life-threatening illness. Wang was diagnosed with [AIDS or leukaemia]. No co-characteristic/blood transfusion/IDU/CSW/blood sale

Slide20: 

Social Distance If you were a friend of Wang’s, would you be willing to continue the friendship at this time? Would you allow your children to visit Wang in his home? Knowledge about HIV/AIDS Transmission routes

Knowledge is uncorrelated or weakly positively correlated levels of stigma: 

Knowledge is uncorrelated or weakly positively correlated levels of stigma

Does Stigma Have a Social Purpose?: 

Does Stigma Have a Social Purpose? Inexplicable cruelty Social Glue Fear of infection Fear of economic loss Moral opprobrium and a loss of trust: CSW IDU MSM

Governments Use and Promote Stigma: 

Governments Use and Promote Stigma Australia’s refugee laws Exported to Europe Thailand’s treatment of IDUs Vietnam’s approach to HIV

The Vietnamese Experience: 

The Vietnamese Experience Six country study Confucian values Supporting the state Supporting the family Discrimination against PLWHA Discrimination against CSW/IDU “Locking” the epidemic in sub-groups

Stigma and Counselling: 

Stigma and Counselling Counsellors themselves may stigmatise Counsellors should try to reduce stigma towards PLWHA Counsellors work with PLWHA to develop their skills in dealing with stigma To access counseling may identify a person as potentially HIV positive

Caveats: 

Caveats The layering of HIV stigma may vary according to the nature of the epidemic The “Laws” of HIV are rarely universal Poverty, Gender, Spread “Self stigma”

Thank you: 

Thank you