stigma

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. Understanding and Responding to HIV/AIDS-related stigma in the health sector

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Origins and causes of stigma and discrimination HIV/AIDS-related stigma and discrimination Stigma and discrimination in the health sector Suggested goals and activities Introduction This presentation contains the highlights of the publication “Understanding and Responding to HIV/AIDS-related stigma in the health sector” It covers the following topics: This report contains 108 sources of information (surveys, papers, interviews), including 21 from Latin American and the Caribbean

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The origin of the word is Greek and refers to the physical mark made by fire or with knives on individuals considered outsiders or inferiors. Today the physical marks have gone, but stigma remains, based on one or more factors, such as age, class, color, ethnicity, religion and sex. Origins and causes of stigma and discrimination STIGMA

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The original meaning of “discriminate” was to note differences. Currently it means to perpetrate an unjust action against individuals who belong to a particular group, in particular stigmatized groups DISCRIMINATION Origins and causes of stigma and discrimination

community discrimination actions or inaction in less formal contexts, such as the workplace or social settings such as a marketplace, sports center or bar: 

community discrimination actions or inaction in less formal contexts, such as the workplace or social settings such as a marketplace, sports center or bar legislative discrimination enshrined in law or policy While discrimination can take many forms, it is basically divided into two categories: community or legislative Origins and causes of stigma and discrimination

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Stigma and discrimination happen in a vicious cycle Origins and causes of stigma and discrimination

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Stigma has long been associated with diseases that provoke disfigurement, such as leprosy, and death such as cholera As the cause of both disfigurement and death, HIV/AIDS provides fertile ground for stigma to take root HIV/AIDS-related stigma and discrimination STIGMA AND HIV/AIDS

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The stigma and discrimination associated with men who have sex with men affects such men in two different ways – lack of services and reluctance to access services. AFFECTED GROUPS Women who sell sex are stigmatized in most societies, whether or not they have HIV. This stigma is often extended to women who contract HIV from their husbands or partners. HIV/AIDS-related stigma and discrimination

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Injecting drug users are often unable to access HIV/AIDS prevention and care services. Poor people with HIV are generally regarded as less “deserving”. Children with HIV who are orphaned or abandoned are seldom adopted in some communities, and those who are known to be HIV+ have been turned away from school. AFFECTED GROUPS HIV/AIDS-related stigma and discrimination

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Health workers themselves are also subject to HIV/AIDS-related stigma and discrimination. In the early years of the epidemic, infectologists – the physicians who worked mostly with people with AIDS – were themselves stigmatized and suffer discrimination and even threats from other physicians. In addition, health workers with HIV often are restrained to perform certain activities or to take safety measures that are not supported by the universal precaution guidelines. AFFECTED GROUPS HIV/AIDS-related stigma and discrimination

Stigma and discrimination in the health sector: 

In the Dominican Republic, nearly a third of surgeons in a 1994 study reported feeling anxiety over treating HIV patients, and one in 10 said they did not accept HIV-positive patients. (Nuñez et al 1995) Stigma and discrimination in the health sector WHAT THE STUDIES SAY (selected sample) In Venezuela, higher rates of discriminatory attitudes among dentists (45 %) and nurses (46 %) than among doctors and students (both 42 %). (Prieto Belisario 1996) In the city of Cochabamba, in Bolivia, high levels of ignorance about HIV/AIDS diagnosis and treatment among health workers. More than a third of 305 respondents were afraid of HIV/AIDS patients and believed they should be isolated. (Valdez Carrizo & Saudan, nd)

Stigma and discrimination in the health sector: 

“I used to say ‘I’m in pain.’ [The nurse] used to say ‘Well, that’s what you get for using drugs’” (Ireland: Surlis & Hyde 2001) “They don’t want to look after you because they say it’s a waste of money, you are going to die after all” (Botswana: ICN 2003) WHAT PATIENTS WITH HIV SAY Stigma and discrimination in the health sector “When I entered the program I did it as a heterosexual; my wife and children came. But two years passed and my homosexuality emerged. Then the treatment changed immediately” (Chile: Vivo Positivo 2002)

Stigma and discrimination in the health sector: 

Stigma and discrimination in the health sector FORMS OF DISCRMINATION IN THE HEALTH SECTOR Refusal to admit patients Treatment delayed or withheld Other forms of care (food, hygiene) delayed or withheld Non-attendance to patients in beds Testing without consent Breach of confidentiality Inappropriate comments or behavior Selective use of universal precautions Use of excessive precautions

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Finding: discriminatory attitudes in the society influence discrimination in the health sector Stigma and discrimination in the health sector According to the report, homophobia is one of the main sources of HIV-related discrimination influencing the health sector Discrimination in society Discrimination In health sector

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Finding: better knowledge of the means of HIV transmission reduces the fear of infection Stigma and discrimination in the health sector Surveys of health workers’ knowledge of HIV/AIDS reveal moderately high (over 10%) or high (over 20%) ignorance of this topic Fear Knowledge

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Finding: fear of casual contagion and fear of occupation exposure are different and require different responses universal precautions, training, post-exposure prophylaxis, voluntary counseling and testing accurate information and appropriate training Stigma and discrimination in the health sector

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Personal contact, combined with accurate knowledge of the disease, is a significant element in improving health workers’ attitudes and behavior towards people with HIV/AIDS. Stigma and discrimination in the health sector OTHER FINDINGS Personal contact Discrimination

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Health workers working with patients with chronic fatal conditions such as cancer and HIV/AIDS frequently suffer from burnout and develop negative or cynical attitudes about their patients. Stigma and discrimination in the health sector OTHER FINDINGS Discrimination Burnout

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Staff receiving appropriate knowledge and skills Conspiracy of silence and secrecy broken Supportive and safer workplaces created Adequate supplies and protective equipment provided Increased access to post-exposure care and treatment Appropriate policy and guidelines to govern interaction between health workers and patients (Codes of ethics and other) Reinforcement of the implementation of universal precautions Suggested goals and activities GOALS

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Training for all health workers, including information and building of practical and attitudinal skills Promotion of voluntary counseling, testing and care (including post-exposure prophylaxis) for all health workers Establishment of staff support groups Establishment of patient support groups Formulation of policies and legislation to protect people living with HIV/AIDS Suggested goals and activities ACTIVITIES

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A final message

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Part of a series of posters and other materials produced by PAHO to raise awareness of the problem

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“Science has yet to find a cure for AIDS. But there is a cure for discrimination in the health sector. It can be found in the thousands of health workers in the Americas”. Mirta Roses Director Pan American Health Organization

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“Understanding and Responding to HIV/AIDS-related stigma in the health sector”