1. Stigma & discrimination associated
with HIV/AIDS
Department of
Population & Family health
22/10/2012
1

2. Presented by
 Liyew Mekonnen(2nd year reproductive
health speciality student)
2

3. Outline of the presentation
 Introduction
 Forms of stigma
 Contributing factor for stigma and
discrimination associated with HIV/AIDS
 The consequence of stigma and
discrimination associated with HIV/AIDS
3

4. Session objectives
At the end of this session you will be able
to
 Differentiate the term stigma and
discrimination associated with HIV/AIDS
 Identify different forms of stigma
associated with HIV/AIDS
 Explain different causes of stigma
associated with HIV/AIDS
 Identify the impact of stigma and
4 discrimination associated with HIV/AIDS

5. Introduction
 Stigma is defined as undesirable or
discrediting attribute that a person or
group possesses
 it is reduction of that person’s or group’s
status in the eye of the society.
 Stigma can result from
 physical characteristics, such as the
visible symptoms of the disease or
 from negative attitude toward the
5 behaviour of a group Such as

6. Intro….
 Discrimination which can be expressed
as both negative attitudes of particular
behaviour or action
 It is a distinction that is made about a
person that results in their being treated
unfairly and unjustly on the basis of their
belonging ,or being perceived to belong
to a particular group.
6

7. Stigma and discrimination associated
with HIV/AIDS
 HIV/AIDS-related stigma refers to
 prejudice,
 discounting,
 discrediting,
 and discrimination
 It is directed at people perceived to have
AIDS or HIV, and the groups and
communities with whom they are
associated (Herek, 1999).
7

8. Cont…
 UNAIDS defines HIV-related stigma and
discrimination as: "... a 'process of
devaluation' of people either living with or
associated with HIV and AIDS
 Discrimination follows stigma and is the
unfair and unjust treatment of an individual
based on his or her real or perceived HIV
status.((UNAIDS, 2003).
8

9. Stigma is experienced at the individual and
societal level
 At the individual level
 AIDS stigma takes the form of
behaviours, thoughts, and feelings that
express prejudice against people living
with HIV or AIDS, and can also be
experienced by persons perceived to be
living with HIV/AIDS.
 At the societal level,
 AIDS stigma is manifested in laws,
policies, popular discourse, and the social
9
conditions of persons living with

10. Forms of stigma can be categorized into
1. Physical
 Isolation
 Separating sleeping quarters
 Marking and separating eating utensils
 Separating clothing and bed linens
 No longer allowing person to eat meals
with family
 Confinement to certain rooms of house
10

11. Intro…
 Isolation
 No longer allowing person to participate in
housework (e.g. cooking food)
 Public rejection (refuse to sit next to person
on bus, bench, at church, tea shops or in
bars)
 Violence
 Beatings
 Being kicked
 Throwing stones
 Arrests
11

12. 2. Social
 Isolation
 Reduction of daily interactions with family
and community
 Exclusion from and shunning at family and
community events
 Loss of social networks
 Decreased visits from neighbors
12

13. Loss of identity/role
 Viewed and treated by community as
having no future
 No longer considered productive member
of society
 Automatically associated with “social evils”
(e.g., drug use, sex work)
 Loss of power, respect, and standing in
community
 Loss of right to make decisions about own
life
13
 Loss of marriage and childbearing

14. 3.Language/Verbal
 Gossip
 Speculation on how person acquired virus
 Spreading rumors
 Whispering behind back
 Taunting
 Insults
 Finger-pointing
 Threats
14

15. Cont…
 Expressions of blame and shame
 Scolding (e.g., blamed for not listening
to elders)
 Blamed for bringing “bad luck” to
whole family
15

16. Cont..
 Labelling and use of derogatory words to
describe people living with HIV or AIDS
 In Africa: “moving skeleton,” “walking corpse,”
16

17. 4. Institutional
 Loss of livelihood/future
 Loss of employment
 Loss of customers/business
 Denial of loans, scholarships, visas
 Loss of housing
 Denied housing
 Eviction by landlord
 Differential treatment in schools
 Teachers supporting the idea of separating
children of HIV+ people to “protect” other
17 students

18. Cont…
 Differential treatment in health are settings
 Shuffled between providers to avoid caring
for HIV+ patient
 Denial of health services
 Provision of substandard treatment
 Use of separate medical tools for people
with HIV or AIDS
 Place patients with HIV in separate rooms
18

19. Cont…
 Differential treatment in public spaces
 Refusal of services
 e.g., will not be served food by vendors
 or not served in shared containers
19

20. Cause of stigma and
discrimination
1. Knowledge and fears:
 Lack of Basic & in-depth knowledge
about HIV
 On research conducted in Ethiopia 2003
 a male respondent from the rural site in
Ethiopia says, “A healthy person might
be infected if he sleeps with PLHA and if
he uses an infected person’s needle and
plates and cups.”
20

21. Cont…
 Fears of casual transmission
 If the family suspected that one member
has the HIV/AIDS, they think that the cows
eat the grass in the compound and the
grass could have been contaminated by
the condom thrown in the field after use.
So if children drink milk produced in such
families, the children can be infected.
(Rural man, Ethiopia)
 Fear of death
21  Is a powerful fear of what is known to be a

22. Cont…
2. Sex, morality, shame and blame
 stigmatizing language and
discriminatory behaviour centers on
the sexual transmission of HIV.
 When asked why HIV is not
considered a “normal disease,” an
urban woman in Ethiopia replies,
“This is because it is transmitted
22 through sexual contact.”

23. Cont….
 Blame :Largely because of the belief
that youth lead a careless life and are
highly sexually active, young people are
blamed for getting HIV through their
promiscuous, immoral, and “improper”
behaviour.
23

24. Consequences of stigma and discrimination
associated with HIV/AIDS
 Private and public disclosure of HIV
status is limited
 Preventive behaviours, such as using
condoms, discussing safer sex with a
partner, and the prevention of mother-to-
child transmission, are not adopted
24

25. Cont…
 Care and support is often undermined when
accompanied by stigma,
 for example in the form of judgmental
attitudes and physical isolation; or in terms of
passing on an HIV patient from provider to
provider because none are willing to
administer treatment
 People with HIV and AIDS may experience
25
stigma when care is reduced over time

26. Cont…
 People who have HIV and AIDS may
delay care until very ill and travel farther
or pay more in search of non-
stigmatizing care
26

27. How Stigma and Discrimination
Impact Each Step in the PMTCT
Cascade
1. Initiating use of ANC
 As routine opt-out HIV testing becomes
standard and well-known in ANC clinics,
 women may avoid ANC services if they
fear HIV testing and lack of
confidentiality of HIV test results.
 women who are HIV positive or suspect
that they are may fear S&D from
healthcare workers during ANC.
27

28. 2.Being offered an HIV test
• Beyond the health system barriers to
offering an HIV test in ANC (lack of test
kits, workers not trained, other system
breakdowns), there is the potential for
health workers’ stigmatizing attitudes
and stereotypes about who is at risk of
HIV to affect who is offered HIV testing,
28 • Health workers may be uncomfortable

29. 3.Accepting an HIV test
Pregnant women may decline an HIV test
for fear of
• being HIV positive,
• unwanted disclosure if found to be
positive,
• and the S&D that may follow.
 In Ethiopia, only 47 percent of pregnant
women accepted HIV testing when offered,
and qualitative interviews revealed the key
role of fears of stigma in low testing uptake
29 (Balcha, Lecerof et al. 2011).

30. 4. Enrolling in PMTCT and/or HIV
treatment services
 Women may defer enrollment in these
services at the time of HIV testing, often
citing a need to go home and confer with
their husband, and then never return to the
health facility due to fears of HIV-related
stigma.
 In a study in Nairobi, stigma was the most
commonly cited barrier for HIV-positive
pregnant women’s failure to enroll in HIV
care (77%)(Otieno, Kohler et al. 2010).
30

31. 5. Adhering to ART and follow-up
visits during pregnancy
 Even if women do enroll in PMTCT
programs and/or HIV care Adherence
becomes difficult if women need to hide
HIV clinic visits and/or medications from
others
 In South Africa, pregnant women
described having to hide their PMTCT
medications from boyfriends, family
31 members, and employers (Mepham,

32. Cont…
 Cross sectional Study conducted in jimma university
hospital in 2007 among patients attending ART revealed
that
 The prevalence of disclosure concern and internalized
stigma were 231 (86.3%) and 232 (85.9%), respectively.
 245(90.7%) of the respondents reported a favorable
attitudinal change on stigma with access to antiretroviral
treatment.
 There was a statistically significant association between
duration of antiretroviral therapy and favourable effect of
access to antiretroviral therapy on stigma reduction
(p<0.005).
32

33. 6. Giving birth with a skilled attendant
 Fears about lack of confidentiality,
unwanted disclosure, and HIV-related
stigma may cause some women to
avoid childbirth in a health facility.
 In urban Kenya, fears of unwanted
disclosure and stigma from neighbors
contributed to HIV-positive women’s
decisions to give birth at home(Awiti
33 Ujiji, Ekstrom et al. 2011).

34. 7. Adhering to recommended infant
feeding practices
 Women may fear that following an infant
feeding regime that is not the cultural
norm/standard (e.g., exclusive
breastfeeding or formula feeding) will
lead to disclosure of HIV status.
 In Kenya, HIV-positive women who did
not stop breastfeeding at 6 months as
34 recommended were most concerned

35. 8. Bringing infant in for HIV testing
 Stigma directed toward adult caregivers
may translate into delays in seeking
testing and care for infants.
35

36. 9. Adhering to maternal and infant
follow-up visits and ART after the
birth
 After the birth, fears of stigma and
discrimination can again be barriers to
adherence to ART for infant and/or self,
due to the need to hide visits and/or
medications from others.
 In Rwanda, infants of women who had
not disclosed their HIV status to
someone other than a partner were less
36 likely to have received infant nevirapine

37. HIV/AIDS doesn’t discriminate;
people do
37

38. Reference
1. Evelyn P. Tomaszewski, MSW,UNDERSTANDING
HIV/AIDS STIGMA AND DISCRIMINATION. HUMAN RIGHTS
AND INTERNATIONAL AFFAIRS DIVISION, March 2012
2. Janet Turan, Laura Nyblade, and Philippe Monfiston3,AND
DISCRIMINATION: KEY BARRIERS TO ACHIEVING GLOBAL
GOALS FOR MATERNAL HEALTH AND ELIMINATION OF
NEW CHILD HIV INFECTIONS, Health Policy Project ,july 2012
3. Laura Nyblade , Rohini Pande ,Aklilu Kidanu et
al ,Disentangling HIV and AIDS stigma in
Ethiopia ,Tanzania and Zambia. International
Center for Research on Women (ICRW),2003
38

39. Reference….
4. Richard Parker,Peter Aggleton et al, HIV/AIDS-
related Stigma and Discrimination: A Conceptual
Framework and an Agenda for Action, Horizons
Program,2002
5. Ross Kidd and Sue Clay ,UNDERSTANDING
AND CHALLENGING HIV STIGMA, international
research center on women, September 2003
6.Theodros S. et al Stigma Against People
Living with HIV/AIDS Ethiopian journal of health
science, July 2008 Vol. 18, No.2
39

40. Thank you!!!
40