6th Regional Conference in Sarajevo, May 17-18 2012.

1. Perception of stigma and
discrimination among PLHIV and
related attitudes of MARPs
toward PLHIV in Serbia
Sladjana Baros, IPH of Serbia / NHAO
Tanja Knezevic, MD PhD
Prof. Viktorija Cucic, MD PhD

2. Stigma
• Greek – body sign / later – ashamed
• Attitude based on prejudices
• Marking the difference, discrediting and isolating the
persons based on the mark of difference
• The Person = 1 characteristic mark of
difference

3. Discrimination
• Act, behavior – positive or negative.
• Making difference, unequal acting based on: race,
ethnicity, citizenship, religion, language, sex, gender, sex
orientation, health condition, age etc.
• Be free from discrimination – one of the basic human
rights
• Sigma, discrimination, human rights violation are
connected and mutually strengthened

4. (Bio)BSS among MARPs and PLHIV, 2010
Sample Sample
• Carrier: Population Methodology Location
size size
Ministry of Health 1.
IDUs Bio-BSS, RDS Belgrade 371
571
Nis 200
MSM Bio-BSS, Snowball Belgrade 280
480
• Implementation:
2.
sampling
Novi Sad 200
IPH of Serbia 3. SWs Bio-BSS, Snowball
sampling
Belgrade 250
250
Roma Youth Bio-BSS, RDS Belgrade 270
4.
Kragujevac 140 410
• Included
indicators related 5.
Institutionalize BSS, cluster study 14 cities in 269
269
to: d children RS
Prisoners BSS, cluster study 14 cities in 599
– Stigma of MARPs 6.
RS
599
toward PLHIV PLHIV BSS, quota sampling Belgrade 230
– Experience of 7. Novi Sad 50 296
stigma and Qualitative study Belgrade 16
discrimination Total Number of Respondents 2875
among PLHIV

5. Stigma toward PLHIV
“It’s theirs own fault” “PLHIV should be
isolated”

6. PLHIV: Stigma & Discrimination vs. Self-
Stigmatization
• Self-Stigmatization: Quilt, Shame, Other

7. Experience of Stigma & Discrimination in the last 12 months
related to HIV status
Among those 21.8%:
37.7% - Gossip, ribbing
31.1% - avoided by people
31.1% - denied services in the
institution (social, health and/or
educational service)
22.9% - family’s inconveniences
18% - social isolation
16.4% - abandoned by partner
14.7% - inconveniences with
colleges
11.5% - insults
6.5% - banned from some places
4.9% - violence
4.9% - physical isolation

8. Experience of the Discrimination in the HC Institutions
because of HIV status

9. Fear of HIV status disclosure in the Community (1)
• Medical treatment and follow up as the risk of disclosure
• Reasons for not using the services of Clinics for Infective Diseases:
– Bureaucracy and social exposure related to request for periodical medical
referral
Because I didn’t felt quite well, I’ve started with therapy. I was 6 months on
therapy and after that I stopped, cause it was very hard for me to come there
for… Cause I have to finish to much papers in 555 for coming to doctor NN. See,
first, I have to go to my general physician, then to specialist for infective diseases
in 555, then on the firs level Commission, and then after all of that I can go at the
Clinic. That have taking too much of my time. And it has badgered me. I have the
fear that somebody will find out… It’s too many people included in all of that…
coming to doctor who actually treat me. I mean, that’s what is actually bothering
me. But, as I said, I was have to go cause I was felt bad. However, afterward,
probably with therapy, my condition was better and then I decided to stop, cause
I didn’t could stand that…

10. Fear of HIV status disclosure in the Community (2)
– Complications at the work place due to medical
referral
• Free days are needed every months or every three months
Did you have problems on the job if you go…? Yes. I
have. It’s because I didn’t ever, for the 4 years, I never
was sick, I didn’t have any absences from work, except
for the vacation and holidays… Now… He (employer)
told me something like - that in the past time for 13
days I’ve wasn’t on the work because some health
problems that I apparently have. He doesn’t know
what’s wrong with me… And… He will take these days
from my vacation. Yep. And now, the last time I wasn’t
personally go to take my therapy… Instead of me,
people from the Organization did go.

11. Fear of HIV status disclosure in the Community (3)
• Perceived lack of discretion on the Clinic:
– Other patients, students
One Department of one Clinic is working on the problem… on the illness which
so many people have. That problem is a serious question… How to everyone
provide the privacy… I don’t want… I understand that, so I don’t want to look
as stupid and to talk nonsense bat… The fact is that they have very short
working time with the patients. The fact is that their range of working hours is
from sometimes 8AM, sometimes 9 AM, 10 AM to 12, 1 PM… And, I suppose
that is why the big crowd is over there. If they would work from earlier hours to
the later hours… then, probably, the crowd wouldn’t be so big and the people
would be less in situation to meet each other. But, probably, there have lack of
personal… A lot of things are lacking there… I suppose also that not too many
people want to work on the 6. Department…

12. Disclosure of status to others then clinicians

13. Know there is the Low on Prohibition of
Discrimination (2009)
20.7% PLHIV think that the
Low will have influence on
their social position
41.8% PLHIV think that Low
will not change anything
37.5% PLHIV – don’t know will
the Low have some influence
on their lives or not.
Special cases of discrimination (health, labor)
Commissioner for Protection of Equality

14. Conclusions
• Stigma and discrimination toward PLHIV is present,
as well as auto-stigma among PLHIV.
• MARPs are showing the stigmatizing attitudes
toward PLHIV.
• PLHIV are perceiving stigma in different institutions.
– Still, there is uncertainty of perception of discrimination
among PLHIV, probably due to lack of familiarity with their
rights.
• Health consequences of stigma and discrimination
can be
– direct – refuse to seek health protection, and
– indirect – obstacle for social integration of PLHIV and
prevention.

15. Recommendations
• development and improvement of programs of psychosocial and
legal support focused on strengthening PLHIV;
• programs for reducing stigma and discrimination toward PLHIV
among MARPs;
• programs for social inclusion of PLHIV;
• Simplify procedures related to obtaining medical referral
• improvement of working conditions at Clinics to be more user
friendly;
• sensitization and CB of health workers;
• campaign for reducing stigma and discrimination in generally.

16. Sladjana Baroš
National HIV/AIDS Office
Institute of Public Health of Serbia
„Dr Milan Jovanovic Batut“
Tel/fax: +381 11 2062 749
E-mail:
sladjana_baros@batut.org.rs