POSITIVE LIVING, STIGMA AND DISCRIMINATION.
Transcript of POSITIVE LIVING, STIGMA AND DISCRIMINATION.
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POSITIVE LIVING, STIGMA
AND DISCRIMINATION.
Dr stephen Watiti,
Mildmay Uganda.
256 772 638466
19/04/2011
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POSITIVE LIVING Accepting the diagnosis that one is HIV +ve, or
coming to terms with that fact should come first.
It is about a positive attitude toward onessituation; the attitude that there are a lot of
things I can do to make my situation better and I
am willing to take up the challenge.
Once these two issues are resolved then we can
talk of unpacking the whole concept of positive
living
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POSITIVE LIVING contd The TASO philosophy of positive living is well articulated
in their brochures and includesSeeking counselling & promptmedical treatment including adherence to ART
Practicing safer sex Carrying on with a normal life style e.g continuing to earn an income
Regular taking of a balanced diet
Use of Basic Care package commonly associated with PSI andavoiding harmful practices
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STIGMA, DENIAL &
DISCRIMINATION Stigma:
Stigma can be defined as anything that
significantly discredits an individual or agroup of people in the eyes of others. It is asign of shame.
Denial:
Denial is a state that something is not true ordoes not exist. Denial usually comes as away people respond to being stigmatised
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STIGMA, DENIAL &
DISCRIMINATION (Contd) Discrimination occurs when a distinction is made
against a person that results in his or her beingtreated unfairly and unjustly on the basis of theirbelonging,or being perceived to belong,to aparticular group.
It can be an act of either silence or exclusion ofPLHIV from our normal agenda. This limits our
ability to get involved in their lives in a meaningfulway.
Discrimination is stigma put into action or acted
out
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STIGMA, DENIAL &
DISCRIMINATION (Contd) It follows that where there is a lot of stigma there
will also be a lot of denial and if there is denial it
complicates the fight against the spread of HIVin the population.
PLHIV will want to make others believe that they
are not infected and this has serious
implications in PMTCT, Discordance, Condomuse etc.
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SOURCES OF STIGMAThe perceptions and metaphors;
AIDS as Death
AIDS as Crime AIDS as Horror
AIDS as War
AIDS being linked to socially marginalisedgroups - commercial sex workers,MSM,Intravenous Drug Users e.t.c.
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FORMSOF
STIGMA
Self Stigma
Family Stigma
Stigmatisation of Children
Stigmatisation in Work places
Stigmatisation in Religious institutions
Stigmatisation in Health care facilities
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SELF STIGMA This is also called felt stigma or internal stigma. It is the way
you feel about yourself especially if you feel ashamed that
you are HIV +ve.
It affects the way people come to see themselves
They can isolate themselves.
Get depressed, refuse medicine & food, refuse to
look for help (can finally die) Self condemnation
Lack of self esteem
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FAMILY STIGMA Hidding the patient from neighbours, friends &
relatives
Fear to be seen with the patient
Can abandon a PLHIV in hospital or insist thathe/she travels aloneeven when he/she is too sick,
some patients die alone!
May want him/her dead quickly so as to get rid ofsource of shame, this might result in lack of care orproper treatment
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FAMILY STIGMA (Contd) Women might be chased with their children as
they are perceived as the ones who broughtAIDS in the family
Other patients are sent to the village to die
F
orcin
g peopl
eto writ
ewills so as to hav
ea wayof sharing property
Sharing ones HIV status can result in seriousmisunderstanding, that may end up in
divorce;family breaks up at a time when they
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STIGMATISATION OF
CHILDREN
Children not taken to school if discovered to be
HIV+ve
Some children discriminated by other children;thiscan cause children to run out of school or fail to
concentrate
Children unable to explain to their friends why theirparents are sickly or what their parents died of.
(need to be helped).
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STIGMATISATION OF
CHILDREN (Contd)
Others confused because they dont believe that
their parents are bad people (yet HIV is associated
with unacceptable behaviours among adults). Denying them treatment when sick (its a waste of
time)
Children on ART have poor adherence unless
disclosure and proper counselling have been done Children lack role models so they fear disclosure
and so take risks which can be fatal in the long run
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STIGMA IN WORKPLACES
Terminate from employment
Refuse to employ
Ostracized by colleagues if person is open abouthis/her HIV status.
Pre-employment screening (HIV testing)
Denying person friendship,handshake,hugs.
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STIGMA IN RELIGIOUS INST.
Ignoring the existance of AIDS and encouraging belief that thiscant happen to us
During preaching and public address, insensitive utterances e.gavoid immorality so that you dont die of HIV/AIDS with no mentionof other modes of HIV transmission (MTCT, blood transfusion,accident victims e.t.c.)
PLHIV are discriminated against e.g. cant preach, marry or be
ordained in ministry.
Restrictions of persons right to anonymity and confidentiality.e.gcompulsory testing and revealing of sero-status.
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STIGMA IN HEALTH CARE
FACILITIES
Denying patients care and support
With holding life saving drugs and treatment
Stigmatisation of health care providers that are HIV+ve
Failure to include ARVs on the list of essential drugs
E.T.C.
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STIGMA AND ART
ART involves not only availability of ARVs,butexpensive laboratory tests, which the patient maynot be able to afford and yet they cant make a loud
appeal for help!
Involves sharing HIV status with your family in orderto explain why you are taking drugs. Adherence andcompliance will always be poor in the face of stigma
Side effects of drugs e.g. nausea and vomiting,skinchanges,body fat redistribution,darkening of nails, etc.
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STIGMA AND ART (Contd)
People that are unwilling to share their HIV status wait until itstoo late and possibly die(this has often been true even with thosewho are economically able to buy the drugs)
Others have privately treated themselves and this has resulted inother serious conditions which could have been avoided (this isespecially true for health care providers)
Others have opted to privately have themselves treated andleave their spouses to die either for fear of telling them orrealising the money cannot go round.
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CONCLUSION
My personal experience is that the more youunderstand issues regarding stigma the more
you are empowered and equipped to manage it It is especially important for people who are HIV
negative or those who would like to think theyare, care givers, activists, and all those involvedin the battle against HIV/AIDS to understand theimplication of stigma in prevention, care, supportand treatment.
HIV/AIDS and the related stigma, thrive on fear,ignorance and secrecy. The best weapon
against these is information.