STIGMA AND DISCRIMINATION AND IMPACT ON HIV AND TB Opoku Addo Sarkodie HIV Data Officer National AIDS/STI Control Programme Agona Government Hospital, Agona

Introduction HIV and TB-related stigma and discrimination have sizable impact on health and are recognized as a major difficult problem on people who are on ART and TB treatment in Ghana. Access to ART and TB treatment has increased in Ghana but related stigma and discrimination are still a major problem despite the increased access to ART and TB Treatment.

What is Stigma and discrimination? Stigma refers to unfavourable attitudes and beliefs directed toward someone or something. Discrimination is the treatment of an individual or group with partiality or prejudice. Socially marginalized people bear heaviest burden of HIV and TB-related stigma and discrimination.

HIV and TB-related stigma Unfavourable attitudes and beliefs toward people living with HIV and TB, those perceived to be infected, and their families, friends, social groups, and communities Stigma is greater when risk of contracting the disease is thought to be under the individual’s control (e.g., commercial sex workers)

HIV and TB-related Discrimination Community shuns women who decide not to breastfeed because it is assumed she is HIV or TB infected. Some Health Workers deny services to person with HIV and TB Individual loses his/her job when it is known he/she is HIV and TB- infected Family and children of people who died of HIV and TB are ostracized by community Individual has difficulty getting a job when revealed he/she is HIV or TB-infected

Where Does Stigma Occur?

Scopes of the Stigma Experience among people on ART and TB Treatment Different forms of HIV and TB-related stigma among people on ART and TB Treatment were experienced by participants including; verbal stigma, social stigma and perceived stigma (fear of stigma associated with disclosing HIV status) .

Scopes of discrimination experience among people on ART and TB Treatment Clients on ART and TB Treatment experienced various forms of discrimination, including: relational discrimination, mistreatment by health care workers, blame and rejection by spouses and workplace discrimination.

Personal stories from Participants “At times if you ask health care providers something they do not reply to your question. They invented to be busy and just neglect us. Occasionally they use offensive language against us and they are deferment giving services. They don’t value people on ART and TB Treatment anymore. When you arrive late to the clinic you are told that you will be moved closer to where you live . They use it as a way to threaten us because they know most of us are going away to avoid discrimination”

Personal stories from Participants cont. “After disclosing my HIV status to my husband, he sudden left the house and came home later to tell me to pack all my belongings and go to my relatives to take care of me since l am the source of the problem. He divorced me a week later when I went to my relatives”

Consequences of AIDS-related stigma and discrimination It causes human suffering due to: Loss of employment Loss of housing Rejection by family Hated by community Deprived of schooling Deprived of marriage Restrictions on movement -> Quarantine Physical and verbal abuse and threats and Interferes with HIV & TB prevention and treatment services

Health Consequences of HIV & TB Stigma Prevention - afraid to access prevention services and be identified as member of "at risk" group. - afraid to disclose positive serostatus to sex partner Treatment - afraid to disclose status to health care staff and not wanting to be seen at "AIDS clinic" Research - not wanting to identify as member of stigmatized group. Concerns of loss of confidentiality Care - unwilling to provide care for sick family member. Unwilling to go into AIDS treatment field Mental health consequences for PWAs: High rates of depression and suicide

Human Rights & HIV & TB-related Stigma and Discrimination Freedom from discrimination is a fundamental human right founded on the principles of natural justice. Discrimination against people living with HIV & TB or people thought to be infected is a clear violation of human rights.

Stigma interventions Few interventions to date No rigorous evaluations conducted Research suggests possible directions, but setting-specific formative work needed to ensure that local issues are addressed

Reducing HIV & TB stigma Targeting at multiple levels Policy: There should be Law and policy reforms needed to prohibit discrimination of PWAs and to protect those who are most vulnerable (e.g. sex workers, MSM, women, substance users, ethnic and racial minorities). Social: There should be Community-based programs, including media (as appropriate in each setting). Work through local NGOs Institutional: Military, schools, prisons, hospitals, and religious institutions and leaders.

Reducing HIV & TB stigma Families - provide support and education in whatever venue that is possible Mobilize and support positive people and encourage their involvement in activities and advocacy Couples - in whatever setting that couples can be reached, including testing and counseling Individuals - during healthcare visits, testing and counseling and other appropriate venues Recruit Opinion Leaders - educate and involve them

References  M Mhode (2013), Experiences and Impact of Stigma and Discrimination among People on Antiretroviral Therapy in Dar es Salaam Maria L Ekstrand, (2011), Center for AIDS Prevention Studies, University of California, San Francisco: Health Consequences of AIDS-related Stigma

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