Addressing Stigma and Discrimination HIV Care, Support, and Treatment

Introduction and Definition HIV-related stigma and discrimination is a process of devaluation of people living with or associated with HIV. Stigma is linked to power and domination in society as a whole and reinforces inequality. When stigma is acted upon, the result is discrimination.

Causes of HIV-Related Stigma and Discrimination Blame: “PLHIV did something wrong” Moral judgments or biases Fear: Life-threatening illness, death, visible debilitation Misinformation: HIV transmission, treatment efficacy Existing social inequalities: race, gender, ethnicity, profession, sexuality

Forms of HIV-Related Stigma and Discrimination Those infected or suspected to be infected Stigma-by-association Self-stigma/internalized stigma Discrimination Arbitrary distinction, exclusion, restriction Takes place in family, community, institutional, national settings

Causes of TB-related Stigma and Discrimination Perceived risk of transmission Association with HIV, urban poverty, overcrowding, physical frailty, low social class, malnutrition, “disreputable behavior” Impact on women, poor, less-educated High death rate

Stigma and Discrimination and Care, Support, and Treatment Major barrier deterring PLHIV from Voluntary testing Access and retention in care and support services across the Continuum of Care Treatment adherence Non-disclosure Self-stigma

Stigma and Discrimination and Care, Support, and Treatment At the same time, despite challenges, CST helps address HIV stigma and discrimination: Care and support acknowledges reality of HIV; demonstrates shared concern and that close and sustained contact does not pose risk of infection Recruiting and training PLHIV Access to treatment enables PLHIV to live positively and productively; encourages testing for HIV

Analyzing and Taking Action Social Ecological Model

Evidence-based Practices to Address Stigma and Discrimination Training and involvement of PLHIV as advocates and role models Mobilization of influential community leaders, especially religious leaders Community engagement through participatory, nonformal education (community dialogue, local radio, and other media, forum theatre that engages the audience, etc.)