The Impact of Stigma on HIV Care Access in the African American Community David P. Lee, MSW, MPH, LICSW African Americans Reach and Teach Health Ministry & Northwest AIDS Education and Training Center Seattle, Washington

About the Sponsors African Americans Reach and Teach Health (AARTH) Ministry. The Northwest AIDS Education and Training Center.

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Introductions  What is your name?  What is your profession?  What are you hoping to learn in this training?

Define stigma and discrimination. Identify the basis for HIV/AIDS stigma. Describe how HIV stigma manifest in the African American community. Discuss the impact of HIV stigma on care access for African Americans. Explore strategies to reduce HIV/AIDS stigma and stigmatizing practices in African Americans. Learning Objectives

QUESTION What is the definition of sigma?

Definition of Stigma Stigma is a discrediting mark or attribute of shame. It is a feeling of undesirability that an individual possesses, thus reducing that individual’s self- esteem and status both in their own eyes and those of society.

Definition of Stigma Stigma often arises from a dynamic process in which community and/or society perceives that there has been a violation of shared attitudes, beliefs and values by the stigmatized individual, his/her group, significant others and associates.

QUESTION What is the definition of discrimination?

Definition of Discrimination Discrimination is a specific prejudicial act that is specific to a distinct stigmatizing mark, theory, fear or perception. It is a distinctive act based on prejudice, emanating from distinguishing features of stigma.

Identify Basis for HIV/AIDS Stigma

HIV/AIDS Stigma Homosexuality Substance use Sex workers Injection drug users Minorities

Stigma Manifestations

Institutionalized Stigma Institutionalized stigma is when an institution, such as a hospital or church, practices stigma either actively or passively.

Example Give 2 examples of institutionalized stigma.

The acting out of stigmatizing attitudes directed towards an individual. It can be done by one person or a group of people directed at an individual or done to oneself based on negative societal attitudes and perceptions. Individualized Stigma

Example Give 2 examples of individualized stigma.

Impact of Stigma on Care Access

Impact of Stigma on care access Avoid HIV testing and treatment Less likely to disclose HIV status Access care late in disease process Refuse to take HIV medications

Strategies to Reduce Stigma

List 5 strategies to reduce HIV stigma and stigmatizing practices in African Americans. EXERCISE

Summary Stigma is defined and differs from discrimination. HIV stigma manifests in the African American community in many ways. Stigma impacts the way that African Americans access HIV care. Several strategies are effective in reducing HIV stigma in African Americans.

QUESTION How will you be able to use what we talked about today in your own work?

Additional Resources David P. Lee – AARTH

NAPWA Facts At-A-Glance: HIV/AIDS Stigma and Discrimination, National Association of People with AIDS, HIV, Stigma, and Rates of Infection: A Rumor without Evidence, Daniel D. Reidpath, PLoS Medicine, October Stigma, Distrust, Fear, Kai Wright, HIVPLUSMAG.COM, HIV/AIDS Stigma: An Impediment to Public Health, Ronald O. Valdiserri, American Journal of Public Health, Additional Reading