1. STIGMA IN THE ERA OF HIV/AIDS AND ITS CONSEQUENCES FOR PUBLIC POLICY
DR. SHEILA NDYANABANGI
PMO- MENTAL HEALTH
MINISTRY OF HEALTH

2. INTRODUCTION
Following decades of dealing with the devasting epidemic of HIV/AIDS the world celebrated the discovery of ARV treatment.
Although the scaling up of ART has restored hope of life to the population, despite HIV/AIDS, stigma remains a key barrier to delivery of quality HIV/AIDS services, utilization of the services as well as prevention of further transmission.
Stigma in the context of HIV/AIDS has varied definition by different people.

3. Continuation
It is a powerful , discrediting and tainting social label that radically changes the way individuals view themselves and are viewed by others.
Stigma is associated with feeling of low value, exclusion , disadvantage and usually leads to discrimination.
Stigma causes suffering and associated with shame and silence.

4. How does stigma manifest?
Neglecting PLWHA and PLWHA can also neglect responsibilities .
Fearing to be infected, person looked at as contagious by others
Avoiding e.g. People not wanting to interact in social setting or community
Rejection – by relatives, husbands or wives
Labeling- making reference to a person using their HIV status
Neglecting- service e.g. mother with HIV in labour- babies have fallen down etc.
1/11/2019

5. contd Abusing- referring to an HIV status as an abuse
Gossiping- when seen at HIV clinic – inform the whole village- even health workers gossip
Self stigma- PLWHA devaluing themselves
Social withdrawal- avoid interaction for fear of reaction of others including from sex in marriage
Self exclusion- decide to live lonely life
Fear of disclosure of ones HIV status, leading to further transmission to partners

6. Effects of stigma
Affects preventive behaviour- leading to continued transmission. Even condoms are stigmatized (even if for FP)
Taking on risky behaviour in retaliation to stigma
Fear of testing for fear of being identified and the consequences
Reduced access to care and treatment e.g. HIV clinics with limited confidentiality – whole community knows the HIV clinic e.g Mild May
Decreased access to HIV prevention services e.g. PMTCT(mothers fear break up if husband or in- laws knows)

7. contd
Distress leading to chronic stress of vulnerable PLWHA leading to mental problems e.g. anxiety disorders, depression, psychosis and suicide
Gender based violence- accused of infecting spouse etc
Discrimination e.g. in schools for children and adolescents, workplace (denied promotion)discrimination in political settings (denial of political office)

8. contd
PLWA may fear demanding their rights due to stigma and may not access justice
Affects adherence to treatment- hiding ARVs, irregular taking of medicine or missing treatment dates of appointment

9. Causes of stigma
Lack of adequate knowledge on transmission , course of HIV especially with the advent of ARVs. A lot not disclosed to public e.g. is it every encounter with PLWHA that one is infected? or knowledge of prophylaxis for rape victims
The false explanatory model of immorality being the main factor in religious and cultural structures
A safe environment of management of HIV- no confidentiality and poor protection for health workers.
Separating the HIV clinic so that people equate going to that clinic with having HIV/AIDS.

10. Continuation
Are the current HR equipped to deal with stigma and its effects?
Is the training received by counselors which emphasize behavior change in HIV/AIDS adequate to address the consequences of stigma.
Does the current data collection system for data on HIV/AIDS pick issues of stigma and its consequences?
Include impact of denial of sex by spouses with HIV/AIDS.

11. Consequences for public policy
Some interventions have been attempted but addressing stigma has not been prioritized despite the fact that it’s the biggest barrier to HIV management currently
Most interventions used, not adequately evaluated for their impact in reducing stigma

12. Proposed interventions
Provide accurate and complete information to the public and all Health Workers regarding transmission , nature and course of HIV e.g. issues of discordance not loudly talked about
Review settings of HIV/AIDS management in health care settings. Issues of confidentiality, integration of HIV/AIDS in general care versus massive HIV/AIDS clinics that deny privacy
Empowering PLWHA with life skills to confront stigma including their rights, do we need a law?

13. contd
Livelihood programs for vulnerable PLWHA e.g. poor , women likely to suffer domestic violence or separation. Is there a fund to support such cases?
Education programs for school children on stigma and its effects and rights of children with HIV/AIDS to keep them in school. School management to be liable to ensuring a positive environment
More research on innovative methods which are cost effective such as interpersonal group approaches to deal with stigma including self stigma
Community dialogue on HIV/AIDS to increase knowledge and demystify HIV /AIDS

14. contd
Engage religious and cultural institutions on stigma and its effects to counteract the beliefs about immorality and HIV/AIDS
The institutions should be encouraged to de- campaign stigma discrimination of PLWHA and provide for a for self support through fellowships
Address mental health problems which causes double stigma by regular screening and management of those problems in HIV treatment services

15. Conclusion
Uganda is seeing an increase in HIV/AIDS cases despite previous success in massively reducing prevalence
The focus on ART without appropriate interventions to address stigma and its effects is likely to rob us of our success
There is need to study and establish innovative interventions that are contextually relevant to sustain and increase gains in the HIV/AIDS war, including addressing stigma