1. EFFECTS OF HIV/AIDS STIGMA AND DISCRIMINATION ON HOUSEHOLD FOOD SECURITY Kolliesuah, Nelson Papi BSC-PSS; CU – Liberia REG: 18/X/2848/MFN 1

2. OUTLINES Background Concept and definition of Stigma and discrimination Forms of Stigma Consequences of Stigma and Discrimination: Context of Household Food security Impact on Food Availability Impact on Food Access Impacts on Food Utilization Conclusion Addressing stigma and Discrimination/Recommendations References 2

3. Background Globally, 36.9 PLWHA; one in every 25 adults (4.1%) living with HIV in Africa (WHO, 2018) For decades, as countries try to respond to the epidemic, stigma, discrimination and denial remain less of priority (Parker & Aggleton, 2003) PLWHA are often discriminated due to stigma Cognizant of this, household food security cannot be achieved in the presence of stigma, discrimination and denial – a concern for actions (Baylies, 2002) 3

4. Background The work aimed at: A. unveiling the sources of and all forms of stigma and discrimination B. its impact on household food security C.strategies that can be adopted my nations of the world to feed a hungry planet in the context of the prevailing circumstance 4

5. Concept of HIV/AIDS stigmatization and Discrimination Stigma derives from a Greek word referring to a tattoo mark Gilmore & Somerville, (1994) indicated it has two meanings, bodily mark from biblical context and marks of disgrace, discredit, or infamy(evil) Today, Stigma is applied more to social disgrace than to any bodily signs (Mbonu, Borne, & Vries, 2009) Stigma refers to the devalued status that society attaches to a condition or attribute (Kabbash, Ali, Elgendy, Abdrabo, & Salem, 2016) 5

6. Concept of HIV/AIDS stigmatization and Discrimination Stigma is a social construct – People deserve it (Chariyalertsak, Konda, & Celentano, 2008) People associated with sexual promiscuity, drug use, and homosexuality are particularly vulnerable to stigma Women are the most vulnerable, often called vectors, diseased, and prostitutes (Ndinda, Chimbwete, Mcgrath, Pool, & Group, 2007) 6

7. Discrimination The end result of stigma is discrimination Occurs when individual is treated unfairly and unjustly – concept of deviance (Deng, Li, Sringernyuang, & Zhang, 2007; Parker & Aggleton, 2003) It is any form of arbitrary distinction (not backed by laws), exclusion, or restriction affecting a person (UNAIDS,2000) 7

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9. Forms of Stigma Self-stigma/internalized stigma: self blame due to fear of disclosing their status (Larson, Story, & Nelson, 2009; Ndinda et al., 2007; Vanlandingham, 2005) Governmental stigma: Country’s discriminatory laws, rules and policies regarding HIV – Screening, testing, treatment, limitation to certain employment, travel and migration (UNAIDS, 2000; Parker & Aggleton, 2003) 9

10. Governmental Stigma Statistics 35 countries Laws that restrict entry and stay 17 Countries Deported individual because of Status 4 countries 5 Countries Required individual to prove HIV- before entry complete entry band on people (UNAIDS, 2015 ) 10

11. Forms of Stigma Healthcare System stigma: Mandatory HIV testing without consent or appropriate counselling Minimal contact with or care Isolation of PLWHA from other Disclosure of a person’s HIV status to other – compromised confidentiality (Chang, Prytherch, & Nesbitt, 2013) 11

12. Forms of Stigma Employment and workplace Stigma Social isolation and ridicule from work mates Termination or refusal of employment(Ministry of Health Jamaica, 2014) Pre-employment screening 12

13. Employment and Workplace Stigma Statistics Estonia – 8% Nigeria – 45% Lost Job due to status Mexico – 5% Nigeria – 27 % Denied access to work Kenya – 28% Nature of work changed Experienced Discriminatory reactions Malaysia – 54% HIV Justice Network, 2012 13

14. Forms of Stigma Community and Household level stigma Fear of contracting HIV – leads to humiliation Perception that HIV is a life threatening disease Fear to loose survival in community Isolation from community activities Lack of support from community members 14

15. Consequences of Discrimination: Context of Household Food Security Impacts on Food availability: physical availability of food Low capacity to work - cultivate the soil Low production – denial of access to land, labor (Communal farming) and capital Low access to information – fear from extensions workers Lack of access to improved varieties and breeds – susceptibility to shock in climatic patterns Encapsulation into poverty traps 15

16. Consequences of Discrimination: Context of Household Food Security Impacts on Food access: Obtained from production, purchase or others sources (gifts, transfers) limited access to community networks, markets and trade associations – reducing potential for acquiring food: poverty distorts chances Lower production and purchase - decline in income (Employment and market) Reduced opportunity to community benefits – social safety nets/political capital (Bishop et al., 2006) 16

17. Consequences of Discrimination: Context of Household Food Security Impacts on food Utilization consumption of poor diet Reduced support to health care services Lower food intake – Internalized: loss of appetite which retard nutrients absorption Micronutrient deficiencies leading to opportunistic infections (Anabwani, Ch, & Navario, 2005) Increased stunting and wasting among children Reduced performance at school 17

18. Conclusion Stigma leads to discrimination Discrimination delivers no advantage but consistently increase the pool of poverty and hunger globally Stigmatization and discrimination at all levels undermines states’ social capital- destabilizing families, communities, business and national economies Fight against Stigma and discrimination must be holistic 18

19. Addressing stigmatization and Discrimination/Recommendations Anti-discrimination policy supported by a law covering health care, employment etc. and effective enforcement mechanisms (UNAIDS, 2000) communication campaigns in the public domain (Parker & Aggleton, 2003) Foster discriminatory policy in health system: Confidentiality Psycho-social counselling Greater attention to gender based nature of HIV/AIDS stigma Address double standards and access to lands (Parker & Aggleton, 2003; UNAIDS, 2000) 19

20. References Anabwani, G., Ch, B., & Navario, P. (2005). Nutrition and HIV / AIDS in sub-Saharan Africa : an overview, 21, 96–99. https://doi.org/10.1016/j.nut.2004.09.013 Avert. (2018). HIV Stigma and Discrimination Why is there stigma around HIV and AIDS ? Whenever AIDS has won, stigma, shame, distrust, discrimination How stigma affects people living with HIV My daughter refused to go hospital to receive medicines. My. Baylies, C. (2002). The Impact of AIDS on Rural Households in Africa : A Shock Like Any Other ? Institute of Social Studies, Blackwell Publishers, 33(4), 611–632 20

21. References Bishop, C., Senefeld, S., Weinhaue, K., & Natalie, K. L. (2006). Nutrition and Food Security for People Living with HIV and AIDS Ministry of Health Jamaica. (2014). GLOBAL AIDS RESPONSE PROGRESS REPORT Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination : a conceptual framework and implications for action, 57, 13–24. UNAIDS. (2000). stigmatization, discrimination and denial : forms, contexts and determinants Research studies from Uganda and India. Women of the Asia Pacific Network of PLWHA. (2012). A study on access to reproductive and maternal health care for women living with HIV in Asia. 21

22. Take Home Messages 22

23. Thanks for Listening! Questions??? 23