1. The Stigma Faced by People Living with HIV/AIDS Joanne A. Cyr, PsyD Clinical Health Psychologist August 9 th, 2006, Journalist to Journalist Training on HIV/AIDS, In collaboration with the XVI International AIDS Conference in Toronto A Project of the NATIONAL PRESS FOUNDATION

2. Health Canada report on HIV?AIDS HIV is transmitted through: Unprotected sexual intercourse (vaginal, anal, oral) Unprotected sexual intercourse (vaginal, anal, oral) Shared needles or equipment for injecting drugs Shared needles or equipment for injecting drugs Unsterilized needles for tattooing, skin piercing or acupuncture Unsterilized needles for tattooing, skin piercing or acupuncture Pregnancy, delivery and breastfeeding (from an HIV-infected mother to her infant) Pregnancy, delivery and breastfeeding (from an HIV-infected mother to her infant) Occupational exposure in health care settings Occupational exposure in health care settings

3. Health Canada report on HIV/AIDS HIV CAN NOT be transmitted through: Casual, everyday contact Casual, everyday contact Shaking hands, hugging, kissing Shaking hands, hugging, kissing Coughs, sneezes Coughs, sneezes Giving blood Giving blood Swimming pools, toilet seats Swimming pools, toilet seats Sharing eating utensils, water fountains Sharing eating utensils, water fountains Mosquitoes, other insects, or animals Mosquitoes, other insects, or animals

4. Social Determinants of Health WHO 2003 Report 1. The Social Gradient 1. The Social Gradient 2. Stress 2. Stress 3. Early Life 3. Early Life 4. Social Exclusion 4. Social Exclusion 5. Work 5. Work

5. Social Determinants, cont’d 6. Unemployment 7. Social support 8. Addiction 9. Food 10. Transport

6. “Vulnerable Groups” Aboriginal population Aboriginal population Migrants & Refugees Migrants & Refugees Women Women People of Colour People of Colour Youth Youth Mentally Ill Mentally Ill Homeless Homeless Sex trade Workers Sex trade Workers Intra-venous drug users (IVDUs) Intra-venous drug users (IVDUs) Men who have sex with men (MSM) Men who have sex with men (MSM) Trauma Survivors Trauma Survivors

7. HIV-Related Stigma Fear of life-threatening illness Fear of life-threatening illness Fear of infection (instrumental) Fear of infection (instrumental) Fear of “lifestyle” associated with “taboo behaviours” (ie. IVDU, MSM) Fear of “lifestyle” associated with “taboo behaviours” (ie. IVDU, MSM) People being seen as responsible People being seen as responsible Religious/moral beliefs about punishment (shame & blame) Religious/moral beliefs about punishment (shame & blame) Misperceptions of “other” groups Misperceptions of “other” groups

8. Consequences of HIV-related stigma Refusal to seek HIV testing or treatment Refusal to seek HIV testing or treatment Deterioration in personal, social and familial relations Deterioration in personal, social and familial relations Negative emotions such as fear, guilt, grief, depression and anxiety Negative emotions such as fear, guilt, grief, depression and anxiety Loss of support, SOCIAL ISOLATION Loss of support, SOCIAL ISOLATION Lack of trust in health care providers Lack of trust in health care providers At the extreme discrimination, persecution, ostracization and violence At the extreme discrimination, persecution, ostracization and violence

9. Secondary Consequences Restriction in one’s rights Restriction in one’s rights Diminished capacity to advocate or negotiate for oneself Diminished capacity to advocate or negotiate for oneself Employment and housing problems Employment and housing problems Healthcare access issues Healthcare access issues Even, access to foreign countries Even, access to foreign countries Denial and avoidance of self-care and self-responsibility Denial and avoidance of self-care and self-responsibility

10. The US vs. THEM dilemna HIV/AIDS is a global issue affecting millions of people largely for financial and social reasons HIV/AIDS is a global issue affecting millions of people largely for financial and social reasons Where consistent access to HAART is available, HIV-related stigma is reduced Where consistent access to HAART is available, HIV-related stigma is reduced

11. Interventions “Understanding and Challenging HIV stigma: A Toolkit for Action” A Toolkit for Action” 1. Naming the Problem 2. More understanding and less fear 3. Sex, morality, shame and blame 4. Living and caring for PLHAs within family 5. PLHAs coping with stigma 6. Stigmatized children 7. Planning for Action www.changeproject.org/technical/hivaids/stigma.htm

12. UNAIDS (2002) Conceptual Framework for Basis of Action: HIV/AIDS Stigma and Discrimination Legal and Policy Decisions Legal and Policy Decisions Program and Service Interventions Program and Service Interventions Give accurate information about how HIV is and is not transmitted Give accurate information about how HIV is and is not transmitted Give people reliable tools and resources for overcoming fear and avoidance Give people reliable tools and resources for overcoming fear and avoidance Highlight the positive, and illustrate the destructive aspect of stigma Highlight the positive, and illustrate the destructive aspect of stigma

13. In Style and Delivery Be aware your own prejudices Be aware your own prejudices Convey messages in fact-based, neutral, non-value laden manner Convey messages in fact-based, neutral, non-value laden manner Encourage thought, discussion, questions, feedback. List resources where people can find accurate information or seek support Encourage thought, discussion, questions, feedback. List resources where people can find accurate information or seek support

14. PROMOTE NON-STIGMATIZING PRINCIPLES LIKE COMPASSION AND EQUAL RIGHTS FOR ALL

15. Respect confidentiality Appreciate the cultural framework Integrate Primary and Secondary Intervention