Jesse is a 22-year-old man who tested positive for HIV two years ago. His suspicions are that hes been HIV positive since his adolescence. You are the peer worker assigned to help Jesse with a
HIVAIDS IN SOCIETY
Discussion Forum- HIV Stigmas & Cultural Barriers
Discussion Topic
For this week's discussion, students are to read the below scenario and answer the following questions:
Scenario:
Jesse is a 22-year-old man who tested positive for HIV two years ago. His suspicions are that he’s been HIV positive since his adolescence. You are the peer worker assigned to help Jesse with adherence issues. You have been seeing him for the past nine months. During the sessions, he has shared his concerns about his increase in alcohol/drug use and depression. Over the past month, Jesse has frequently mentioned his fear of failing his HAART regimen.
The thought of having to switch medications because of failing his current regimen has caused Jesse to feel depressed; he has been on the current regimen for one year. The combination of fear of failing his HIV treatment in addition to disappointing his doctor has caused Jesse’s depression to worsen. Over the past nine months, Jesse has also been concerned with his body image. Although he works out in the gym regularly with weights, he’s never satisfied with his physique. He has noticed changes in body fat buildup throughout his body, loss of fat in the face area, and his limbs have thinned. Jesse has also expressed concern about the effects of long-term treatment. Jesse recently read an article in an HIV/AIDS magazine that heart disease is another side effect of long-term treatment.
Besides his cousin, Jesse does not have anyone else he can talk to about his HIV status. But he rarely shares with his cousin his sex life involving men he meets at parks or in clubs. He admits to his peer worker that he often finds extra pills in his bottles at the end of the month. Jesse feels healthy, but his doctor has told him that his CD4 count (T-cells) is dropping and his viral load is increasing.
Discussion Questions
• How would you address Jesse’s concerns and work with him on adherence issues?
At least 250 words. APA Format.
Article: Facts About HIV Stigmas
Social Aspects of HIV Infection
I. Defining Stigma
A. Erving Goffman defined stigma as “ An attribute that is deeply discrediting that reduces the bearer from a whole and usual person to a tainted, discounted one.”
B. Stigma not only affects the sufferer, but also affects significant others and loved ones, close associates, social groups, and communities.
C. Stigma leads to patterns of prejudice, which include:
1. Devaluing
2. Discounting
3. Discrediting
4. Discriminating against those affected
II. Categories of Stigma
A. Stigma falls into 3 categories:
1. Abominations of the body—physical deformities.
2. Blemishes of character—weak will, domineering or unnatural passions, rigid beliefs, or dishonesty.
a. They are inferred from mental disorders, imprisonment, addiction, homosexuality, unemployment, suicidal attempts, or radical political behavior.
3. Tribal stigma of race, nation, and religion— beliefs that are transmitted through lineages and equally contaminate all members of a family.
III. Stigma and HIV
A. HIV-related stigma refers to all unfavorable attitudes, beliefs, and policies directed toward people perceived to have HIV/AIDS.
B. According to Goffman, diseases associated with the highest degree of stigma share common attributes:
1. The person with the disease is seen as responsible for having the illness.
2. The disease is progressive and incurable.
3. The disease is not well understood among the public.
4. The symptoms cannot be concealed.
C. HIV infection fits the profile of a condition that carries a high level of stigmatization.
D. How?
1. People infected with HIV are often blamed for their condition and many people believe HIV could be avoided if individuals made better decisions.
2. Although HIV is treatable, it is nevertheless a progressive, incurable disease.
3. HIV transmission is poorly understood by some people in the general population, causing them to feel threatened by the mere presence of the disease.
4. Although asymptomatic HIV infection can often be concealed, the symptoms of HIV-related illness cannot.
IV. Internalized Stigma
A. When someone living with HIV or AIDS imposes stigmatizing beliefs and actions on themselves.
B. Why? Since they are members of the same cultural group as those who stigmatize them, they too ascribe to the same values and norms.
C. Therefore, they have the same idea about HIV and what it means to live with it.
D. Internalized Stigma leads to:
1. Feelings of worthlessness
2. Suicide
3. Hopelessness
4. Inferiority
5. Self-isolation
6. Feelings that there is no future
V. Secondary Stigma
A. Is experienced by relatives and extended families (children, caregivers)
1. Blaming
2. Gossiping
3. Social ostracism
4. Loss of income, employment of housing
VI. Discrimination and HIV
A. Discrimination is defined as “the making of a distinction in favor or against a person based on the group, class or category to which that person belongs rather than on individual merit.”
B. Discrimination, as related to those who are HIV positive, has lead to:
1. Denial of employment, housing, medical insurance, education, privacy and confidentiality.
VII. The Media and HIV
A. The media has historically played a significant role in shaping public
understanding of and response to the HIV epidemic.
B. Over time, the media has portrayed AIDS as:
1. A woman’s disease
2. A disease of prostitutes
3. An African disease
4. A gay plague
5. A gay cancer
C. Men on the “down low” – Referring primarily to African American men who have sex with other men and deceive women by not telling them of their risky sexual activities.
D. Labeling AIDS patients as “victims”.
1. Patients prefer the term People Living with AIDS (PLWA).
E. Famous People with HIV
· Magic Johnson ─ Pedro Zamora
· Alvin Ailey ─ Gene Anthony Ray
· Arthur Ashe ─ Rudy Galindo
· Greg Louganis ─ Robert Reed
· Rock Hudson ─ Isaac Asimov
· Gia ─ Rudy Galindo
· Eazy E ─ Liberace
· Anthony Perkins ─ Rudolph Nureyev
· Freddy Mercury
F. Despite HIV’s impact on the world, few movies or television programs have had
HIV/AIDS as the central theme. Several of them include :
· And The Band Played On
· Philadelphia
· Life Support
· Rent
VIII. Changing Perception of AIDS
A. The Case of Ryan White
1. Ryan White was a 13 year old boy from Indiana. He was a hemophiliac.
2. In 1984, he was diagnosed with HIV, which he contracted through contaminated blood products.
3. Ryan was barred from attending school.
4. He changed the face of HIV/AIDS.
5. To that point, HIV/AIDS was largely seen as a homosexual disease.
6. Because of Ryan White, Americans began to understand that anyone could be at risk of HIV infection and that the disease was not just limited to “high risk” groups.
IX. Examples of Stigma and Discrimination Around the World
A. China- Attitudes in China about people with HIV include:
1. AIDS patients got what they deserved
2. HIV is a problem for sex workers and IV drug users only
3. HIV positive people should not be allowed to marry or have children
4. AIDS is a disease of the low class and illegal people
5. Condoms are viewed as a form of contraception, not to prevent STDs
6. Condoms are too expensive to use every time
7. These attitudes have lead to a slow response by the government to the epidemic.
8. Other problems in China include:
a. Lack of openness in confronting the epidemic
b. Lack of commitment and leadership in government
c. Lack of adequate resources
d. Ex. Glove use is sporadic, due to lack of resources
e. Lack of knowledge regarding universal precautions
f. A crumbling public health system
g. Lack of emphasis on occupational safety
h. Severe stigma and discrimination against those who are infected.
i. Medical students, health administrators and other health care workers think that AIDS is a result of germ warfare.
j. Some still question how HIV is transmitted.
k. For example, some believe that HIV can be transmitted through casual contact, handling the belongings of HIV patients and through insect bites.
l. Result? Negative consequences for those who care for HIV patients (being stigmatized and discriminated against too).
B. South Africa
1. Attitudes in South Africa about HIV include:
2. HIV patients are to blame for their illness because they refuse to listen to advise.
3. AIDS is associated with lack of morality and promiscuity.
4. AIDS is a punishment from God.
5. One can get AIDS from touching.
6. The use of euphemisms when talking about HIV:
a. For example, patients will say they have TB, not HIV.
b. People in the street will raise 3 fingers of a hand to point out someone with AIDS (3-Finger Wave).
C. Cuba
1. From 1986 until 1989, HIV postive Cubans were quarantined to treatment centers.
2. Most of the early HIV patients were heterosexual aid workers, returning from Africa.
3. The quarantine system was relaxed in 1989 to allow travel between home and the treatment centers.
4. All HIV infected people are asked to attend a program called 'Living with HIV'.
5. In this program patients are monitored to see if they are ‘trustworthy’ – that is, sexually responsible, and if their diet, self-care and medication is adequate.
6. They are asked to disclose the names of any sexual partners from the last 5 years.
7. Those sexual partners are then traced and tested for HIV.
8. Certain groups are targeted for testing (HIV positive sexual contacts, blood donors, pregnant women, people with STDs).
9. All testing is voluntary, but strongly encouraged amongst the target groups.
10. Cuba has undertaken extensive campaigns against HIV/AIDS focusing on education and treatment
11. In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest ratios in the world.
12. According to the Cuban National Centre for Prevention of STDs and HIV/AIDS (November 2005) there were 5,422 persons living with HIV and 1,454 living with AIDS.
13. Population of Cuba- approximately 11 million.
,
Social Aspects of HIV Infection:
Stigma & Discrimination
Defining Stigma
Erving Goffman defined stigma as: “An attribute that is deeply
discrediting that reduces the bearer from a whole and usual person to a tainted, discounted one.”
Stigma not only affects the sufferer, but also affects significant others and loved ones, close associates, social groups, and communities.
Stigma (cont’d)
• Stigma leads to patterns of prejudice, which include: – Devaluing – Discounting – Discrediting – Discriminating against
those affected
Categories of Stigma • Stigma falls into 3 categories:
1) Abominations of the body—physical deformities.
2) Blemishes of character—weak will, domineering or
unnatural passions, rigid beliefs, or dishonesty. They are inferred from mental disorders, imprisonment, addiction, homosexuality, unemployment, suicidal attempts, or radical political behavior.
3) Tribal stigma of race, nation, and religion —
beliefs that are transmitted through lineages and
equally contaminate all members of a family.
Stigma and HIV
• HIV-related stigma refers to all unfavorable attitudes, beliefs, and policies directed toward people perceived to have HIV/AIDS.
• According to Goffman, diseases associated with the highest degree of stigma share common attributes:
Stigma and HIV (cont’d)
1. The person with the disease is seen as responsible for having the illness. 2. The disease is progressive and incurable. 3. The disease is not well understood among the public. 4. The symptoms cannot be
concealed.
HIV infection fits the profile of a condition that carries a high level of stigmatization.
Stigma and HIV (cont’d) • How?
– People infected with HIV are often blamed for their condition and many people believe HIV could be avoided if individuals made better decisions.
– Although HIV is treatable, it is nevertheless a progressive, incurable disease.
– HIV transmission is poorly understood by some people in the general population, causing them to feel threatened by the mere presence of the disease.
– Although asymptomatic HIV infection can often be concealed, the symptoms of HIV-related illness cannot.
Internalized Stigma • When someone living with HIV or
AIDS imposes stigmatizing beliefs and actions on themselves.
• Why? • Since they are members of the
same cultural group as those who stigmatize them, they too ascribe to the same values and norms.
• Therefore, they have the same idea about HIV and what it means to live with it.
Internalized Stigma (cont’d) • Internalized Stigma leads to:
– Feelings of worthlessness – Suicide – Hopelessness – Inferiority – Self-isolation – Feelings that there is no future
• Secondary Stigma – Experienced by relatives and extended
families (children, caregivers) • Blaming • Gossiping • Social ostracism • Loss of income, employment of housing
Discrimination and HIV
• Discrimination is defined as “the making of a distinction in favor or against a person based on the group, class or category to which that person belongs rather than on individual merit.”
• Discrimination, as related to those who are HIV positive, has lead to: – Denial of employment, housing,
medical insurance, education, privacy and confidentiality.
The Media and HIV • The media has historically played
a significant role in shaping public understanding of and response to the HIV epidemic.
• Over time, the media has portrayed AIDS as:
(1)a woman’s disease (2)a disease of prostitutes (3)an African disease (4)a gay plague (5)a gay cancer
The Media and HIV (cont’d) • Men on the “down low” –
Referring primarily to African American men who have sex with other men and deceive women by not telling them of their risky sexual activities.
• Labeling AIDS patients as “victims”. – Patients prefer the term People
Living with AIDS (PLWA).
The Media and HIV (cont’d)
• Famous People with HIV – Magic Johnson ─ Pedro Zamora – Alvin Ailey ─ Gene Anthony Ray – Arthur Ashe ─ Rudy Galindo – Greg Louganis ─ Robert Reed – Rock Hudson ─ Isaac Asimov – Gia ─ Rudy Galindo – Eazy E ─ Liberace – Anthony Perkins─ Rudolph Nureyev – Freddy Mercury
The Media and HIV (cont’d)
• Despite HIV’s impact on the world, few movies or television programs have had HIV/AIDS as their central theme.
• Several of them include: – And The Band Played On – Philadelphia – Life Support – Rent
Changing Perception of AIDS The Case of Ryan White
• Ryan White was a 13 year old boy from Indiana. He was a hemophiliac. In 1984, he was diagnosed with HIV, which he contracted through contaminated blood products.
• Ryan was barred from attending school.
• He changed the face of HIV/AIDS. • To that point, HIV/AIDS was largely
seen as a homosexual disease.
Examples of Stigma and Discrimination Around the World
• China – Attitudes in China about people with HIV include:
• AIDS patients got what they deserved • HIV is a problem for sex workers and IV drug
users only • HIV positive people should not be allowed to
marry or have children • AIDS is a disease of the low class and illegal
people • Condoms are viewed as a form of
contraception, not to prevent STDs • Condoms are too expensive to use every time
Examples of Stigma and Discrimination Around the World
(cont’d) • These attitudes have lead to a slow response
by the government to the epidemic. Other problems in China include: – Lack of openness in confronting the
epidemic – Lack of commitment and leadership in
government – Lack of adequate resources
• Ex. Glove use is sporadic, due to lack of resources
• Lack of knowledge regarding universal precautions
– A crumbling public health system • Lack of emphasis on occupational safety
– Severe stigma and discrimination against those who are infected.
Examples of Stigma and Discrimination Around the World
(cont’d) – Medical students, health administrators
and other health care workers think that AIDS is a result of germ warfare.
– Some still question how HIV is transmitted. • For example, some believe that HIV
can be transmitted through casual contact, handling the belongings of HIV patients and through insect bites.
• Result? Negative consequences for those who care for HIV patients (being stigmatized and discriminated against too).
Examples of Stigma and Discrimination Around the World
(cont’d) • South Africa
– Attitudes in South Africa about HIV include: • HIV patients are to blame for their illness
because they refuse to listen to advise. • AIDS is associated with lack of morality and
promiscuity. • AIDS is a punishment from God. • One can get AIDS from touching. • The use of euphemisms when talking about HIV:
– For example, patients will say they have TB, not HIV.
– People in the street will raise 3 fingers of a hand to point out someone with AIDS (3- Finger Wave).
Examples of Stigma and Discrimination Around the World
(cont’d) • Cuba
– From 1986 until 1989, HIV postive Cubans were quarantined to treatment centers.
– Most of the early HIV patients were heterosexual aid workers, returning from Africa.
– The quarantine system was relaxed in 1989 to allow travel between home and the treatment centers.
– All HIV infected people are asked to attend a program called 'Living with HIV'.
Examples of Stigma and Discrimination Around the World
(cont’d) • In this program patients are monitored to
see if they are ‘trustworthy’ – that is, sexually responsible, and if their diet, self-care and medication is adequate.
• They are asked to disclose the names of any sexual partners from the last 5 years.
• Those sexual partners are then traced and tested for HIV.
• Certain groups are targeted for testing (HIV positive sexual contacts, blood donors, pregnant women, people with STDs).
• All testing is voluntary, but strongly encouraged amongst the target groups.
Examples of Stigma and Discrimination Around the World
(cont’d) • Cuba has undertaken extensive
campaigns against HIV/AIDS focusing on education and treatment
• In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest ratios in the world.
• According to the Cuban National Centre for Prevention of STDs and HIV/AIDS (November 2005) there were 5,422 persons living with HIV and 1,454 living with AIDS.
• Population of Cuba- approximately 11 million.
- Social Aspects of HIV Infection: Stigma & Discrimination
- Defining Stigma
- Stigma (cont’d)
- Categories of Stigma
- Stigma and HIV
- Stigma and HIV (cont’d)
- Slide 7
- Internalized Stigma
- Internalized Stigma (cont’d)
- Discrimination and HIV
- The Media and HIV
- The Media and HIV (cont’d)
- Slide 13
- Slide 14
- Changing Perception of AIDS The Case of Ryan White
- Examples of Stigma and Discrimination Around the World
- Examples of Stigma and Discrimination Around the World (cont’d)
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
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