Addressing internal stigma in Mexico Stigma and Discrimination: the undoing of universal access?

1. Addressing internal stigma in MexicoStigma and Discrimination: the undoing of universalaccess? AnuarLuna Cadena Red Mexicana de Personas que Viven con VIH/SIDA Policy Project

2. Although I have accepted the virus myself, the thing is I don’t want anyone next to me.” Personliving with HIV

3. “It is a kind of a lie, not telling the truth…. Like if they don’t ask, I don’t tell…” Person living with HIV

4. “If I say that I’ve got HIV they would fire me and then many possibilities in my life would be over.” Person living with HIV

5. “When I learned that I had HIV, I cut myself off from the world, because I felt bad about about myself. I locked myself in the house, I didn’t answer the phone; all day I slept.” Person living with HIV

6. Internal Stigma Internal stigma refers to self-perceived stigma or the internal manifestations of accepted stigma or of negative social perceptions transformed into such things as fear, anxiety or hurt.

7. Framework for Understanding InternalStigma Experience of context Self perception Internal stigma: The shame associated with HIV/AIDS and fear of being discriminated against Protective Action

8. Experience of context • Focus on physical and environmental situations • Several interacting elements that led to an overall sense of loss of control • Elements: • Denigration and negative prejudices • Misinformation • Economic and social pressures • Physical deterioration

9. Self Perception • Recurring deep-seated feelings of: • Shame • Guilt • Fear (of being discovered, of dying, of infecting others, etc.) • Blame • Anguish

10. Protective Action • Avoidance and self exclusion • Avoiding longer term plans • Avoiding activities in general including, for example, seeking health services • Isolation and self withdrawal • Keeping to oneself, avoiding social activities • Avoiding intimate encounters • Subterfuge and denial • Hiding or misleading others as to sero-status, sexual orientation, etc.

11. Impact in Access issues • Fear to being tested • Fear to being seen in HIV related facilities o receiving HIV services • Loss of adherence to treatment. • Loss of opportunity to receive adequate treatment, no matter if it is available. • Fear to side effects (lipodistrophia) • Shame to talk with health service provider on sexual issues • Fear to discuss reproductive issues with health service providers.

12. Strategies for Internal Stigma Reduction • Enhancing capacity building, social capital and personal development • Building capacities in areas related to personal and social growth • Increasing self-esteem and sense of self-worth • Improving individual social capital (involvement in social organizations and groups, sense of influence in social spheres and sense of social integrity or trust in social institutions and authorities)

13. Strategies for Internal Stigma Reduction 2. Improving support services for persons living with HIV • Ensuring quality of care and comprehensive care and support • Developing economic independence • Maintaining confidentiality in the workplace, health settings and various social spheres

14. Strategies for Internal Stigma Reduction 3. Increasing visibility of persons living with HIV as productive members of society • Providing more positive role models • Building leadership skills • Strengthening self-support groups

15. So where to from here? • Capacity building for PLHA networks: internal stigma & strengthening self-support groups or social support networks. • Training and sensitization of health professionals • Baseline measurements of internal stigma • Develop and implement stigma mitigation in pre-stigmatized communities

16. Internal stigma represents an obstacle for HIV visibility The lack of VIH visibility in the community is and obstacle for access Lack of access reinforces all the elements linked with stigma

17. “I am like any other person, being sero-positive does not stop or limit me, but on the contrary, it motivates me.” Juan, diagnosed with HIV in 1997