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Stigma and discrimination පහත්කොට සැලකීමේ හැගීම හා වෙනස්කම් කිරීම

Stigma and discrimination පහත්කොට සැලකීමේ හැගීම හා වෙනස්කම් කිරීම. Dr. Ajith Karawita, MBBS, PgDip Ven, MD National STD/AIDS Control Programme. Introduction.

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Stigma and discrimination පහත්කොට සැලකීමේ හැගීම හා වෙනස්කම් කිරීම

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  1. Stigma and discrimination පහත්කොට සැලකීමේ හැගීම හා වෙනස්කම් කිරීම Dr. Ajith Karawita, MBBS, PgDip Ven, MD National STD/AIDS Control Programme

  2. Introduction • Stigma has often been associated with disfiguring or incurable diseases, in particular diseases that society perceives to be caused by the violation of social norms, including those that sanction sexual behaviour. • HIV/AIDS is a good example of this type of disease (Crandall and Moriarty 1995)

  3. Causes of stigma පහත කොට සැලකීමට හේතු Forms of stigma පහත්කොට සැලකීමේ  ආකාර  Definition of stigma පහත්කොට සැලකීමේ හැගීම - අර්ථ දැක්වීම Stigma පහත්කොට සැලකීම/හැගීම Types of stigma පහත් කොට සැලකීම් වර්ග Self stigma Felt stigma Effects of Stigma පහත්කොට සැලකීමේ ප්‍රතිපල

  4. Definition of stigma • Societal labeling of and individual or group as different or deviant because of a “discrediting attribute” අපකීර්තිමත් ගුණාංග/ලක්ෂණ (Goffman 1963) • This came from a study on stigma in relation to mental illness, physical deformities and “socially deviant” behaviours

  5. More recently • Stigma has been defined as a dynamic process that is linked to competition for power and tied into existing social mechanism of exclusion and dominance (Link and Phelan 2001) • Social process that involves identifying and using “differences” between groups of people to create and legitimize social hierarchies and inequalities (Parker and Aggleton 2002)

  6. What is HIV stigma and discriminationHIV හා සම්බන්ද  පහත්කොට සැලකීමේ හැගීම හා වෙනස්කම් කිරීමයනු කුමක්ද?

  7. UNAIDS defines HIV-related stigma and discrimination as: • A ‘process of devaluation’ of people either living with or associated with HIV and AIDS • Discrimination follows stigma and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status.

  8. Types of stigma • Self / Internal stigma - තමා සමාජයෙන් අවමානයට ලක්වීඇතැයි තමා විසින්ම සිතාගෙන සිටීම හා ඒ අනුව ක්‍රියාත්මක වීම • Felt stigma - එචි.අයි.වී ආසාදිතයන් කෙරෙහි පහත්කොට සැලකීමේ හැගීම හෝ අවබෝධය • Enacted stigma - පහත්කොට සැලකීමේහැගීම ක්‍රියාවටනැගීම • Compound / layered stigma - පහත් කොට සැලකීම් ස්ථරගත වීම 

  9. HIV positive, MSM, Drug User HIV positive Normal

  10. Range of stigma and discrimination Enacted Stigma (stigma in action) Gossip, Isolation Rejection Blaming Insult Ignore Not talking Not listening Unlawful acts such as Dismissal from employment; Refusal from healthcare Chasing from home/village stigma Discrimination

  11. Fear or actual experience with stigma and discriminationReduce an individual’s willingness to • Practice prevention • Seek HIV testing • Disclose his or her HIV status to others • Ask for (or give) care and support • Begin and adhere to treatment

  12. stigma and discrimination are major “road blocks” to universal access to HIV prevention, treatment, care and support

  13. Vision to get to Zero New Infections Zero Discrimination Zero AIDS-related Deaths

  14. How to measure stigma

  15. Four key domains(ප්‍රධානවිෂයපථයන් හතරක්)in HIV stigma and discrimination (S&D): • Fear of transmission (HIVසම්ප්‍රේෂණ බිය) - Fear of casual transmission and refusal of contact with people living with HIV/AIDS (PLHA); • Fear of values and morality-related attitudes (සාරධර්ම හා සදාචාරය හා බැඳුනු ආකල්පවලට‍ ඇති බිය). • Enacted stigma (discrimination)පහත්කොට සැලකීමේ හැගීම ක්‍රියාවටනැගීම (වෙනස්කම් කිරීම) • Disclosure (අනාවරණය කිරීම) - Disclosure often is considered a proxy measure for S&D

  16. Recommended Indicators and Questions are Segmented into Three Populations • Community, • Health care workers and • People living with HIV/AIDS.

  17. Objectives of research with key populations • with PLHIV - Can provide insight into internalized stigma and their experiences of AIDS-related discrimination • with community members - can help demonstrate the scope of stigmatizing attitudes in a given society. • with health care workers - offers an indication of the discrimination and barriers to appropriate care that PLHIV may face within the health care system.

  18. Measuring HIV/AIDS related stigma and discrimination – measuring tools

  19. PLHIV Stigma Index Who developed this How will the index benefit Document various experiences of PLHIV Compare situations Measure changes over period of time Provide an evidence base for policy change (powerful advocacy tool) Shape the design of programmatic interventions The PLHIV Stigma Index is the joint initiative of several organizations who have worked together since 2005 to develop this survey. These include: • The Global Network of People Living with HIV/AIDS (GNP+) • The International Community of Women Living with HIV/AIDS (ICW); • The International Planned Parenthood Federation (IPPF); and • The Joint United Nations Programme on HIV/AIDS (UNAIDS).

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