Contact tracing in the context of STDs before HIV relied on the patient's cooperation and this cooperation was secured by the fact that the anonymity of the index patient (that is, the patient who is to serve as the reference point for all contact traces - the one in the doctor ís office) would be preserved. The people being notified would then be able to begin treatment. In the initial stages of the AIDS epidemic, several facts about HIV led to the opposition of contact tracing; namely, the fact that it was untreatable in the early stages (and ultimately incurable) and the fact that it was initially spread most commonly by homosexual contact. Thus the battle began between invasion of privacy vs. potential benefit.

AIDS RELATED STIGMA Thinking Outside the Box: The Theological Challenge

For the churches, the most powerful contribution we can make to combating HIV transmission is the eradication of stigma and discrimination…Given the extreme urgency of the situation, and the conviction that the churches do have a distinctive role to play in the response to the epidemic, what is needed is a rethinking of our mission, and the transformation of our structures and ways of working.

Pdf 521 kb

A Profile of the Stigma and Discrimination faced by People Living with HIV/AIDS

HIV/AIDS leaves people both physically and emotionally vulnerable: physically, because their immune systems are fighting a difficult battle, and emotionally because of the threat of death, and the stigma and discrimination attached to a condition that is associated with sex, sex work, and injection drugs. As a result, people living with HIV/AIDS are sometimes forced out of their homes and jobs. They can be rejected by families and friends. Often, they are accused of being personally responsible for their situation. As a consequence of the notion that particular social groups and sectors are more vulnerable to HIV than others (e.g., those who sell sex, men who have sex with other men, and those who inject drugs), people already on the margins of society encounter greater hostility and face further stigma and discrimination.

Pdf 262 kb

Confidentiality Considerations When Your Patient Has HIV or AIDS+

The following case study focuses on a variety of common issues and scenarios related to HIV/AIDS confidentiality which could arise over the course of a patient’s care.

Pdf 135 kb

Criminal Law, Public Health and HIV Transmission

A number of cases have been reported in which people living with HIV have been criminally charged for a variety of acts that transmit HIV or risk transmission. In some cases, criminal charges have been laid for conduct that is merely perceived as risking transmission, sometimes with very harsh penalties imposed. Some jurisdictions have moved to enact or amend legislation specifically to address such conduct. The issue has also received public and academic commentary.

Pdf 865 kb

Discriminatory attitudes towards people living with HIV/AIDS and associated factors: a population based study in the Chinese general population

Around 42% of the respondents exhibited discriminatory attitudes in at least five out of the 20 relevant items. For instance, about 42% would avoid making physical contact with PLWHA; 35% believed that all infected medical staff should be dismissed and about 47% would agree with enacting a law to prohibit PLWHA from visiting Hong Kong. A sizeable proportion of the respondents also hold negative perceptions about PLWHA (for example, 43.7% agreed that the majority of PLWHA are promiscuous, 20.7% thought that PLWHA are merely receiving the punishment they deserve, etc). Multiple regression analysis found that age, HIV related knowledge, the above mentioned negative perceptions about PLWHA, fear related to AIDS, and exposure to HIV related information were independent predictors of discriminatory attitudes towards PLWHA. About 30% would give PLWHA the lowest priority in resource allocation among five groups of patients with chronic diseases.

Pdf 102 kb

Effect of Training Program on Physicians' Attitude Towards Knowledge and Practice Related to Assessment and Screening of Clients with HIV/AIDS

This is a study which examines the effects of an educational program on Hispanic physicians' attitudes towards and knowledge of HIV/AIDS. The study also examines physicians' practice patterns related to the screening and testing of Hispanic patients at risk for the disease. A one on one educational program was taken to the physician's office at a time convenient to the physician. A pre- and post-test design is used with questionnaires developed for the study that assess self-reported data related to physicians' attitudes, knowledge and practice patterns. A convenient sample of physicians participated. This limited the generalizability of the results to other groups. However, it does point out that a training program can alter physicians' screening and testing practices as well as their attitudes towards clients with HIV/AIDS

EVOLVED DISEASE-AVOIDANCE PROCESSES AND CONTEMPORARY ANTI-SOCIAL BEHAVIOR: PREJUDICIAL ATTITUDES AND AVOIDANCE OF PEOPLE WITH PHYSICAL DISABILITIES

Drawing on evolutionary psychological logic, we describe a model that links evolved mechanisms of disease-avoidance to contemporary prejudices against individuals with physical disabilities. Because contagious diseases were often accompanied by anomalous physical features, humans plausibly evolved psychological mechanisms that respond heuristically to the perception of these features, triggering specific emotions (disgust, anxiety), cognitions (negative attitudes), and behaviors (avoidance). This disease-avoidance system is over-inclusive: Anomalous features that are not due to disease (e.g., limb amputation due to accident) may also activate it, contributing to prejudicial attitudes and behaviors directed toward people with disabilities. This model implies novel hypotheses about contemporary variables that may amplify or reduce disability-based prejudice. We discuss past research within this context. We also present new evidence linking chronic and temporary concerns about disease to implicit negative attitudes toward and behavioral avoidance of disabled others. Discussion focuses on the conceptual and practical implications of this evolutionary approach.

Pdf 130 kb

EXAMPLES OF DISCRIMINATION IN EMPLOYMENT

Impairment in pre-work, Race discrimination in work, Pregnancy discrimination and victimization at work, Prospective employee asked age at interview, Race discrimination,  Young worker harassed at work, Sex discrimination and sexual harassment

Pdf 285 kb

Factors related to staff stress in HIV/AIDS related palliative care

Staff stress in HIV related palliative care has been identified as an important problem worldwide. This study aimed at estimating prevalence of staff stress and its correlates in a sample of palliative caregivers in HIV/AIDS in India.

GLOBAL APPEAL TO END STIGMA AND DISCRIMINATION AGAINST PEOPLE AFFECTED BY LEPROSY

Leprosy is among the world’s oldest and most dreaded diseases. Without an effective remedy for much of its long history, it often resulted in terrible deformity. It was also thought to be extremely communicable. Patients were abandoned, forced to live in isolation and discriminated against as social outcasts.

Pdf 177 kb

GUIDELINES for HIV/AIDS interventions in emergency settings

During a crisis, the effects of poverty, powerlessness and social instability are intensified, increasing people’s vulnerability to HIV/AIDS. As the emergency and the epidemic simultaneously progress, fragmentation of families and communities occurs, threatening stable relationships. The social norms regulating behaviour are often weakened. In such circumstances, women and children are at increased risk of violence, and can be forced into having sex to gain access to basic needs such as food, water or even security. Displacement may bring populations, each with different HIV/AIDS prevalence levels, into contact. This is especially true in the case of populations migrating to urban areas to escape conflict or disaster in the rural areas.

Pdf 525 kb

Hepatitis B, and prejudice, ravage a nation

Hepatitis C – a relationship with stigma

PowerPoint Presentation

116 kb

Hepatitis Education for Inmates

PowerPoint Presentation

445 kb

History of Epidemics and Plagues

Diseases like measles and mumps that ravaged virgin populations are now rarely lethal for even the most susceptible human hosts. What were once fatal epidemic diseases are now simply childhood annoyances. These diseases attack only those with the least well-developed immune systems, young children. The microbes and their hosts have coevolved and adapted to a form of equilibrium. A truce has been called—at least temporarily.  Infectious diseases must be closely watched and appropriately feared; as the past has taught us, humility is a far greater virtue than either arrogance or hubris when it comes to dealing with Nature.

HIV/AIDS AND THE LAW

There are many untrue stories about AIDS. People who are living with HIV or AIDS are discriminated against in all kinds of ways in our society. For example, some people are refused employment or proper health care. This is mostly because very few people understand what HIV and AIDS mean. It is important that people understand what HIV and AIDS are, what causes the illness and what the law says about peoples rights

HIV/AIDS EMPLOYMENT POLICY AND PROCEDURE

The NHS in Wales recognises that as an employer and a public health body it has a duty to counter discrimination and stigma against people who are or may become HIV positive or who have AIDS. This duty includes employees of Local Health Boards. It recognises the need to protect patients, to retain public confidence, and to provide safeguards for the confidentiality and employment rights of HIV infected health care workers.

Pdf 23 kb

HIV/AIDS Stigma Finding Solutions to Strengthen HIV/AIDS Programs

HIV/AIDS-related stigma has long been recognized as a crucial barrier to the prevention, care and treatment of HIV and AIDS. Yet not enough is being done to combat it. One reason has been a lack of information: How do we define stigma? Can stigma be measured? Another reason has been the assumption by development practitioners that stigma is too tied to culture, too context-specific and too linked to taboo subjects like sex to be effectively addressed. Action also has been impeded by a lack of tools and tested interventions.

Pdf 413 kb

HIV Patients Perceive Discrimination by Physicians

One in four HIV-infected adults reported that they had experienced discrimination by a healthcare provider, with more than half citing their physicians as offenders, according to a large nationally representative study.

Holocaust as a Paradigm of Empathy

Since 1945 we have seen genocide repeated, in Cambodia and Uganda, in Rwanda and Bosnia. Modernity, with its access to science and technology, has perfected the killing of others in a way that makes the carnage exacted by religious wars of the past pale by comparison. In fact, the very question "Why be good?" challenges the assumption of modern Western thought that goodness is innate. If we have to ask the question, then perhaps we are not good; what we are trying desperately to do is to find reasons to keep at bay the chaos unleashed by seeing what we human beings really are. The Shoah is not an historical aberration, but a paradigm of human behaviour

Neighborhood stigma and the perception of disorder

Many Americans hold persistent beliefs linking blacks and other disadvantaged minority groups to social images, including crime, violence, disorder, welfare, and undesirability as neighbors. These beliefs are reinforced by the historical association of involuntary racial segregation with concentrated poverty—in turn linked to institutional disinvestments and neighborhood decline. Stereotypes about race, poverty, and disorder may loom especially large when residents have uncertain or ambiguous information about the neighborhood as a whole. In poor neighborhoods, many activities that in better-off neighborhoods occur in private (e.g., drinking or hanging out) necessarily take place in public. The resulting social structure of public places reinforces the assumption that disorder is a problem mainly in poor, African American communities. This stereotype may lead to actions by members of the stigmatized group that seem to confirm the statistical association between race and social disorder, usually inextricably linked, in a kind of developmental sequence. . . .

Pdf 392 kb

Our story

Personal story of being infected

Prejudice, Discrimination and HIV

Many people with HIV experience problems in their everyday lives purely because of the virus. People fear – and can face - rejection from friends and family and difficulties at work. They may get worse treatment from health and social care services. Sometimes their own communities appear to turn their backs on them. As a result, as this report shows, many people choose to conceal their HIV diagnosis for fear of the possible consequences. This can result in other problems; increased anxiety; difficulty in making relationships; lack of access to information or services; unexplained absences from work; misdiagnosis of health problems. Some people choose not to get tested at all because they fear the difficulties a positive diagnosis could bring, thus risking long term damage to their health and possibly even death. This understandable concealment also means that the real extent of discrimination remains hidden.

Pdf 206 kb

Primary School Teachers' Knowledge, Attitudes and Practices on HIV/AIDS, Life Skills, Gender and Sexuality

The study revealed that a significant number of teachers did not have adequate general knowledge of the sexually transmitted diseases, including AIDS, while others had either incorrect or little information. Approximately, 85% of teachers said that they encountered problems in finding appropriate responses to questions related to HIV and AIDS with more female teachers (88%) than male teachers (78%) indicating greater difficulties. In addition, less than 20% of the in-service female and male teachers were able to give correct estimates of HIV prevalence in

PSYCHOSOCIAL ASPECTS OF HIV/AIDS

HIV/AIDS has many physical effects, but perhaps some of its most profound effects are on the psychological, social, and economic health of the HIV-positive person, his or her loved ones, and the community. Since the beginning of the epidemic, stigma and fear have surrounded many of those who live with and die from HIV/AIDS, as well as those who love and care for them. The magnitude of these psychosocial effects makes them central to HIV prevention efforts, care for people with HIV, and the response of communities to the massive losses of people in their most productive years of life. This lecture will examine the effects of stigma on care for people with HIV; the effects of HIV on the individual, family, group, community, and society; and potential interventions on each of these levels.

Pdf 797 kb

Racism, Racial Discrimination and HIV/AIDS

It is an increasingly acknowledged reality today that through out the world those most deeply affected by the HIV epidemic are also the most severely disadvantaged, whether on grounds of race, economic status, age, sexual orientation or gender.  As in the case of most other stigmatized health conditions such as tuberculosis, cholera and plague, fundamental structural inequalities, social prejudices and social exclusion explain why women, children, sexual minorities and people of colour are disproportionately impacted by AIDS and the accompanying stigma and discrimination.  The nearly two decades old global history of the HIV epidemic reinforces yet again the well documented interaction of disease, stigma and `spoiled’ social identities based on race, ethnicity, sexuality and so on.

Reducing AIDS-related Stigma and Discrimination in Indian Hospitals

AIDS-related stigma and discrimination is a pervasive problem worldwide. People living with HIV/AIDS (PLHA) in India, as elsewhere, face stigma and discrimination in a variety of contexts, including the household, community, workplace, and health care setting. Research in India has shown that stigma and discrimination against HIV-positive people and those perceived to be infected are common in hospitals and act as barriers to seeking and receiving critical treatment and care services (UNAIDS 2001).

Pdf 342 kb

Response to consultation on Aids/HIV infected health care workers

This guidance will have the effect of restricting the occasions on which it is considered necessary to notify patients that they may have been at risk of exposure to the HIV virus. This reflects the evidence which shows that in the UK there has been no recorded case of infection passing from a healthcare worker to a patient, and only two reported incidents worldwide. The NHS therefore seeks to reduce the possibility of anxiety, and the costs of unnecessary counselling and testing for the virus, in situations in which the risk of infection is considered to be very low. Previously, all patients in the UK have been notified regardless of their level of risk. The new policy is designed to avoid unnecessary anxiety to patients and puts Britain more in line with practice in other countries. From now on the risk of HIV transmission to patients will be assessed on a case by case basis and whether patients are notified will depend on the level of risk.

Pdf 41 kb

Risk of confidentiality breach can make HIV patients shy from treatment

"A breach of confidentiality carries the potential for a greater consequence on the lives of these patients than it may in many other diagnoses, and so confidentiality has a deeper meaning for them," said Kathryn Whetten-Goldstein, assistant professor in the Terry Sanford Institute of Public Policy's Center for Health Policy, Law and Management and primary investigator for the study, which was funded by the Department of Health and Human Services. "A perceived risk of a breach of confidentiality can prompt an HIV patient to choose a clinic several hours away rather than one closer to home, to withhold information from providers or even to reject treatment altogether."

Social Stigma, HIV/AIDS Knowledge, and Sexual Risk

A cross-sectional study of 481 sexually active, heterosexual late adolescents showed that: (a) heterosexual people may be distancing themselves from HIV/AIDS because of its association with the gay community while also engaging in greater behavioral risk for HIV/AIDS; and (b) the ways a person comes to know about HIV/AIDS (perceived knowledge, passive classroom learning, media influence, and knowing people with HIV/AIDS) can be related to sexual risk behavior through the operation of two mediating variables, condom self-efficacy and perceived HIV/AIDS risk. The variables studied are closely linked with Stage 1 factors in the AIDS Risk Reduction Model. Implications for understanding how stigmatizing can affect behavior are discussed, as well as implications for education in HIV/AIDS related issues.

Pdf 229 kb

Spiritually Rooted Diseases

Behind every health issue and every emotional or spiritual problem resides the "Spirit of Fear." The Spirit of Fear is the Devil's faith working in people by using lies to control them. And if we dwell on those lies long enough, we will begin to believe them, thus resulting in responding to them which can lead to all kinds of problems. We need to discover the root behind our problems.

STEREOTYPING MENTAL ILLNESS BY VISUAL PERCEPTION

The link between stereotyping and mental illness was examined. The data showed for each picture that was presented, significance was found. The purpose of the examination was to find out if people, while looking at a picture of another person determined them to be mentally ill based solely on their appearance. Some persons were known to be ill while other subjects were known not to be ill. Based on the photographs people did stereotype these persons.

Stigma and Hepatitis C

Millions of Americans live with the hepatitis C virus (HCV). Although potentially life threatening, the vast majority of those with HCV will die with it and not of HCV. In most cases, HCV is manageable and treatable. However, HCV may test the physical, emotional and spiritual health of those with it. HCV touches the homes, workplace and communities of all those within its reach. An often overlooked and painful component of HCV is stigma. Although invisible, stigma is a harsh reality. For some, the stigma of HCV hurts more than HCV itself. This guide discusses the ways in which HCV is stigmatized and provides tools for confronting and living with HCV’s senseless labels. Stigmas hurt all of us. We may not all have HCV, but we all live with it. Living without stigmas and with compassion is just plain good sense.

Pdf 197 kb

Stigma and Social Control

Social interactions provide a set of incentives for regulating individual behavior. Chief among these is stigma, the status loss and discrimination that results from the display of stigmatized attributes or behaviors. The stigmatization of behavior is the enforcement mechanism behind social norms. This paper models the incentive effects of stigmatization in the context of undertaking criminal acts. Stigma is a flow cost of uncertain duration which varies negatively with the number of stigmatized individuals. Criminal opportunities arrive randomly and an equilibrium model describes the conditions under which each individual chooses the behavior that, if detected, is stigmatized. The comparative static analysis of stigma costs differs from that of conventional penalties. One surprising result with important policy implications is that stigma costs of long duration will lead to increased crime rates.

Pdf 387 kb

Stigma Interventions and Research for International Health

Stigma has become an increasingly important priority for health policy and research. The topic encompasses a broad set of interests and specifies a field of study, however, that without critical rethinking may be too broad to contribute as much as we expect to health policy. The diversity of international health problems and the complexity of their social and cultural settings make questions of stigma even more challenging. Too little attention has been paid to the concept of stigma, distinct from its impact; careful consideration of the particular features of a useful formulation to guide public health policy and action is needed, especially with respect to the stigmatizing diseases of low- and middle-income countries. As we critically review of the topic, we begin by considering a few key points from the seminal contribution of the sociologist Erving Goffman

"Stigma is Social Death"

Stigma of Hepatitis C and Lack of Awareness Stops Americans From Getting Tested and Treated

Hepatitis C is a potentially life-threatening viral disease of the liver transmitted through blood and blood products. Over time, chronic infection can lead to cirrhosis, liver failure, and liver cancer. The survey findings indicate the need for increased awareness and education about hepatitis C, the most common blood-borne disease in the US. While only about half of the general public believes it is a public health threat, more than 80 percent recognize HIV poses a serious threat. In contrast, physicians and hepatitis C sufferers surveyed view HCV as a threat on par with HIV.

Stigma without Impairment: Broadening the Scope of Disability Discrimination Law

It may, however, be more difficult in the case of disability than race to decide what classes of individuals face evils comparable to those addressed by the statute’s “core prohibitions.” Construing the 1964 Civil Rights Act to include Hispanic-Americans, Asian-Americans, or Caucasians appears (at least in retrospect) straightforward, because it is clear that people of any racial, ethnic, or national-origin group can be treated as moral inferiors by virtue of their membership in that group. In contrast, the justices in Sutton disagreed about whether discrimination against individuals with minor and correctable impairments was an evil comparable to discrimination against individuals with more severe, less tractable impairments. For the majority it was not, because the former, unlike the latter, are not a discrete and insular minority, left poor and powerless by a long history of exclusion and neglect. Because of this difference, the majority held an employer was “free to decide that physical characteristics or medical conditions that do not rise to the level of an impairment—such as one’s height, build, or singing voice—are preferable to others, just as it is free to decide that some limiting, but not substantially limiting impairments make individuals less than ideally suited for a job.”

The Enigma of HIV/AIDS-related Stigma

HIV/AIDS-related stigma is understood as a dynamic, multifaceted phenomenon that emerges from the intertwinement of human motivations, social structures, discourses and power relations. This understanding of stigma implies taking a broad approach when responding to stigma, calling attention to the importance of involving all levels of  the community. Community psychology and community counselling provide suitable frameworks for such an approach, as they emphasize local adaptation, empowerment and action research. Because the severity of the HIV/AIDS-epidemic requires urgent response, research and action need to be integrated. Ethical and methodological issues pertaining to the understanding, alleviation and prevention of HIV/AIDS-related stigma in Sub Saharan Africa are taken into consideration. 

Pdf 712 kb

The Impact of Stigma on Service Access and Participation

Research has shown that the psychiatric symptoms, psychological distress, and life disabilities caused by many mental illnesses are significantly remedied by a variety of evidence- based practices (EBPs).  Central to the success of these treatments is an obvious rule:  people with psychiatric disorders must participate in treatment to enjoy its benefits.  Unfortunately, research suggests many people who meet criteria for treatment, and who are likely to improve after participation, either opt not to access services or fail to fully adhere to treatments once they are prescribed.  Health belief theorists have shown that a rational consideration of the costs and benefits of participating in specific treatments will directly impact whether a certain route of intervention is pursued.  A significant cost to engaging in mental health treatment is the stigma associated with it.  Many people choose to not pursue mental health services because they do not want to be labeled a .mental patient. nor do they wish to suffer the prejudice and discrimination this label entails.

Pdf 132 kb

THE KNOWLEDGE AND ATTITUDES OF PHYSIOTHERAPISTS TOWARDS PATIENTS WITH HIV/AIDS IN THE LUSAKA PROVINCE, ZAMBIA.

With the increase in the number of persons suffering from HIV/AIDS, physiotherapists are often required to treat these patients who present with respiratory and neurological complications. Although physiotherapists are at a lower risk of HIV infection in the workplace than nurses and doctors, it is necessary to determine their knowledge and perceptions of the risks, fears of HIV transmission and their attitudes towards patients with the disease. The aim of the study was to determine the physiotherapists’ knowledge of, and their attitudes towards patients with HIV/AIDS.

Pdf 925 kb

The Root Of Homophobia

Why Religion Matters: The Impact of Religious Practice on Social Stability

Widespread stigma undermining international AIDS promises

"Stigma and discrimination are the two major hurdles that continue to hamper rehabilitation of people infected and affected by HIV in India," says India contributor Swapna Majumdar. "For women and girls the degree and impact of this stigma is even more acute."