Stigma and Discrimination…

The same picture as my first presentation –

with a bit more revealed

Themes of presentation…

Suggesting some entry points for both

What we do What we say

Programmes Advocacy

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To counter Stigma and Discrimination , as well as reminding us all of our agreed definitions , and showing some of the effects researched effects of these two evils…

بالعار الوصم والتمييز تعريف

بالعار الوصم “ اختالفات ” تجاه اإلزدراء أو سلبية اجتماعية معتقدات أو مواقفطبيعية . بصورة يوجد ال شعور وهو اآلخرين إزاء وهمية أو حقيقية

. المجتمعات وفي األفراد لدى ينشأ وإنما

. اإليدز ومرض اآلخرين قدر من يحط سلوك هو بالعار والوصم. الموجود التحامل ويقوي ?د يول وفيروسه

خصوصا االجتماعية المظالم تقوية على يعمل بالعار الوصم أن كما. والعرق والجنس بالنوع ترتبط التي تلك

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والتمييز بالعار الوصم تعريف

التمييز ) ينكر ) بشيء القيام عدم أو القيام إلى بالناس بالعار الوصم فكرة تؤدي

من حرمانه أو آخر لشخص خدمة تقديم عن االمتناع أو الشخصية الكرامةحقوقه.

وتنتهك للتمييز وأسرهم وفيروسه اإليدز بمرض المصابون يتعرض ما وكثيرابمرض مصابون أنهم يفترض أو مصابون ببساطة ألنهم وحقوقهم كرامتهم

. فيروسه أو اإليدز. تمييز هذا ويمثل

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Defining stigma and discrimination

StigmaDerogatory or negative social attitudes or beliefs towards the perceived or real 'differences' of others do not naturally exist, they are created by individuals and by communities.

Stigma is a process of devaluation. HIV/AIDS builds upon and reinforces existing prejudices.

It also plays into, and strengthens existing social inequalities – especially those of gender, sexuality and race.

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Defining stigma and discrimination

DiscriminationStigmatising thoughts frequently lead people to do (or not do) something that denies personal dignity, services or rights to another person.

People living with HIV and AIDS (PLWHA) and their families are frequently discriminated against and their dignity and rights violated simply because they are known or presumed to have HIV/AIDS.

This is discrimination.

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Stigma• Does stigma enhance risk?• Consistent evidence that people experience

discrimination and believe HIV is stigma bound. (Sherr & Sherr 99, 2000, Haour Knipe, Price 1992, Kraft 95, Altman 92, Leach 95, Young 94, Van der Ven 96, Herman 95)

• Psychological effects of felt and enacted stigma is low self esteem, depression, anxiety, isolation (Hall 92)

• Gold (2000) noted that negative mood and feeling bad about themselves in a sample of gay men in Australia was a predictor of risk

• Fear of disclosure linked with risk exposure• But is it stigma or rejection that is the issue?

Some data from the European Study (Sherr & Sherr 2001)

• Data collected from 108 HIV positive individuals in UK (83.2% male, 87.3% UK born, x age 36.1 yrs, 30.6% minorities)

• 82.4% had fears or concerns of discrimination.

• Only 6.5% did not hesitate telling people their diagnosis

• 19.4% told not to tell at time of diagnosis

EXPERIENCE OF DISCRIMINATION

Subtle Discrimination 57.4%Mild acts of discrimination, hard to quantify but hurtful 56.5%Obvious acts of discrimination 47.2%Acts of discrimination resulted in:- i. Hurt feelings 67.6%ii. Exclusion 49.1%iii. Loss 42.6%iv. Physical damage 12%v. Mental damage 54.6%vi. Financial damage 40.7%

Impact of DiscriminationEmotional Trauma 63%Secondary Physical 38%Deterioration of health 44%Despair 55%Fear of recriminations 50%Reluctance to proceed 45%Stigma 48%Depressed 63%Confidentiality problems 46%Concern for dependants 31%Reluctance to seek help 59%Suicidal 37%

Action taken

• 34.3% kept it to themselves

• 31.5% report to health care worker

• 25% seek formal legal advice

• 11.1% note legal action

• Only 5 people (4.6% of the sample) had gone to court on the issue.

Use of the LawSherr L Sherr A Orchard et al JAMA 1999

• 76 Clients recounted at least one experience

• 35.5% believed not actionable in law

• 22% lack of energy• 17% time barrier• 19% expense• 22% exhaustion• 20% confidentiality

worries

Accepting the challenge - internationally

• Overall objectives accepted at the Federation's General Assembly '01, agreeing to scale-up HIV/AIDS action

• Coalition being built with partners including UNAIDS, and the Global Network of People living with HIV/AIDS (GNP+)

• Campaign design undertaken by Secretariat – presenting message, graphics, actions, advocacy, tools, events etc. in discussion with National Societies, and partners

• Subsequent role of the Secretariat to motivate, guide and co-ordinate work with National Societies, and globally

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Accepting the challenge - nationally

• Present and integrate the campaign into your National Society programmes in accordance with the General Assembly decision, co-ordinating regionally wherever possible

• Build partnerships for the campaign, including the national and local networks of people living with HIV/AIDS

• Prepare national campaign strategy, adapting the global materials as appropriate for your needs and sensitivities

• Motivate, guide and co-ordinate the campaign at national and local levels

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Building your campaign

• Establish your campaign task force, appoint a campaign co-ordinator, prepare your strategy

• Build partnerships especially with PLWHA

• Identify and provide direction on agreed advocacy issues

• Promote 'profile programmes' e.g. peer education, support groups, and initiate or strengthen prevention and care programmes

• Plan ongoing media campaign with peaks at key dates

• Organise and co-ordinate activities, events, seminars, Red Cross/Red Crescent ambassadors and spokespersons at national and local levels

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Visibility and credibility

Keeping the balance

What we do What we say

Programmes Advocacy

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Red Cross Red Crescent visibility and credibility

• Ensure your Society is a 'safe' environment for your members and volunteers living with HIV/AIDS. Put appropriate policies in place

• Strengthen or initiate prevention and care/support programmes organised by your society, making sure Red Cross/Red Crescent is seen as a 'safe house' for PLWHA

• Cooperate, learn from, share ideas and initiatives with other groups and organisations working with HIV/AIDS programmes and advocacy

• Organise specific events, communications and activities to raise awareness on stigma and discrimination among targeted groups and the general public, and advocate for specific objectives wherever possible

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Stigma and Discrimination…All is now revealed ! This is me nearly 20 years ago.

Myself and 30 others dressed as nuns, priests, monks formally exorcised the spirits of AIDSPHOBIA and HOMOPHOBIA from the Anglican Church by performing an excorcism ceremony with PRESS coverage (TV, film crews, photographers) outside the official residence of the Head of the Church of England .

I am not suggesting you do anything like this – but do think creatively please …remembering and aligning to…

Global campaign objectiveYour action and communications will work to changeperceptions, attitudes, policies, behaviour in order to:

• ensure that those people who are already HIV+ or have AIDS are able to receive the appropriate care and support, have access to affordable drugs, and can live full and useful lives within their communities

• prevent a further spread of the infection and increase every individual's willingness to be tested, to protect him or herself, and their loved ones

This might mean you getting it wrong occasionally, taking a few risks ,…’ pushing the envelope’

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An opportunity to partner at the strategic level…

The criminalisation of HIV transmission in Europe and Central Asia

We (GNP+ Europe) needs partners to help map and monitor the existing situation ..

Aims of the Project

• To map the use of the criminal or state law in prosecuting persons for the transmission of HIV. Specifically to record the rate of prosecutions/convictions and the type of laws used.

• To map who is being prosecuted and how this compares to national epidemiology of HIV.

• To identify local organisations working on these issues.

• To examine the ease of access to this information.

Use of the Law

• At least 36 countries have laws that can be used to prosecute individuals ‘transmitting’ HIV – and 14 of these have created specific legislation or amended existing legislation to ‘criminalise’ transmission in certain circumstances

• Exceptions are: •Albania, Bulgaria, Luxembourg,

Slovenia

What is punishable?Only actual transmission punishable

Exposing another person to the risk of transmission also

punishable

Belgium, Bosnia & Herzegovina, Croatia, Czech Republic, Estonia, Finland, Hungary, Ireland, Latvia, Lithuania, Malta, Portugal, Romania, Serbia and Montenegro, Switzerland and the UK

Armenia, Azerbaijan, Denmark, France, Georgia, Germany, Iceland, Liechtenstein, Moldova, The Netherlands, Norway, Poland, Russia, Slovakia and Ukraine.

Punishments

• Differed widely

• From payment of medical treatment of the person you ‘infected’

to

• Life imprisonment in four countries

• And deportation as well as imprisonment

Next Steps• We would like to finish off this research by• Filling in the gaps – for which we need your help• Publishing a brief overview of this report • Making the complete report – including the

country by country data – available electronically

• Want to get involved possibly? - contact me

Global campaign objectiveYour action and communications will work to changeperceptions, attitudes, policies, behaviour in order to:

• ensure that those people who are already HIV+ or have AIDS are able to receive the appropriate care and support, have access to affordable drugs, and can live full and useful lives within their communities

• prevent a further spread of the infection and increase every individual's willingness to be tested, to protect him or herself, and their loved ones

This might mean you getting it wrong occasionally, taking a few risks ,…’ pushing the envelope’

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And you know that you can do it …

So keep on doing it …but find ways of worker

SMARTER not HARDER and broaden what you do …and involve all the objectives of the global campaign at all levels