Transcript Document 7378809

Qian Ceng Gao: The layering of the
stigmas of HIV/AIDS, commercial sex
work, injecting drugs use and
commercial blood donation.
Kit Yee Chan
Overview
► Background
& Conceptualisation
► Method (brief description)
► Results
Definitions
HIV/AIDS-Related Stigma:
“a process of devaluation’” of people living with or
associated with HIV/AIDS”.
HIV/AIDS-related Discrimination:
“Discrimination follows stigma and is the unfair
and unjust treatment of an individual based on his
or her real or perceived HIV status”.
Relations?
Stigma (marking/labelling) Discrimination (action)
Why Study HIV-related Stigma
and Discrimination in Asia?
► "HIV-related
stigma and discrimination
remain an immense barrier to effectively
fighting the most devastating epidemic
humanity has ever known… If HIV-related
stigma and discrimination are not tackled,
AIDS will blight the 21st century just as
racism affected the 20th century."
- Dr Peter Piot, Executive Director,
UNAIDS
► Asia
described as “the next battlefield for
AIDS”
► Research
gap
 a general lack of research on HIV stigma in Asia
Study Background
► The
Deakin University study of HIV
Structural/institutional forms of
discrimination (2001-2005)
 Studied in China, India, Indonesia,
Philippines, Thailand, Vietnam
► Having
rules is not enough
► Need to understand HIV stigma
as a layered phenomenon
Poverty Stigma
MSM Stigma
HIV Stigma
IDU Stigma
CSW Stigma
Qian Ceng Gao?
AIDS
IDU
+
=
OR
Aims
►A
test of methodology
► To disentangle the layering of “HIV/AIDS
related stigma” in the health care context;
specifically:
 How much of the “HIV stigma” is actually
attributable to co-stigmas?
 What are different strengths of the co-stigmas?
Method
► Survey
Design
 Survey materials based upon a study by Kelly et
al (1987)
 Study design and analysis outlined in Reidpath,
& Chan (2005)
 Vignettes
 Judgements on attitudinal scales
►
Sample: 360 2nd year medical students in
Guangzhou (Southern China)
Factors Examined
No Disease Leukaemia HIV/AIDS
No co-occurring
characteristics
Blood Transfusion
Injecting drug use
(IDU)
Commercial Sexual
Transaction (CST)
Commercial blood
donation (CBD)
Vignettes
Wang is a bright young man with many talents. He was
considered to be a dutiful son to his parents, and a kind,
selfless and responsible person by everyone who knew
him.
Over the past six months, Wang developed a range of
health problems including fatigue, physical decline and
recurrent infections. He learned from his doctor that he
was seriously ill, and his family and friends were said to
have difficulty adjusting to his life-threatening illness.
Wang was diagnosed with [AIDS or leukaemia].
No co-characteristic/blood transfusion/IDU/CSW/blood sale
Social Distance
► If
you were a friend of Wang’s, would you
be willing to continue the friendship at this
time?
► Would you allow your children to visit Wang
in his home?
RESULTS
AIDS & IDU
60
50
% SM
40
30
20
10
0
AIDS
AIDS/IDU
Disease/Co-Characteristic
IDU
60
50
% SM
40
30
20
10
0
AIDS
AIDS/IDU
Disease/Co-Characteristic
IDU
60
50
% SM
40
30
20
10
0
AIDS
AIDS/IDU
Disease/Co-Characteristic
IDU
60
50
% SM
40
30
20
10
0
AIDS
AIDS/IDU
Disease/Co-Characteristic
IDU
60
50
% SM
40
30
20
10
0
AIDS
AIDS/IDU
Disease/Co-Characteristic
IDU
60
50
% SM
40
30
20
10
0
AIDS
AIDS/IDU
Disease/Co-Characteristic
IDU
60
50
%SM
40
30
20
10
0
AIDS Stigma Only
IDU Stigma Only
Intervention Targets
60
50
%SM
40
30
20
10
0
AIDS Stigma Only
IDU Stigma Only
Intervention Targets
AIDS & CST…
60
50
% SM
40
30
20
10
0
AIDS
AIDS/CST
Disease/Co-Characteristic
CST
60
50
% SM
40
30
20
10
0
AIDS
AIDS/CST
Disease/Co-Characteristic
CST
60
50
% SM
40
30
20
10
0
AIDS
AIDS/CST
Disease/Co-characteristics
CST
60
50
%SM
40
30
20
10
0
AIDS Stigma Only
CST Stigma Only
Intervention Target
AIDS & Commercial Blood
Donation…
60
50
% SM
40
30
20
10
0
AIDS
AIDS/CBD
Disease/Co-Characteristic
CBD
60
50
% SM
40
30
20
10
0
AIDS
AIDS/CBD
Disease/Co-Characteristic
CBD
60
50
% SM
40
30
20
10
0
AIDS
AIDS/CBD
Disease/Co-Characteristic
CBD
60
50
%SM
40
30
20
10
0
AIDS Stigma Only
CBD Stigma Only
Intervention Targets
Overall Interpretations
► “Unique”
HIV/AIDS stigma does not
exist
► Variations exist in the layering of AIDS
stigma and the different co-stigmas
► Disease focus stigma interventions
may have very limited effects
► Understanding the disease does not
make the disease less stigmatising
What Next?
► Further
model building
► Issue of triple stigma?
► Patterns in other contexts? Other
populations?
► Reasons underlying the relative stigma
scores?
Thank You…
Email: [email protected]
60
50
Degrees of Stigmatisation
%SM
40
No Disease
Leukaemia
AIDS
30
20
10
0
None
BT
CBD
Co-Characteristics
CST
IDU
Is AIDS more stigmatising than
Leukaemia?
60
50
%SM
40
30
20
10
0
None
BT
CBD
Co-Characteristics
CST
IDU
60
50
% SM
40
30
20
10
0
Luekaemia
LUE/IDU
Disease/Co-Characteristic
IDU
60
50
% SM
40
30
20
10
0
Luekaemia
LUE/CST
Disease/Co-Characteristic
CST
60
50
% SM
40
30
20
10
0
Luekaemia
LUE/CBD
Disease/Co-Characteristic
CBD
► Consistent
with the findings from stigma
intervention studies:
 E.g. Increasing students’ knowledge levels only
moderately increase their acceptance of PLWHA
(e.g. South African study, 41% at follow-up, up
from 17% at baseline; Khun et al., 1994)
► Survey
with youths in Singapore:
 “while AIDS education and campaigns may
increase knowledge and awareness about HIV
transmission, they do not really reduce personal
concern about the possibility of infection and
the potential stigma associated with working
with HIV infected persons” (Lim et al. 1999)
Innocent
No Disease
Leukaemi HIV/AIDS
a
No co-occurring
characteristics
Visit CSW
IDU
Blood Transfusion
Sell Blood
●
●
●
HIV is more stigmatised than control
disease conditions
No Disease Leukaemia HIV/AIDS
No co-occurring
characteristics
CST
IDU
Blood Transfusion
CBD
●
●
●
Co-stigmas vs Control
No Disease Leukaemi HIV/AIDS
a
No co-occurring
characteristics
CST
IDU
Blood Transfusion
CBD
●
?
?