recognizing and responding to hiv-related stigma tim vincent, mft california std/hiv prevention...
Post on 21-Dec-2015
231 views
TRANSCRIPT
Recognizing and Responding to HIV-Related Stigma
Tim Vincent, MFT
California STD/HIV Prevention Training Center
Goals To offer recommendations on how to address
stigma in training engagements
To define and describe stigma, and HIV-related stigma
To offer recommendations on how to assess HIV-related stigma with patients
To present strategies to respond to stigma on institutional and community levels in order to improve service delivery
Then and Now
HIV-related stigma is not as prevalent now as it was 20 years ago.
Agree
Disagree
How Has Stigma Changed
Research on prevailing attitudes
Acute to chronic model
Depends on the population group and other layers of stigma operating
Focus was not on the recipients of the stigma
How important is it to you to focus on
addressing stigma?
4-Extremely 3-Significant 2-Somewhat 1-Not at all relevant
How does stigma impact your work with the AETC?
Recommendations For Faculty:
Instruction in the manifestations of stigma
Instruction in how to assess impact of stigma on patient care and quality of life
Instruction to increase provider awareness of their own bias and the potential to stigmatize patients
I. Manifestations of Stigma
Defining Stigma
A powerful discrediting social label that radically changes the way an individual views themselves and are viewed as persons.
People who are stigmatized are usually considered deviant or shameful, and as a result are shunned, discredited, rejected or penalized.
Stigma Can Happen Due To:
Who someone is (Identity)
What he or she has done (Behavior)
Something that may not be accurate or current (Perception)
Someone Can Be Stigmatized As A Result Of: Racism Homophobia HIV Status Drug Use Social and Economic Status Cultural Stereotypes Sexual Orientation Mental Health Diagnosis Gender Identity Immigration Status Age Disability
Different Levels Of Impact
Intrapersonal
Interpersonal
Institutional
Community/Cultural
Stigma can intensify if someone has a disease or condition which is:
life-threatening contagiousassociated with behaviorassociated with moral fault visible
HIV
Impact Of Stigma On Patients
Overall quality of lifeAbility to access servicesAbility to communicate effectively with
providerAbility to succeed with treatment Ability to make choices about potential
risks
Responding To Hiv-related Stigma
People develop or use coping strategies that can be effective or dysfunctional
The coping mechanism may work to alleviate the stress of the stigma. It may or may not create other problems.
II. Assessing the Impact of Stigma
Stigma as a lens to:
assess understand diagnose respond to presenting problems
When Assessing the Impact of Stigma
Establish rapport
Consider whether stigma may impact behavior
Decide if it is okay just to ask
Ask if things were different historically
Ask about coping strategies
Care and Treatment Concerns
How do you feel your status affects your ability to get good care services?
How do you feel you have been treated at this clinic?
Do you feel comfortable getting your medications at the pharmacy?
Do you feel the need to hide your medications? How do you manage this?
The Potential Impact On Behavior
In what ways might your behavior change if you sense that you will be judged for having HIV?
Many people feel that they are treated differently as a result of having HIV, what has been your experience?
Have you ever used drugs or alcohol to cope with feeling judged or mistreated for having HIV?
What challenges you in having a healthy sexual life?
Questions Generated From Providers
Do you have any problems taking your meds? Do you have any problems with this clinic?
In general, what works and what doesn’t work for you?
How has your view of yourself changed since your diagnosis?
Is it okay to call you at home and identify myself?
Do you ever feel excluded from activities because of your HIV status? Do you exclude yourself?
Increasing Sensitivity of Providers
Client/Provider Relationship Concerns
The natural development of a relationship may be impaired by a patient’s experience
The ability to be genuine, demonstrate
empathy and respect may be challenged by the client’s presentation
Stigma Impacting Your Work
“You have to peel thru layers of defense mechanisms to get to the core of their true selves. With rapport and trust built across time, they do open up eventually. They open up sooner if they perceive that the provider is genuine, trust worthy and non-judgmental”
Felt and Enacted Stigma
Felt stigma refers to how someone may anticipate the discrimination and the shameful feelings associated with it.
Enacted stigma is the actual experiences of the discrimination.
Suggestions To Increase Self-awareness
Experiential exercises with a clear purpose
Education in the cyclical dynamics of stigma
Emphasize the impact on patient/provider relationship
Institutional and Community Levels
Approaches Beyond The Individual Level
Access for the clients in creative waysCommunity educationLinkages to agencies that serve clientsConsistency of care providersHIV advocacy/activismNot putting HIV out on the spotlight
NAPWA Recommendations
Provide knowledge and educationProvide contact with stigmatized peopleDevelop coping mechanismsLegal and regulatory responsesProvide care and treatmentChallenging the social acceptability
Faculty Implications
How does the topic currently get addressed in the trainings?
Is there something that you would like to change or create in the trainings?
What happens when a participant displays a stigmatizing attitude toward a patient?
Then and Now
Stigma is a vital and evolving concern
You are the experts in moving the thought process forward
Closing Quote:
Not everything that is faced can be changed, but nothing can be changed until it is faced.
James Baldwin
References:
NAPWA Facts At-A –Glance: HIV/AIDS Stigma and Discrimination
How does stigma affect HIV prevention and treatment, CAPS Fact Sheet
Stigma and Discrimination: Definitions and Concepts, Canadian AIDS Society
Internalized Stigma Among People with HIV-AIDS, AIDS and Behavior, Vol. 6, No 4, Dec 2002
