PLHIV Stigma Index in Nepal

Less than half of the respondents (44%) were diagnosed with HIV in between 3—5 years priorto survey, one-third of the respondents (33%) were diagnosed with HIV more than 5 yearsago and less that one-fourth (21%) had been diagnosed with HIV within the last 1 year. Veryfew respondents (4%) reported disability besides the HIV infection. Among these, more femalesthan males were suffering from physical disability (47% vs. 39%) and blindness (40% vs. 28%),whereas more males than females were suffering from hearing impairment (33% vs. 13%).According to the categorization of the respondents by their vulnerability, 23 per cent (195) ofthe respondents belonged to the migrant group and 20 per cent (165) belonged to the injectingdrug user (IDU) group. Thirty-one per cent (260) of the respondents indicated that they hadnever belonged to any of the key population (KP) groups.nExperience of Stigma and Discrimination due to HIVHalf of the respondents (50%) had experienced at least one event of stigma and discriminationin the past 12 months, the most frequent event being “gossiping” (as reported by 36% of therespondents). As compared to male and female respondents, a higher number of transgenderrespondents reported experiencing discrimination and stigma in the form of psychologicalpressure by wife or partner, sexual rejection, discrimination by other PLHIV and discrimination/hatred by wife or partner or any other household member. Moreover, the results indicate thatthe society pressurizes PLHIV by barring them from attending religious functions and socialgatherings. As compared to male and female respondents, transgender respondents reportedslightly fewer experiences of exclusion from social gatherings/activities and religious activities.Approximately one out of ten respondents had experienced discrimination by other PLHIV.Variation in the proportion of the stigma and discrimination faced by respondents in terms oftheir occupation, place of residence (urban or rural) and level of education was low. However,the younger population was found to be more prone to stigma and discrimination as comparedto older age groups (i.e. people aged over 40 years).The PLHIV who had been diagnosed less than one year ago (37%) were less likely toexperience stigma and discrimination as compared to those who had been diagnosed morethan one year ago (>49%). A greater percentage of PLHIV who were IDUs (60%) and femalesex workers (FSWs) (68%) had experienced stigma and discrimination than those who wereMigrants (50%), men who have sex with men (MSM) (53%) and others (Refugee/Indigenousgroups) (50%).Approximately one-third of the respondents who were compelled to change their place ofaccommodation or were denied rental accommodations and those who were reportedlyrefused employment during the 12 months prior to the survey said that this was due to theirHIV status. The study found that discrimination of PLHIV at educational institutions was low,with only 2.2% of the PLHIV and 2.6% of the children of PLHIV being dismissed, suspendedor prevented from attending any educational institution.The results of the study indicated that health personnel were somewhat involved indiscriminating against and stigmatizing PLHIV. Respondents reported instances of denial ofhealth services including dental care (7%) and denial of family planning services (3%) andsexual and reproductive health services (2%) by health workers. A few respondents believedthat their medical/health records were not kept confidential.nSelf-stigmaApproximately nine out of ten respondents (87%) had experienced at least one feeling ofself-stigma, such as shame, guilt, blaming others, low self-esteem, suicidal thoughts andwillingness to be punished. The feelings of self-stigma were slightly lower among female(81%) than male (92%) and transgender (100%) respondents. Moreover, it was found thatself-stigma was high among residents of both urban (90%) and rural (87%) areas. Similarly,the results indicated that such feelings were more common among young respondents whowere below the age of 25 years (98%) than those belonging to older age groups.Most of the transgender respondents (93%) and male (87%) respondents blamed themselvesfor becoming infected, whereas a large number of female respondents (57%) blamed othersfor acquiring the infection. Guilt, shame and low self-esteem were the most prevalent feelingsamong transgender and male respondents. Furthermore, a larger percentage of transgenderrespondents (56%) experienced suicidal feelings, as compared to female (17%) and male(11%) respondents.Self-stigma had also led respondents to adopt various measures, such as “not havingadditional children” (males: 60%, females: 62% and transgender people: 52%), “notgetting married” (males: 30%, females: 47%, and transgender people: 77%), “becomingcelibate” (males: 7%, females: 35%, transgender people: 7%) and “stopping to attend socialgatherings” (13% of the respondents). One out of 10 or 11 per cent of the respondentsdecided not to visit local clinics and 7 per cent decided not to visit hospitals when they neededtreatment.The most common reason cited for HIV-related stigma and discrimination was, “peopleare afraid of acquiring HIV infection from me” (53%) followed by “ignorance about HIVtransmission” (49%). Almost one-fourth of the respondents were uncertain regarding thereason that they experienced HIV-related stigma and discrimination.n Rights, laws and policiesThe stigma index referred to an international agreement of 2001 called “Declaration ofCommitment on HIV/AIDS.” A quarter of the respondents (26%) had heard of this declaration8vii9viii