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Lazare Manirankunda, Institute for Tropical Medicine (Belgium ... - BTC

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Fear of stigma among Sub‐Saharan Africanmigrants (SAM)<strong>Lazare</strong> <strong>Manirankunda</strong><strong>Institute</strong> of <strong>Tropical</strong> <strong>Medicine</strong>HIV‐SAM Project


Outline1) SAM in <strong>Belgium</strong>2) Epidemiological background3) Stigma (definition and mechanism)4) Causes of stigma5) Outcomes of stigma6) Discrimination7) Experience of HIV‐SAM Project8) What can be done <strong>for</strong> stigma reduction?9) Conclusion


1. Sub‐saharan African migrants in <strong>Belgium</strong>• Minority– 175000 SAM (1.60% of Belgian pop)– Man/women: 1.03–15 ‐ 49 years: 70%• Heterogeneous population–48 nationalities–Causesof immigration & Residence permit• Weak socio‐economical status• Hard‐to‐reach (length of residence, mobile, littlesocial capital …)Source: Gegevens FOD 2010 Economie, KMO, Middenstand & Energie


2. Epidemiological backgroundTotal Belgians SAMCumulative HIV diagnoses 25 556 31% 32%Gender More men More womenTransmission routes MSM Heterosexual transmissionNewly diagnosed (end2012)1227 33% 25%Late diagnosis end 2012(


3. StigmaUndesirable or discrediting attribute that person orgroup possessesStigma refers to process of devaluating, labeling, andstereotyping that are manifested in the loss of status,unfair, and unjust treatment, and social isolation ofindividuals or groups.*Goffman E. Notes on the Management of a spoiled Identity. New York: Simon &Schuster; 1963 (p5)


4. CAUSES of STIGMA1. Moral judgement–Sexual norms of society• Heterosexual relationship•No sex be<strong>for</strong>e marriage•Be faithful to your wife/husband•Not having multiple partners•Do not visit prostitutes–What do people say about people living with HIV?• “They are prostitutes, womanizers, unfaithful people, etc.” Cross sexual norms of society = stigmatizedCree, V.E et al. Qualitative Social Work 3 (1), 2004


CAUSES of STIGMA2. Fears about death and disease‐ Nature of people• Everybody is afraid to get sick/ die‐ Perception of HIV•Death/ Deteriorating sickness– Infectious disease People stigmatize because they fear the person whoreminds them of death and sickness3. Insufficient knowledge leads to misbelieves andmyths– Can get HIV from touching, kissing somebody with HIV– Can get HIV from drinking from the same glass


5. Outcomes of stigma• Uninfected people–Social distancing from PLHA– Discrimination– Violence (verbal, physical)–No HIV testing• Infected people– Lower mental health (Depression…)– Suicide– Alcoholism–Greater HIV symptoms–….(Earnshaw VA & Chaudoir SR, AIDS Beh 2009)


6. Discrimination of African migrants in France• Women experienced more discrimination comparedwith heterosexual non‐African man– Health services (OR:2.1, p


7. Experience of HIV‐SAM project


7.1. Perceptions of HIV/AIDS in SAM• HIV/AIDS is a “killer disease”, “slim disease”‐ Can not touch someone /Can not be touched/Outcast‐ You don’t see PLHA in <strong>Belgium</strong>• HIV associated with immoral behavior, promiscuity“womanizers, runners, prostitutes “• HIV transmitted through contact with PLHA• Volunteering <strong>for</strong> HIV prevention‐ You are probably HIV infected‐ Some people feel that you accuse them of running risk or being HIVinfectedAttitude and act of community toward PLHA: isolation,rejection Challenge to get volunteers <strong>for</strong> prevention


7.2. Involvement of SAM in HIV prevention•HIV prevention networks (non‐profit social culturalorganizations)Tasks of the networks‐ Participating in meetings‐ Planning activities‐ Implementing culturallyadapted activities‐ EvaluationTasks of the HIV‐SAM Project‐ Training /coaching/supervision‐ Providing free prevention materials to the networks


7.3. Resistance of the communities to volunteering• WHY ONLY US? Fear of double stigma/stigmatisingothers• SAM living with HIV are not visible,where they are? Doubt on statistics (immigration services)• Do you know what it means beinglabeled as HIV positive in ourcommunity?• Communities are not demanding HIVprevention, they need jobs13


7.4. Prevention networks and challenges• WHY ONLY US?• AIDS doesn’t exist in <strong>Belgium</strong>, goto Africa• SAM don’t dare to take condoms(immoral behavior, promiscuity)


7.5 Effect of stigma on HIV testing•It is better not to know‐ “You don’t want to know you are going to die”‐ “You don’t want to know you will be rejected”‐ “You don’t want to know your will be deported”‐ “You don’t want to know your life will dramatically change”•Low personal risk– I’m married– I have just been tested– My wife has just delivered a baby<strong>Manirankunda</strong> L et al, AIDS Education and Prevention, 2009


7.6. Effect of stigma on living with HIV•Fear<strong>for</strong>the future (death, unsecure life)•Great fear of being known as HIV positive orbreaching of confidentiality– Gossip in the community until homeland with risk ofrejection– Anxiety about family in Africa knowing the bad news (mumwill die)• Will I be able to get a partner?• Will I be able to have a child?


7.7. Effect of stigma on Peer support group• Monthly meetings• Exchange of life experiences, coping with HIV• Positive prevention• Recreative moments‐ Are there people from my country?‐ Prefer to have a person from another country, whohas child, live many years with the disease, ….‐ ARC support is sufficient, don’t need help of SAM


•Coping strategiesEffect of stigma–Isolation– Keeping secret– Avoiding to be seen at the ITM(ARC) clinic– Hidding medication– Victimize themselves “I was raped” vs “promiscuity”•Impact of no‐disclosure– Mental health problem (depression)–No help–Risk behavioral– Antiretroviral adherence


7.8. Disclosure and its challenges• Need of social contacts– They don’t invite you anymore, they don’t call you– I have been thrown out of the house, I can’t touch childrenanymore, I eat on my own plate/use my own glass– When I talked about, I was accepted (very few)• Need of partner– Fear of rejection and gossip around/Fear of passingHIV infection– I told him and he/she accepted me (very few)•Desireof having a child• Weight of keeping secret


8. Reduction of Stigma/discrimination•Multi‐level interventions– In<strong>for</strong>mation in the community (knowledge, fear, attitude)– Normalizing HIV in health services (universal HIV testing,early access to treatment <strong>for</strong> all including the undocumentmigrants)– Reducing stigma in general health facilities– Supporting PLHA (counseling and skills)• Better coping with HIV infection• Improving knowledge on laws against discrimination & claimingtheir rights• Positive prevention, role models– Reducing intersecting stigma• Participation of key populations in prevention, HIV testing &treatment policy


9. Conclusion• Stigma/discrimination are great barriers <strong>for</strong>prevention, HIV testing and access to treatment• Peer support group in Antwerp‐ Some PLHA in need don’t benefit of it‐ Very few offer their testimonies in the communities•SAMLHA as community researcher (ongoing HIVprevalence study)•“… stigma, denial and complacency are still amongus, putting us in danger of failing of the nextgeneration. We must join our hearts and our voicestogetherwe are stronger.”(Director of UNAIDS, World AIDS Day, message, 2013


Thank you <strong>for</strong> your attentionwww.hivsam.be

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