Tackling HIV Stigma What works?

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2 STIGMA: THE WHAT, WHERE AND HOW 2 STIGMA: THE WHAT, WHERE AND HOW UNAIDS describes HIV stigma as ‘negative beliefs, feelings and attitudes towards people living with HIV’ and as a ‘“process of devaluation” of people either living with or associated with HIV and AIDS…’ 6 Early stigma theory defined stigma as a ‘mark of disgrace’. 7 More recent thinking has developed from this to see stigma as a construct of a range of psychological, social and societal factors, for example, stereotypes, cultural norms, economic circumstances and power structures. 8&9 Stigma holds social structures in place, maintaining boundaries and inequalities between groups of people and between those who have power and those who do not. 10 2.1 What is stigma made up of? Figure.1 describes a framework for HIV stigma based on the work of a number of agencies and academics working on stigma reduction. It shows stigma as a cycle, where stigma and discrimination 6 UNAIDS (2014), ‘Reduction of HIV-related stigma and discrimination’. Available at: http://www.unaids.org/sites/default/files/media_ asset/2014unaidsguidancenote_stigma_en.pdf 7 Goffman E. ‘Stigma: notes on the management of spoiled identity’. Englewood Hills, NJ: Prentice Hall; 1963. 8 Link. B. G., & Phelan. J. C. (2001) Conceptualizing stigma. Annual Review of Sociology. 27, p363 – p385 9 Parker. R., & Aggleton. P. (2003) HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Social Science and Medicine. 57, p13 – p24 10 Dodds, C (2015) ‘Evidence of HIV-related stigma among African people in the UK’, presentation at Croydon University Hospital, 3 June 2015. http://sigmaresearch.org.uk/presentations/item/talk2015g reinforce those things that helped to form it in the first place. • Drivers These are causes of stigma at an individual level. They are the outcomes of our cognitive processes which help us to make sense of the world around us. Things like fear of transmission from casual contact, lack of awareness and our use of stereotypes all fall into this category. • Facilitators These are causes at a societal level that facilitate stigma. They include laws, rights, systems, cultural and gender norms and economic status. • Power structures These are power structures within society that influence stigma – who has power and who does not. • Intersecting stigmas These are the multiple prejudices experienced by people at increased risk of HIV within a society. Prejudices associated with same-sex relationships, race, sex work and drug use, for example, all intersect with HIV stigma. 4 NAT Tackling HIV stigma: What works?
2 STIGMA: THE WHAT, WHERE AND HOW Manifestations of stigma Drivers and facilitators Intersecting stigmas Power structures Fig.1 A framework for the construction of HIV stigma, adapted from Stangl et al (2010) and Stangl et al (2012). • Manifestations These are how stigma is exhibited or experienced, for example, direct discrimination, thoughts or feelings about a person living with HIV, anticipated stigma or self-stigma. 11 2.2 Where do we find stigma? Stigma can be experienced in a range of social environments. This can be thought of as the level or context at which stigma is experienced and it is helpful in determining where we should target stigma reduction interventions. 12 They can include: • Individual This is how the individual feels about HIV, how they understand and respond to it. • Interpersonal and community Stigma between individuals, including family, friends, social networks and acquaintances. • Organisational Stigma within institutions such as the work-place, schools and hospitals. • Societal Stigma across society as informed by cultural norms and attitudes. 11 These categories and descriptions are derived from the ‘domains’ of stigma described in Stangl et al (2010) and Stangl et al (2013) 12 Stangl et al (2013) • Public policy Stigma as reflected in national and local laws and policies – these will often be related to cultural values. 13&14 2.3 How do we reduce stigma? Many different approaches have been used to address stigma. Programmes designed to reduce stigma might utilise more than one approach. Here are some broad categories of approach which might be part of a campaign or programme. Though not exhaustive, these are useful to consider when comparing interventions. 15 1. Providing information on HIV, HIV stigma and on key affected populations Information may be provided to the general public or to targeted groups. 2. Skills-building and participatory learning approaches This goes further than simply providing information. Often characterised by workshop-based activities, skills can be taught to support a person to recognise and challenge stigma. 13 Ibid 14 Campbell. C., & Deacon. H. (2006) Unravelling the contexts of stigma: From internalisation to resistance to change. Journal of Community and Applied Social Psychology. 16 p411 – p417 15 Brown. L., Macintyre. K., & Trujillo. L. (2003) Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention. 15, p49 – p69 Tackling HIV stigma: What works? NAT 5
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