Essay On Aids Victims And Stigmatization Pdf
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HIV continues to be a major public health crisis both in the United States and around the world. While major scientific advances have made it easier than ever to prevent and treat HIV, there remains no vaccine or cure, and tens of thousands of people continue to contract HIV every year. Insufficient funding for public health programs, ideological opposition to common sense prevention policies, and societal barriers like stigma and discrimination, have made it especially difficult for us to turn the tide against the epidemic.
It is the prejudice that comes with labeling an individual as part of a group that is believed to be socially unacceptable. While stigma refers to an attitude or belief, discrimination is the behaviors that result from those attitudes or beliefs. HIV stigma and discrimination affect the emotional well-being and mental health of people living with HIV.
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Metrics details. HIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. This review aims to synthesize qualitative evidence that explored the intersections of stigma and health for people with HIV.
A thematic summary was conducted that was guided by the qualitative metasummary technique developed by Sandelowski and Barraso. Literature searches yielded 8, references of which 55 qualitative studies were identified that illustrated HIV-related stigma in the context of health. The metasummary classified qualitative findings into three overarching categories: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma is avoided or addressed.
A number of health care practices were identified — some rooted in institutional practices, others shaped by personal perceptions held by practitioners — that could be stigmatizing or discriminatory towards people with HIV.
There existed interconnections between enacted stigma and felt stigma that influenced health care utilization, treatment adherence, and overall health and well-being of people with HIV.
Intersectional stigma also emerged as instrumental in the stigma experiences of people living with HIV. A number of strategies to address stigma were identified including social support, education, self-efficacy, resilience activities, and advocacy.
This review of the qualitative evidence indicates that HIV-related stigma within health contexts is a broad social phenomenon that manifests within multiple social spheres, including health care environments. Findings from this review indicate that future stigma research should consider the social structures and societal practices — within and outside of health care environments — that perpetuate and reinforce stigma and discrimination towards people with HIV.
Peer Review reports. Though health-related stigma has been associated with other health conditions such as mental illness, cancer, and other sexually transmitted infections, much of the recent illness stigma literature has been devoted to the stigma and discrimination associated with HIV and AIDS HIV-related stigma and the development of conceptual frameworks specific to HIV-related stigma [ 3 — 9 ].
These conceptual frameworks have identified particularities of stigma in the context of HIV including: the moral valuations ascribed to the illness, modes of transmission, and populations impacted; the intersections of HIV-related stigma with other forms of social marginalization; and the recognition of societal power relations within mechanisms of stigma [ 3 — 9 ]. There has been a growing body of literature exploring stigma and health for people with HIV.
Studies have reported on discrimination in healthcare environments towards people with HIV manifesting as denial of care, confidentiality breaches, negative attitudes, and humiliating practices by health care workers [ 12 — 14 ].
Stigma has been shown to impact mental health factors for people with HIV including anxiety [ 17 — 19 ], depression [ 20 — 22 ], suicidal ideation [ 23 , 24 ], emotional health [ 25 ], psychological well being [ 26 ], life satisfaction [ 27 ], and quality of life [ 28 , 29 ].
Stigma has also been linked to health care seeking and adherence to antiretroviral medication [ 30 — 33 ]. Fears of disclosure, anticipated stigma, internalized shame, and experiences of discrimination within health care settings and in greater society can influence future decision making around prevention activities [ 35 — 38 ]. Although there has been a number of recent reviews that examined stigma and HIV [ 16 , 39 — 41 , 42 ], there has been limited research that systematically integrates qualitative evidence in its exploration of stigma, HIV and health.
Qualitative synthesis, a method of aggregating qualitative evidence, is a burgeoning approach to synthesizing research evidence and has grown in popularity within health research [ 43 — 47 ]. While syntheses of quantitative evidence have been used to understand causal mechanisms, to measure effect size, or to determine intervention effectiveness, qualitative syntheses are better suited for understanding the nature of a phenomenon, to explore contextual features of experience and to develop theoretical concepts derived from findings across studies [ 48 — 50 ].
Qualitative evidence is particularly helpful in understanding the socially constructed nature of HIV infection, interpreting the social processes, interactions, or contextual features that influence health care decision making, and delineating the interconnections between stigma-related processes and related health impacts. The original objectives of this project were to conduct a synthesis of the qualitative and quantitative research evidence to better understand the impacts of stigma on the health of people with HIV.
This paper reports on the qualitative evidence that explored the intersections of stigma and health for people with HIV. From February to May , a series of electronic and manual searches were carried out to yield qualitative and quantitative literature related to HIV, stigma and health.
To ensure that important evidence not captured in an electronic database search was not missed, manual search strategies were also performed including: citation searches of systematic reviews addressing the topic of stigma for people with HIV [16, 39, 40, 41, 42, 52], a bibliographical review of articles included after full paper review, and recommendations from content experts knowledgable in HIV-related stigma.
The date range of the literature search spanned from January to The literature search was restricted to post, since the introduction of cART is often cited as a key turning point in the HIV epidemic. To avoid the exclusion of relevant health-related literature at this stage, the search strategy used key terms for HIV and stigma exclusively, and then incorporated health-related inclusion criteria in the review stages see Additional file 1 — Screening process for qualitative sysnthesis.
The inclusion process went through three review stages: title and abstract review to determine clear inclusion, full-paper review to determine general applicability to the synthesis aims, and methodological review to determine applicability based on the pre-specified inclusion criteria. The inclusion criteria were as follows: 1 qualitative studies; 2 published after ; 3 that reported thematic findings on stigma and health; 4 and had participants with experiential knowledge of stigma based on their own experience people with HIV or from the perspective of living with or working with people with HIV i.
Although language restrictions were not applied as an inclusion criterion, this review was only able to synthesize studies that were written in English, French or Spanish. Prior to extracting the data, the authors developed an analytical focus guided by the following questions:. The analysis of qualitative literature also accounted for any other health-related findings that may further delineate the interconnection between stigma and health i.
The conceptualization of stigma used for analysis was shaped by broad conceptual frameworks of stigma such as those proposed by Goffman [ 2 ]; Alonzo and Reynolds [ 3 ]; and Link and Phelan [ 54 ]; and HIV-specific frameworks of stigma such as the work of Herek et al. The authors chose these frameworks as they captured the particularities of stigma in the context of HIV and delineated the social mechanisms that could potentially contribute to emotions, beliefs and behaviours that shape health-related experiences for people with HIV.
A thematic summary guided by the qualitative metasummary technique developed by Sandelowski and Barraso was completed. Qualitative metasummary is a synthesis method used to aggregate qualitative findings and to create a thematic taxonomy across studies [ 46 , 55 ].
Thematic analytical approaches were also used to identify, interpret, and report overarching themes and patterns of meanings emerging from the included literature [ 50 , 56 , 57 ]. An inductive analytical approach was used so that the themes identified for the synthesis were strongly linked to the thematic findings reported within each study [ 58 ]. Next, similar findings were grouped using a coding key developed from the analysis.
The coding key was established using the themes identified in the original studies. Each reviewer coded each study independently, then met to compare coding to ensure consensus. Using constant comparison methods, codes were grouped into themes, then findings were organized thematically based on replication confirming what is said in other studies , extension providing additional contextual information that extends findings or refutation providing a contrary view to what is said in other studies.
Conceptual frameworks for stigma also guided the integration of findings into the overarching themes. Three reviewers were involved in the data extraction and analysis of qualitative findings LAC, DNB, and RD , and a fourth reviewer ER was involved in the verification of data extraction and thematic coding.
Each included reference was reviewed and appraised in duplicate by two independent reviewers. Data extraction was conducted by one reviewer and verified by a second reviewer. Any disagreements between reviewers were resolved by consensus and, if that failed, a third independent reviewer resolved the disagreement. Thematic analysis was conducted by a team of two reviewers with audits conducted by a third reviewer to ensure authenticity of extracted data to the original study, and to ensure consistency of thematic analysis.
The qualitative team met regularly to discuss review findings. As part of the peer review process, members of the team for the quantitative review also joined the qualitative review meetings at three review stages: completion of data extraction, completion of thematic coding, and preliminary analysis of qualitative findings.
The literature searches yielded 8, references 5, after duplicate references were removed of which papers were included for qualitative or quantitative data extraction. From the studies that met the criteria for inclusion, 76 were excluded from the qualitative synthesis see Additional file 2 for a listing of articles excluded from qualitative data extraction : 65 studies that reported only quantitative findings and 11 studies published in languages other than English, French or Spanish.
The inclusion process has been documented in Fig. Screening process for qualitative synthesis. The settings for included studies were geographically diverse, with a mixture of studies conducted in high-, middle- and low-income countries see Additional file 3 for a summary of study characteristics. Of the 55 studies included in this qualitative synthesis, only two specifically aimed to study the intersections of HIV, stigma and health [ , ].
The remaining 53 papers indirectly reported on the intersection of health and stigma within their thematic results: 16 studies explored stigma or discrimination and 37 explored health-related topics. Nineteen studies applied an explicit concept of stigma to their study findings. Of these nineteen studies, four developed conceptual stigma frameworks using the original study findings [ 77 , , , ].
While the qualitative studies on HIV-related stigma were geographically and topically diverse, review findings suggest that the included studies shared some common conceptions of stigma within the health context. In this synthesis, we initially categorized the qualitative findings using the themes commonly identified across the included literature; then, in the thematic analysis, we identified overarching themes in relation to HIV, stigma and health.
The metasummary classified qualitative findings into three overarching themes: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma was circumvented, buffered or combated. See Additional file 4 , for a matrix summary classifying the common themes identified in the included literature; see Additional file 5 , for a detailed description of these themes.
The reviewed studies identified six dimensions of HIV-related stigma: enacted stigma discriminatory behaviours, actions or attitudes from others , felt stigma internalization of stigma; devaluing beliefs, behaviours or actions in which people with HIV may hold or engage , marginalization other forms of social devaluation , disclosure disclosure of seropositive status , morals and values social mores and societal values , and visible health visible symptoms of seropositivity.
These dimensions informed how stigma was experienced by people with HIV and addressed within health care contexts. Lastly, these studies offered various strategies through which stigma was managed. This synthesis of the qualitative literature indicates that the six dimensions of HIV-related stigma are interconnected thereby illustrating the complex dynamics between marginalization, disclosure, social mores and values, and visible health in enacted and felt stigma.
To better illustrate these connections, summarized here are aspects of HIV, stigma and health that were prominent in the qualitative literature. The first section, HIV and stigma in health care environments describes some of the ways in which health care practices can be discriminatory towards or interpreted as stigmatizing by people with HIV.
In the last section, strategies identified to address HIV-related stigma are explored. These modes of addressing stigma offer people with HIV, as well as health care practitioners and other advocates in their care, alternative ways of managing stigma that could contribute to stigma reduction. Three practice strategies emerged from the literature: risk management, where strategies to mitigate perceived health risks were institutionalized in care; fear management, where care practices stemmed from practitioner fears of HIV exposure; and moral management, where care practices derived from judgmental perceptions towards people with HIV and transmission activities.
The literature also identified intersectional stigma, or interconnections between HIV-related stigma and other forms of social marginalization as they inform access to health care. Whether these practices were codified in institutional systems or engaged indiscriminately by health care providers, they were distinguished as stigmatizing health care practices as they had the potential to expose people with HIV to discrimination or enacted stigma.
A number of risk management procedures institutionalized in organizational policies were characterized as being potentially discriminatory towards people with HIV. Segregation of people with HIV was an example of a precautionary measure that could incite stigma.
Other studies noted acts of segregation that may intially have been instituted to protect people with HIV, such as protecting them from opportunistic infections. The qualitative literature also discussed segregation practices as intentionally used to differentiate people with HIV from the general care population.
Infected people want as few people to know about their situation as possible. This disease is repellent. Anyone coming there is infected. That room is for this disease. You go elsewhere for other diseases or for consultation.
As illustrated above, segregation as an institutional practice could demark people with HIV. Furthermore, by separating people with HIV from the general public, health institutions could inadvertently disclose serostatus. Confidentiality violations were another form of disclosure within health care settings discussed as inciting stigma. Everyplace I went I was carrying this. Whether confidentiality was violated consciously or unconsciously, enacted by individuals or codified in health care practices, it had a profound impact on how people with HIV experienced health care and on their future health care seeking behaviours.
The qualitative literature identified ways in which health care strategies designed to mitigate health risks could become discriminatory care practices. However, Li et al. Additionally, historical experiences of discrimination may influence the interpretation of behaviors as discriminatory [ ]. Nevertheless, the literature illustrated ways in which institutional practices became stigmatizing forces for a person with HIV even if discrimination was not intended.
Behaviors that may seem benign to a health care practitioner may be stigmatizing for a person with HIV, particularly if these actions mirror prior discriminatory experiences within health care settings or are reflective of HIV-related stigma within greater society. The qualitative literature also illustrated that misperceptions of HIV transmission could fuel fears of infection.
COVID-19 and HIV: What you need to know
Not a MyNAP member yet? Register for a free account to start saving and receiving special member only perks. An epidemic is both a medical and a social occurrence. Medically, it is the appearance of a serious, often fatal, disease in numbers far greater than normal. Socially, it is an event that disrupts the life of a community and causes uncertainty, fear, blame, and flight.
More than thirty years after the first clinical evidence of acquired immunodeficiency syndrome was reported, AIDS has become one of the most devastating diseases humankind has ever faced. Since the epidemic began, more than 60 million people have been infected with the virus and nearly 30 million people have died of HIV-related causes. AIDS has become the sixth-largest cause of death worldwide. At the end of , an estimated In that year alone, there were an estimated 1. This is in large part due to more people living longer as access to antiretroviral theraphy increases, but these gains remain fragile and disparities continue to exist among countries and within countries.
COVID is an emerging, rapidly evolving situation. Get the latest CDC public health information. HIV stigma refers to irrational or negative attitudes, behaviors, and judgments towards people living with or at risk of HIV. It can negatively affect the health and well-being of people living with HIV by discouraging some individuals from learning their HIV status, accessing treatment, or staying in care. HIV stigma can also affect those at risk of HIV by discouraging them from seeking HIV prevention tools and testing, and from talking openly with their sex partners about safer sex options.
Approach: Improving clinical care for patients living with HIV through participatory activities From the start of the AIDS epidemic, stigma and discrimination have fuelled the trans- mission of HIV and org/pdfs/horizons/hc4hcommunityfair.org
Standing Up to Stigma
Metrics details. HIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health.
Metrics details. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. A descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from HCWs.
Stigma is when someone sees you in a negative way because of a particular characteristic or attribute such as skin colour, cultural background, a disability or a mental illness. When someone treats you in a negative way because of your mental illness, this is discrimination. Stigma happens when a person defines someone by their illness rather than who they are as an individual. For people with mental health issues, the social stigma and discrimination they experience can make their problems worse, making it harder to recover. It may cause the person to avoid getting the help they need because of the fear of being stigmatised.
Банк данных АНБ был сконструирован таким образом, чтобы никогда не оставался без электропитания - в результате случайности или злого умысла. Многоуровневая защита силовых и телефонных кабелей была спрятана глубоко под землей в стальных контейнерах, а питание от главного комплекса АНБ было дополнено многочисленными линиями электропитания, независимыми от городской системы снабжения. Поэтому отключение представляло собой сложную серию подтверждений и протоколов, гораздо более сложную, чем запуск ядерной ракеты с подводной лодки. - У нас есть время, но только если мы поспешим, - сказал Джабба.
Если Стратмор получил от Следопыта информацию, значит, тот работал. Она оказалась бессмысленной, потому что он ввел задание в неверной последовательности, но ведь Следопыт работал. Но Сьюзан тут же сообразила, что могла быть еще одна причина отключения Следопыта. Внутренние ошибки программы не являлись единственными причинами сбоя, потому что иногда в действие вступали внешние силы - скачки напряжения, попавшие на платы частички пыли, повреждение проводов.
Спасибо, - сказал Беккер.