Stigma and Distrust WHEN NOv 23rd 07

56 %
44 %
Information about Stigma and Distrust WHEN NOv 23rd 07

Published on January 2, 2008

Author: Crystal


Fragile access to HIV treatment and stigma: the experience of living with HIV in Serbia and Montenegro:  Fragile access to HIV treatment and stigma: the experience of living with HIV in Serbia and Montenegro Sarah Bernays and Tim Rhodes London School of Hygiene and Tropical Medicine. Relevance of case study:  Relevance of case study Serbia and Montenegro: 100% access to HIV state-funded treatment but not 100% delivery Context of HIV treatment global scale up - case study has relevance regionally and globally Understand impact of insecure access to HIV treatment and high stigma on ‘living with HIV’. HIV in Serbia and Montenegro:  HIV in Serbia and Montenegro Eastern Europe and Central Asia (Dec 2007): 1.6 million people living with HIV (PLHIV) Source: UNAIDS Epidemic update 2007. UNAIDS, Geneva. Serbia (Dec 2006): cumulative HIV/AIDS cases 2,103 1,137 registered PLHIV approximately 600 PLHIV receiving HAART Source: Serbian Republican Institute for Public Health, Belgrade 2007. Montenegro (Dec 2006) 43 registered PLHIV 22 PLHIV receiving HAART Source: Institute of Public Health, Montenegro, 2006. Serbia and Montenegro What we did :  What we did Qualitative research- 2005-2007 Baseline study-2005-2006 UK’s department for International Development (DfID) funded In-depth interviews 40 people living with HIV (PLHIV) and 18 service providers Prospective study- 2006-2007 Economic and Social Research Council (ESRC) funded Followed up 20 PLHIV 3 further interviews with each participants+ written and/ or audio diaries Findings::  Findings: Access to HIV treatment perceived as insecure High levels of stigma Interaction- significant consequences for: PLHIV’s quality of life HIV= manageable chronic illness? Participation in community action Efficacy of prevention efforts Access to HIV treatment perceived as uncertain:  Access to HIV treatment perceived as uncertain Delivery problems (high burden of financial costs, small market, protracted licensing)->shortages of drugs and monitoring tests= unstructured interruptions and unmonitored conditions Anxiety caused by failings in system absorbed by individuals 2006-2007 seen improvements in the provision of continuous, appropriate therapy Impact of treatment uncertainty:  Impact of treatment uncertainty HIV treatment access and delivery continues to be perceived as fragile. “It’s very depressing you know to go there and to wait so many hours and every time is the same fear, ‘will there be some medicines or not’. I’m living with this fear”. Interview, Sept 2007. Serbia- transitional state. Context of uncertainty: politics, economy, regional position, possible future conflict- seen as threats to HIV treatment opportunity. Stigma: Institutional access:  Stigma: Institutional access Institutional access (health care and social welfare) Disclosure- risk to access “None of them wanted to operate on his broken jaw, because he said he was HIV positive. They had a team meeting, to make the decision on who would do the surgery on this patient and in the end they told me they couldn’t operate on him. He was angry. It’s 2007, it happened some twenty days ago, when he was rejected by the doctors.” Interview, September 2007. Frequently experience poor treatment when receive care “ He cleaned the table and he removed the chair so that I could not sit and talk with him. I was supposed to stand. I just asked him for a referral paper and he started to clean the table with alcohol again. The main thing he was interested in was how I became ill. I never went to that institution again.” Interview, August 2005. Stigma: employment and poverty:  Stigma: employment and poverty Restricted access to seeking, attaining and maintaining employment. Increased poverty post diagnosis. Reduced capacity to respond to treatment difficulties “I have no income. Anyone who finds out about my status or my history they take me for a day and when they check they don’t want me there anymore and so I couldn’t afford treatment for myself.” Interview April, 2006. Stigma: communities, friends and families, :  Stigma: communities, friends and families, Community response: “I had terrible stress in April because of that woman downstairs, who shouted from her terrace, ‘He has AIDS! Get away from him!’ And then some bloke from my building when I pass by says, ‘ He should be treated with a stick!’ I didn’t react at all, I didn’t want to mess around… I was shivering. I neither had the physical or psychological strength to confront them.” Interview, June 2006. Family response: Quarantined in own home by families. Those supportive, consequences for families: “I mean dad’s like well-known in town… He had a lot of friends, a lot… as dad says you didn’t know how many people went through the house in a month, now he says only two or three people come over. The house’s like died out. A lot… No one will come, everyone’s afraid.” Interview, August 2007. Retreat and isolation “Loneliness kills, not AIDS”. Diary, May 2007. Distrust:  Distrust Priority for many- concealment of status- distrust response Who or what to trust? Scarce treatment information- rumour Rationed expertise- overstretched resources Institutional ‘care’- perceived to reinforce stigma Lack of community action (not engaged on treatment issues, fluid turnover of organisations). Conclusion:  Conclusion Stigma shapes HIV treatment access: Unable to speak out Risks from disclosing status Energy-> chasing/ securing treatment Remains a hidden, unresolved issue. Fragile treatment access exacerbates stigma: Reduces trust in provision and support services Treatment anxiety and distrust reduce involvement in community action. Weakens action against stigma Increases sense of isolation Lack of confidence in sustainability of treatment access and poor progress on fighting stigma- possible impact on efficacy of prevention efforts. Implications for action:  Implications for action Recommendations (some pursued currently): Robust contingency strategies in event of treatment shortages- stocks and information Regional procurement coalitions HIV NGOs engage with treatment support (action on access, literacy) Identify forums in which voices of PLHIV can be heard and listened to. Commitments to universal access must also commit to securing continuous treatment if HIV is to be meaningfully described as a ‘manageable chronic illness’ Curb physiological development of HIV/AIDS Counter stigma through community mobilisation and improving the quality of life for PLHIV- in Serbia and elsewhere. Resources from study:  Resources from study Baseline study UN report available today: S. Bernays, T. Rhodes, A. Prodanovic, 2007. HIV treatment access, delivery and uncertainty: a qualitative study in Serbia and Montenegro. UNDP, Belgrade. Available early 2008: Advocacy and training kit- including diary extracts. Radio documentaries with participants. Further details: or

Add a comment

Related presentations

Related pages

Antiretroviral Treatment Knowledge and Stigma ...

Antiretroviral Treatment Knowledge and Stigma—Implications for ... in Tanzania: stigma and distrust among ... 2013 Nov 13; 16(3 Suppl 2 ...
Read more

NewsNow: AIDS/HIV news | Breaking News & Search 24/7

Stigma in the way of aboriginal gay men getting HIV testing 17:39 6-Nov-15. ... 07 6-Nov-15. Health department retesting 300 for HIV TheIndyChannel ...
Read more

STAND UP AGAINST STIGMA - Scottish Mental Health Arts and ...

STAND UP AGAINST STIGMA. ... Fri 23rd Oct. 7–10pm. Booking Info: £5. Booking: 07754 914 480. Venue: St Ninians Church.
Read more

Barriers to participation in mental health research: are ...

... may also affect willingness to participate in mental health ... Stigma, fear, and distrust were consistently ... 10.1016/j.cct.2008.07 ...
Read more | Documents in Help-Seeking -

Additionally, our research found that cultural stigmata, ... (p<.07, d=.69). Participants’ recalled feelings of ostracism show similar patterns ...
Read more

Distrust – Tickets – Tremont Music Hall – Charlotte ...

Upcoming Events Tremont Music Hall. Wed, October 28. ... Distrust with Society Sucker, ... // 07:08:39 PM October 25, 2015; Buying Tickets.
Read more

Templar help! - Templar - AION Europe - UK

Hi all...Can some1 help me with a templar pvp stigma build and a pve stigma build pls im lvl 65
Read more