Recognizing and Responding to HIV-Related Stigma Tim Vincent, MFT California STD/HIV Prevention...

Recognizing and Responding to HIV-Related Stigma

Tim Vincent, MFT

California STD/HIV Prevention Training Center

Goals To offer recommendations on how to address

stigma in training engagements

To define and describe stigma, and HIV-related stigma

To offer recommendations on how to assess HIV-related stigma with patients

To present strategies to respond to stigma on institutional and community levels in order to improve service delivery

Then and Now

HIV-related stigma is not as prevalent now as it was 20 years ago.

Agree

Disagree

How Has Stigma Changed

Research on prevailing attitudes

Acute to chronic model

Depends on the population group and other layers of stigma operating

Focus was not on the recipients of the stigma

How important is it to you to focus on

addressing stigma?

4-Extremely 3-Significant 2-Somewhat 1-Not at all relevant

How does stigma impact your work with the AETC?

Recommendations For Faculty:

Instruction in the manifestations of stigma

Instruction in how to assess impact of stigma on patient care and quality of life

Instruction to increase provider awareness of their own bias and the potential to stigmatize patients

I. Manifestations of Stigma

Defining Stigma

A powerful discrediting social label that radically changes the way an individual views themselves and are viewed as persons.

People who are stigmatized are usually considered deviant or shameful, and as a result are shunned, discredited, rejected or penalized.

Stigma Can Happen Due To:

Who someone is (Identity)

What he or she has done (Behavior)

Something that may not be accurate or current (Perception)

Someone Can Be Stigmatized As A Result Of: Racism Homophobia HIV Status Drug Use Social and Economic Status Cultural Stereotypes Sexual Orientation Mental Health Diagnosis Gender Identity Immigration Status Age Disability

Different Levels Of Impact

Intrapersonal

Interpersonal

Institutional

Community/Cultural

Stigma can intensify if someone has a disease or condition which is:

life-threatening contagiousassociated with behaviorassociated with moral fault visible

HIV

Impact Of Stigma On Patients

Overall quality of lifeAbility to access servicesAbility to communicate effectively with

providerAbility to succeed with treatment Ability to make choices about potential

risks

Responding To Hiv-related Stigma

People develop or use coping strategies that can be effective or dysfunctional

The coping mechanism may work to alleviate the stress of the stigma. It may or may not create other problems.

II. Assessing the Impact of Stigma

Stigma as a lens to:

assess understand diagnose respond to presenting problems

When Assessing the Impact of Stigma

Establish rapport

Consider whether stigma may impact behavior

Decide if it is okay just to ask

Ask if things were different historically

Ask about coping strategies

Care and Treatment Concerns

How do you feel your status affects your ability to get good care services?

How do you feel you have been treated at this clinic?

Do you feel comfortable getting your medications at the pharmacy?

Do you feel the need to hide your medications? How do you manage this?

The Potential Impact On Behavior

In what ways might your behavior change if you sense that you will be judged for having HIV?

Many people feel that they are treated differently as a result of having HIV, what has been your experience?

Have you ever used drugs or alcohol to cope with feeling judged or mistreated for having HIV?

What challenges you in having a healthy sexual life?

Questions Generated From Providers

Do you have any problems taking your meds? Do you have any problems with this clinic?

In general, what works and what doesn’t work for you?

How has your view of yourself changed since your diagnosis?

Is it okay to call you at home and identify myself?

Do you ever feel excluded from activities because of your HIV status? Do you exclude yourself?

Increasing Sensitivity of Providers

Client/Provider Relationship Concerns

The natural development of a relationship may be impaired by a patient’s experience

The ability to be genuine, demonstrate

empathy and respect may be challenged by the client’s presentation

Stigma Impacting Your Work

“You have to peel thru layers of defense mechanisms to get to the core of their true selves. With rapport and trust built across time, they do open up eventually. They open up sooner if they perceive that the provider is genuine, trust worthy and non-judgmental”

Felt and Enacted Stigma

Felt stigma refers to how someone may anticipate the discrimination and the shameful feelings associated with it.

Enacted stigma is the actual experiences of the discrimination.

Suggestions To Increase Self-awareness

Experiential exercises with a clear purpose

Education in the cyclical dynamics of stigma

Emphasize the impact on patient/provider relationship

Institutional and Community Levels

Approaches Beyond The Individual Level

Access for the clients in creative waysCommunity educationLinkages to agencies that serve clientsConsistency of care providersHIV advocacy/activismNot putting HIV out on the spotlight

NAPWA Recommendations

Provide knowledge and educationProvide contact with stigmatized peopleDevelop coping mechanismsLegal and regulatory responsesProvide care and treatmentChallenging the social acceptability

Faculty Implications

How does the topic currently get addressed in the trainings?

Is there something that you would like to change or create in the trainings?

What happens when a participant displays a stigmatizing attitude toward a patient?

Then and Now

Stigma is a vital and evolving concern

You are the experts in moving the thought process forward

Closing Quote:

Not everything that is faced can be changed, but nothing can be changed until it is faced.

James Baldwin

References:

NAPWA Facts At-A –Glance: HIV/AIDS Stigma and Discrimination

How does stigma affect HIV prevention and treatment, CAPS Fact Sheet

Stigma and Discrimination: Definitions and Concepts, Canadian AIDS Society

Internalized Stigma Among People with HIV-AIDS, AIDS and Behavior, Vol. 6, No 4, Dec 2002

Contact Information

Tim Vincent, M.S., MFT

(510) 625-6015tim.vincent@cdph.ca.gov