Kit Yee Chan

Qian Ceng GaoQian Ceng Gao: The layering of : The layering of the stigmas of HIV/AIDS, the stigmas of HIV/AIDS,

commercial sex work, injecting commercial sex work, injecting drugs use and commercial blood drugs use and commercial blood

donationdonation..

Kit Yee ChanKit Yee Chan

OverviewOverview

►Background & Conceptualisation Background & Conceptualisation ►Method (brief description)Method (brief description)►ResultsResults

DefinitionsDefinitions

HIV/AIDS-Related StigmaHIV/AIDS-Related Stigma: : “ “a process of devaluation’” of people living a process of devaluation’” of people living

with or associated with HIV/AIDS”. with or associated with HIV/AIDS”.

HIV/AIDS-related DiscriminationHIV/AIDS-related Discrimination:: ““Discrimination follows stigma and is the unfair Discrimination follows stigma and is the unfair and unjust treatment of an individual based on and unjust treatment of an individual based on his or her real or perceived HIV status”. his or her real or perceived HIV status”.

Relations?Relations? Stigma (marking/labelling) Stigma (marking/labelling) Discrimination Discrimination

(action)(action)

Why Study HIV-related Why Study HIV-related Stigma and Discrimination in Stigma and Discrimination in

Asia?Asia?►"HIV-related stigma and discrimination

remain an immense barrier to effectively fighting the most devastating epidemic humanity has ever known… If HIV-related stigma and discrimination are not tackled, AIDS will blight the 21st century just as racism affected the 20th century."

- Dr Peter Piot, Executive Director, UNAIDS

►Asia described as “the next battlefield Asia described as “the next battlefield for AIDS”for AIDS”

►Research gapResearch gap a general lack of research on HIV stigma a general lack of research on HIV stigma

in Asiain Asia

Study BackgroundStudy Background

►The Deakin University study of HIV The Deakin University study of HIV Structural/institutional forms of Structural/institutional forms of discrimination (2001-2005)discrimination (2001-2005) Studied in China, India, Indonesia,Studied in China, India, Indonesia,

Philippines, Thailand, VietnamPhilippines, Thailand, Vietnam

►Having rules is not enoughHaving rules is not enough►Need to understand HIV stigmaNeed to understand HIV stigma

as a layered phenomenonas a layered phenomenon

HIV StigmaHIV StigmaIDU StigmaIDU Stigma

CSW StigmaCSW Stigma

MSM StigmaMSM Stigma

Poverty StigmaPoverty Stigma

Qian Ceng Gao?Qian Ceng Gao?

++ == OROR

AIDAIDSS

IDUIDU

AimsAims

►A test of methodologyA test of methodology►To disentangle the layering of To disentangle the layering of

“HIV/AIDS related stigma” in the “HIV/AIDS related stigma” in the health care context; specifically:health care context; specifically: How much of the “HIV stigma” is actually How much of the “HIV stigma” is actually

attributable to co-stigmas? attributable to co-stigmas? What are different strengths of the co-What are different strengths of the co-

stigmas?stigmas?

►Survey DesignSurvey Design Survey materials based upon a study by Survey materials based upon a study by

Kelly et al (1987) Kelly et al (1987) Study design and analysis outlined in Study design and analysis outlined in

Reidpath, & Chan (2005)Reidpath, & Chan (2005) VignettesVignettes Judgements on attitudinal scalesJudgements on attitudinal scales

► Sample: 360 2Sample: 360 2ndnd year medical students year medical students in Guangzhou (Southern China) in Guangzhou (Southern China)

MethodMethod

Factors ExaminedFactors ExaminedNo Disease Leukaemia HIV/AIDS

No co-occurring characteristics

Blood Transfusion

Injecting drug use (IDU)

Commercial Sexual Transaction (CST)

Commercial blood donation (CBD)

VignettesVignettes

Wang is a bright young man with many talents. He Wang is a bright young man with many talents. He was considered to be a dutiful son to his parents, was considered to be a dutiful son to his parents, and a kind, selfless and responsible person by and a kind, selfless and responsible person by everyone who knew him. everyone who knew him.

Over the past six months, Wang developed a range Over the past six months, Wang developed a range of health problems including fatigue, physical of health problems including fatigue, physical decline and recurrent infections. He learned from decline and recurrent infections. He learned from his doctor that he was seriously ill, and his family his doctor that he was seriously ill, and his family and friends were said to have difficulty adjusting to and friends were said to have difficulty adjusting to his life-threatening illness. Wang was diagnosed his life-threatening illness. Wang was diagnosed with [with [AIDSAIDS oror leukaemia leukaemia].].No co-characteristic/blood No co-characteristic/blood transfusion/IDU/CSW/blood saletransfusion/IDU/CSW/blood sale

Social DistanceSocial Distance

► If you were a friend of Wang’s, would If you were a friend of Wang’s, would you be willing to continue the you be willing to continue the friendship at this time?friendship at this time?

►Would you allow your children to visit Would you allow your children to visit Wang in his home?Wang in his home?

RESULTSRESULTS

AIDS & IDUAIDS & IDU

0

10

20

30

40

50

60

AIDS AIDS/IDU IDU

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS AIDS/IDU IDU

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS AIDS/IDU IDU

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS AIDS/IDU IDU

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS AIDS/IDU IDU

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS AIDS/IDU IDU

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS Stigma Only IDU Stigma Only

Intervention Targets

%SM

0

10

20

30

40

50

60

AIDS Stigma Only IDU Stigma Only

Intervention Targets

%SM

AIDS & CST…AIDS & CST…

0

10

20

30

40

50

60

AIDS AIDS/CST CST

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS AIDS/CST CST

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS AIDS/CST CST

Disease/Co-characteristics

% S

M

0

10

20

30

40

50

60

AIDS Stigma Only CST Stigma Only

Intervention Target

%SM

AIDS & Commercial Blood AIDS & Commercial Blood Donation…Donation…

0

10

20

30

40

50

60

AIDS AIDS/CBD CBD

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS AIDS/CBD CBD

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS AIDS/CBD CBD

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

AIDS Stigma Only CBD Stigma Only

Intervention Targets

%SM

Overall InterpretationsOverall Interpretations

►““Unique” HIV/AIDS stigma does not Unique” HIV/AIDS stigma does not existexist

►Variations exist in the layering of Variations exist in the layering of AIDS stigma and the different co-AIDS stigma and the different co-stigmasstigmas

►Disease focus stigma interventions Disease focus stigma interventions may have very limited effectsmay have very limited effects

►Understanding the disease does not Understanding the disease does not make the disease less stigmatisingmake the disease less stigmatising

What Next?What Next?

►Further model building Further model building ► Issue of triple stigma?Issue of triple stigma?►Patterns in other contexts? Other Patterns in other contexts? Other

populations?populations?►Reasons underlying the relative stigma Reasons underlying the relative stigma

scores?scores?

Thank You…Thank You…

Email: [email protected]: [email protected]

0

10

20

30

40

50

60

None BT CBD CST IDU

Co-Characteristics

%SM

No Disease

Leukaemia

AIDS

Degrees of Degrees of StigmatisationStigmatisation

Is AIDS more stigmatising than Is AIDS more stigmatising than Leukaemia?Leukaemia?

0

10

20

30

40

50

60

None BT CBD CST IDU

Co-Characteristics

%S

M

0

10

20

30

40

50

60

Luekaemia LUE/IDU IDU

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

Luekaemia LUE/CST CST

Disease/Co-Characteristic

% S

M

0

10

20

30

40

50

60

Luekaemia LUE/CBD CBD

Disease/Co-Characteristic

% S

M

►Consistent with the findings from stigma Consistent with the findings from stigma intervention studies: intervention studies: E.g. Increasing students’ knowledge levels E.g. Increasing students’ knowledge levels

only moderately increase their acceptance of only moderately increase their acceptance of PLWHA (e.g. South African study, 41% at PLWHA (e.g. South African study, 41% at follow-up, up from 17% at baseline; Khun et follow-up, up from 17% at baseline; Khun et al., 1994)al., 1994)

►Survey with youths in Singapore:Survey with youths in Singapore: ““while AIDS education and campaigns may while AIDS education and campaigns may

increase knowledge and awareness about HIV increase knowledge and awareness about HIV transmission, they do not really reduce transmission, they do not really reduce personal concern about the possibility of personal concern about the possibility of infection and the potential stigma associated infection and the potential stigma associated with working with HIV infected persons” (Lim with working with HIV infected persons” (Lim et al. 1999)et al. 1999)

InnocentInnocentNo Disease Leukaemi

aHIV/AIDS

No co-occurring characteristics

Visit CSW

IDU

Blood Transfusion ●● ●● ●●

Sell Blood

HIV is more stigmatised than control HIV is more stigmatised than control disease conditionsdisease conditions

No Disease Leukaemia HIV/AIDS

No co-occurring characteristics

●● ●● ●●CST

IDU

Blood Transfusion

CBD

Co-stigmas vs ControlCo-stigmas vs Control

No Disease Leukaemia

HIV/AIDS

No co-occurring characteristics

CST

IDU

Blood Transfusion ●●

CBD ?? ??