Qian Ceng Gao: The layering of the stigmas of HIV/AIDS, commercial sex work, injecting drugs use and...
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Transcript of Qian Ceng Gao: The layering of the stigmas of HIV/AIDS, commercial sex work, injecting drugs use and...
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 ?? ??