Case 17- SAP Flashcards
The major social and cultural barriers to health
• Stigma and discrimination • Violence • Marginalisation • Law and policies • Poverty and inequality Effect of these barriers- negative psychological impact, social isolation, prevents the patient from coming in for diagnosis and treatment
Cultural attitudes to condom use
• People from Central and East Africa believe that if the condom breaks it can lead to infection, sterility and death
• Uganda- some women view condoms as bad for reproductive health
• South Africa- believe that condoms hold bodily fluid that may be used by sorcerers
• Cultural patterns of masculinity identity.
Cultural patterns leads to negative HIV/AIDS outcomes.
Stigma
When an adverse social judgement is made about a person or a group which leads to rejection, blame, social exclusion or devaluation
What is stigma about
An enduring feature of identiyt i.e. race, ethnicity and sexual preference
Health related stigma
Social judgement which is based on an enduring features of identity conferred by a health problem or health related condition i.e. HIV, epilepsy or mental health
Stigma and deviance
People are stigmatised if they follow deviant activity instead of the social norms, how stigma and deviance are defined varies across cultures. Stigma is not an innate attribute but arises through social interaction
Examples of stigmatised health issues
Schitzophrenia, bipolar, epilepsy, autism, diabetes, HIV
Labelling theory
Labels create social outsiders, labels are created for people outside the social norm
Euphemism treadmill
Whatever term is used is likely to develop stigma eventually
Even when we stop using an originally offensive term, the replacement term will also pick up negative connotations
The metaphors of AIDs
The metaphors and myths surrounding AIDs adds to the suffering
• AIDS as a plague
• AIDS as an invisible contagion
• AIDS as moral punishment
• AIDS as an invader
• AIDS as war
• AIDS as a primitive or pre-social force or entity
Modes of adaption to illness
- The pragmatic type- downplay their illness
- The secret type- use tactics to conceal their disease, which they regarded as stigmatizing
- The ‘quasi-liberated type’ publicly proclaiming their disease in order to educate others
- Unadjusted- overwhelmed by their condition
Types of enacted stigma
Overt discrimination due to their social unacceptability
• Subjected to degrading or insulting language
• Labels such as cheap, bad, greedy, shameless, dirty
• Spat on laughed at
• Harassment and abuse from the police
Types of felt stigma
Denotes both a sense of shame and a fear of encountering enacted stigma
• Exhibiting a degree of shame in their profession/illness
• Angry and hurt by negative community responses
• Fear of encountering enacted stigma
• Concealing activity from friends and family
Felt normative stigma
A subjective awareness of stigma which motivates individuals to take actions to avoid enacted stigma
What does internalised stigma result in
Results in prejudice and enacted stigma, subjects of stigma accept discredited status
Early generations of HIV patients
- Many more side effects
- Memories of friends and partners who had died
- Coped by getting involved in HIV activism (some still are)
Later generations of HIV patients
- Rejected activism- HIV should only claim a small part of their social identity
- Praised the self-reliance and HIV anonymity made possible by ART
- Distanced themselves from a public HIV identity
- Because of stigma most concealed their HIV status
Causes of stigma
1) Believing people with certain attributes are vectors of disease- especially HIV/AIDs
2) Believing people are deviant and dont fit in with social norms i.e. sex workers
Stigma surrounding HIV
- Believing only certain people can get HIV
- Feeling like people deserve to get HIV due to their lifestyle choices
- Refusing contact with someone who has HIV
- Believing HIV is only transmitted through sex
How can the stigma around HIV be reduced?
- Talk about HIV and normalise it
- Take actions to protect i.e. anti-discrimination laws
- Educated people
- Empower people to act on violations and understand rights
Right
An entitlement or justifiable claim to have or obtain something or to act in a certain way. They are often provided by the state and enshrined in law
When were human right established
The united nations was founded in 1945 and the WHO was founded in 1948. In 1958 the UN adopts the universal declaration of human rights. Enjoying the highest attainable standard of health is a human right. Many countries have incorporated the right to health in their national constitution
Human rights and HIV
- International laws and treaties give every person the right to health and to access HIV and other healthcare services
- Human rights violations in the context of HIV include criminalisation, stigma, discrimination and denial of treatment
- Countries that fail to meet human rights requirements for people living with HIV should be held legally accountable
Critiques to the right to health
- Where do we stop?
- Where does the money come from?
- Where do resources come from?
- How do we know the extent of the public health impact?
- Who is responsible?
- Any individual responsibilities i.e. smoking and alcohol
