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
Human rights- HIV
- Every person has the right to access HIV medication and healthcare
- There should be no violence or discrimination against someone who has HIV
- No denial of treatment
- National AIDS trust stops reckless transmission of HIV and can prosecute anyone transmitting it on purpose
Sensitive issues that may arise in a consultation
1) Grief
2) HIV
3) Doctors errors
4) Mental health
5) Sexual health
6) Criminal acts
7) Safeguarding
Aims of sexual history taking
- To gather information- patients presenting symptoms, patients risk of STI including routes of acquiring potential infections
- To explore other significant risks to sexual health
- To allow effective management of presenting problems and other risks to health
- To promote health
Non-clinical determinants of health
Education, Diet, Exercise, Alcohol and drugs, Living conditions, Poverty, Dependents, Access to green spaces, Access to transport, Gender, Age, Occupation, Sleep, Stress levels, Politics, Religion, Relationships
Psychological context of risk
- Scared of the consequences
- Don’t want everyone else to have a good time - miss out
- Scared of being judged
- Grief
Social context of risk
- All of their friends are doing it
- Never been told about the actual risks
- Family ideas - if their parents don’t care then they will probably be more likely to take health risks
- Cultural and national consensus on something influences attitudes
- Lack of education around their health
- Predisposition
- Socioeconomic status
GMC advice on working with a medical condition
If your judgment or performance could be affected by a condition, consult a suitably qualified colleague. You must follow their advice about any changes to your practice they consider necessary and must not rely on your own assessment of the risk to patients.
If you have any concerns that a colleague may not be fit to practice and may be putting patients at risk, ask for advice from a colleague, your defence body or the GMC. If you are still concerned, report this and make a record of the steps you have taken.
GMC guidance on disclosing information about a serious communicable disease
You should follow guidance - raising and acting on concerns about patient safety - if you are concerned that a colleague who has a serious communicable disease is practicing or has practiced in a way that puts patients at risk of infection. You should inform your colleague before passing on the information as long as it is practicable and safe to do so.
Public health act 1984- dealing with infectious patients
May act if:
- Person is or may be infected or contaminated
- The infection or contamination is one which presents or could present significant harm to human health
- There is risk that patient may infect or contaminate others
- It is necessary to make the order in order to remove or reduce that risk
What might a doctor to do for an infectious patient
Submit medical examination, be removed to hospital or other suitable establishment, be detained in hospital, be kept in isolation or quarantine
The law on notifiable disease
Registered doctors have the legal duty to notify suspected cases of certain infectious disease to the proper officer at their local council
Ethical issues relating to patients with serious communicable disease
Confidentiality for the patient balanced against the benefit for the people who may have been in close contact with the infected patient
Legal issues relating to patients with serious communicable diseases
Registered doctors have a legal duty to notify suspected cases of certain infectious diseases. Follow guidance on raising concerns published by the GMC
Describe when its justifiable and when its mandatory to breach confidentiality?
Health Service Regulations 2002 provides the legal basis for sharing confidential health information without consent
• Reckless transmission of HIV
• Notifiable diseases
• Police requests for investigations e.g. driving offence / terrorism
The social and political factors affecting health
1) Impact of the media
2) Gender, race, ethnicity
3) Acess to health service
WHO key concepts of the social determinants of health
Employment conditions Social exclusion Public health programmes and social determinants Women and gender equity Early child development Globalisation Health systems Measurement and evidence Urbanisation
The Dahlgren and Whitehead model of health determinants
1) Personal characteristics include- sex, age, ethnicity and hereditary factors
2) Lifestyle factors- behaviours such as smoking, alcohol use and physical activity
3) Social and community- family and wider social circle
4) Living and working conditions- access and opportunities in relations to jobs, housing, education and welfare services
5) Socioeconomic, cultural and environmental factors- disposable income, taxation and available work
