Harmonizing to Herek and Glunt ( 1988 ) , HIV/AIDS is a disease epidemic, but besides an epidemic of stigma. In the UK, the figure of new HIV has been lifting each twelvemonth since the 1990 ‘s. Since the twelvemonth 2000, there have been more than 3000 new diagnosing of HIV each twelvemonth, with 6932 people diagnosed in 2003 entirely. This is more than double the rate of diagnosing of new infections in 1999 ( Aventa, 2005 ) . As the incidence of HIV sensing in the population additions, there is besides a demand to turn to the societal stigma associated with the disease, and its deductions for wellness attention entree, and wellbeing, amongst HIV positive persons. This paper will analyze how societal stigma affects the lives of persons with HIV/AIDS and how it influences revelation within the community and entree to wellness attention services. A definition of the job has been provided by Herek and Mitnick ( 1996 ) :
AIDS-related stigma ( or set more merely, AIDS stigma ) refers to prejudice, discounting, discrediting and favoritism directed at people perceived to hold AIDS or HIV and at persons, groups and communities with which they are associated. It persists despite transition of protective statute law and revelations by public figures that they have AIDS or are infected with HIV ( p 1 )
While Goffman ( 1963 ) has identified stigma as a common constituent in many chronic unwellnesss, it represents an built-in portion of the HIV/AIDS person ‘s experience of seeking diagnosing, populating with the status, describing their status to others and seeking appropriate wellness and societal attention. Being rejected and fearing societal rejection have been identified through the research literature as chief beginnings of emphasis for HIV/AIDS sick persons ( Berger, Ferrans and Lashley, 2001 ) . Lee et Al ( 2002 ) have argued that there are four beds to the stigmatization of HIV/ AIDS. First, it is a disease associated with incrimination and self-inflicted behavioural forms because the primary manner of transmittal is sexual behavior and drug pickings. Indeed, public apprehension of HIV/AIDS, and understanding with its victims, is delineated by the beginning of the infection. There are ‘innocent ‘ victims that have contracted the disease through blood transfusion, or hemophilia or perinatal transmittal, and there are ‘guilty ‘ sick persons who have contracted the disease as a effect of sexual behavior or drug usage ( Novick, 1997 ) . As Novick ( 1997 ) has argued, there is a alone association between HIV/AIDS and already discriminated subgroups ; Somehow, the virus could place and infect certain people with truncated civil rights – homosexual and bisexual work forces, injection drug users, African-Americans, Haitans, Hispanics and sex workers. All of these people have been, by tradition and by jurisprudence, isolated, ostacised or constrained from busying full citizenship and societal equality ( p 53 ) . Novick ( 1997 ) uses the term multiple stigmata to depict the experience that most AIDS/ HIV sick persons encounter in society. This refers to the fact that HIV/AIDS may non be the lone beginning of stigmatization and favoritism in a individual ‘s life and it can be piled up five or six deep ( p 59 ) for being a adult female, black, on public assistance, HIV infected, and an addicted female parent. Or, for being a sex worker, HIV infected and a substance maltreater ( p 59 ) . He argues that the long-run stigmatization of HIV/AIDS can be linked to societal ostracisation, denounciation and criminalization of the behavior of minority groups. This is highlighted in the intervention of people that have contracted HIV through sexual behavior. As Lee et Al ( 2002 ) argue, transmittal of the disease through heterosexual patterns between work forces and adult females is more socially acceptable than homosexual or bisexual patterns.
The 2nd bed of stigma remainders with the fact that at the present clip the disease is incurable and potentially fatal, with intervention confined to antiretroviral therapies that may detain the oncoming, but non forestall, the oncoming of AIDS. It has been suggested that new interventions and therapies for HIV may cut down this type of stigma ( Lee et al, 2002 ) and it is possible that there is a difference between existent degrees of stigma expressed through current positions held by the general populace, and ‘perceived stigma ‘ as people infected with HIV feel society to be ( Green, 1995 ) . However, research is inconclusive and there possibly a dual criterion of accepting HIV positive people in general but non accepting them, or services aimed at back uping them, ‘in my back-yard ‘ ( Law and Takahashi, 2000 ) .
The 3rd bed of stigma of HIV/ AIDS is due to its contagiousness, and public fright and misconstruing about the manner of transmittal. The 4th bed of stigma is due to the fact that AIDS in its concluding phases is frequently associated with unpleasant physical marks of disease such as profound weight loss, respiratory hurt and skin lesions. These marks and symptoms contribute to stigmatization as a effect of physical disfiguration. The societal punishments associated with a HIV/ AIDS diagnosing are high, and show a peculiar challenge to wellness attention services aimed at testing for and handling the status ( Lee et al, 2002 ) .
Goffman ( 1963 ) has described how stigmatised persons incorporate and internalize the criterions set by society and can discredit, fault or minimize themselves as a effect of their status and Novick ( 1997 ) argues that, systematic stigmatization leads to internalised stigmatization ( p 57 ) . Harmonizing to Sandlelowski, Lambe and Barroso ( 2004 ) , and based on their interviews with HIV positive adult females, this procedure of internalization leads to cultural positions of HIV infection that contributed to their feeling dirty, lifelessly and deficient ( p 124 ) . Chesney and Smith ( 1999 ) have shown that the stigma associated with HIV/AIDS is such that it deters people from being tested, and it besides prevents people from declaring their positive position to community contacts and besides prevents them from seeking appropriate medical attention. This can be aggravated by existent, or perceived, stigma by the wellness professional against patients with HIV/ AIDS. Green and Platt ‘s ( 1997 ) interviews with HIV positive patients revealed that some had experience of negative attitudes or had been refused treatment/ attention as a effect of their HIV position from physicians, nurses and tooth doctors. Furthermore, internalised stigma can be associated with psychosocial symptoms such as depression, that may speed up the oncoming of AIDS ( Green, 1995 ) . It can be argued that societal stigma is a major challenge to wellness publicity, and can increase the likeliness that persons will prosecute in hazardous behaviors or non take attention of themselves ( Wenger, Kusseling, Beck and Shapiro, 1994 ) .
Most research surveies on stigma have focussed on understanding the perceptual experiences towards HIV/AIDS by non-infected people. However, farther research is required that explores the existent experience of life with HIV/AIDS and existent experiences of stigma and bias ( Lee et al, 2002 ) . In a survey of 268 HIV positive work forces and adult females, Lee et Al ( 2002 ) explored the prevalence of internalised stigma, every bit good as its relationship to psychosocial position. About half of the sample were homosexual or bisexual, and 45.9 % were heterosexual. Research participants completed standardized steps of mental wellness position, wellness attention patterns, quality of life, get bying and perceived societal support. A structured clinical interview was besides undertaken. The bulk of respondents reported that they were embarrassed by their status and that it was difficult for them to unwrap their position to other people. Over 60 % of heterosexual respondents had a high degree of internalised stigmatization, and amongst this group there were greater studies of their households non accepting the disease. This group were identified over and above other respondents as being less likely to go to support groups and more concerned about transmittal of the disease to others. Furthermore, for all the respondents, irrespective of their sexual penchant, it was noted that high internalised stigma evaluations were associated with greater symptoms of depression, anxiousness and a sense of hopelessness. Wenger et Al ( 1994 ) and Lee et Al ( 2002 ) argue that internalised stigma contributes to high hazard behavior because such persons are frequently loath to discourse their position with other people, and may prosecute in hazardous patterns that would be less common where possible spouses had been notified. Furthermore, it can be argued that the heightened anxiousness of diagnosing and poorer use of wellness attention and support services by HIV positive persons with high internalised stigma may cut down chances for instruction about remaining good, and cut downing the hazard of future infection to others. As Lee at Al ( 2002 ) have found, Although HIV support groups may supply an alternate societal web for HIV positive persons who have been stigmatised by friends and household due to their unwellness, those persons who are most ashamed of their infection are the least likely to entree the support that is available to them ( p 317 ) . The precise characteristics of stigma associated with a diagnosing of HIV/AIDS have been elicited by Berger, Ferrans and Lashley ( 2004 ) utilizing their HIV Stigma Scale, which was designed to assist the medical and nursing professional understand their patients psychosocial troubles. This was completed by 207 HIV positive persons and the graduated table revealed four stigma factors. The factors were personalised stigma ( related to negative reactions from others and fright of rejection ) , revelation stigma ( related to commanding information and privateness ) , negative ego image and concerns about favoritism against people with HIV more by and large. This survey found that perceived stigma was linked to depressive symptoms which in bend may hold affected intervention conformity and willingness to seek support in the community.
This paper has shown that the relationship between stigma and HIV/AIDS is a complex combination of social/cultural stigma related to how society treats people with the status, and internalised stigma related to how HIV positive persons feel about their ain status. Health publicity work aimed at increasing the rate of diagnosing and pull offing the attention of people with HIV/AIDS must turn to the societal and internalised stigma associated with the status at the same time. Stigma direction within the wellness and societal attention system must normalize HIV infection as a chronic upset like any other, continue to supply balanced instruction and protagonism in the community, and make support groups led by HIV positive people for HIV positive people and informational control ( Goffman, 1963 ) . Further research is required to back up grounds based pattern by the medical and nursing profession to cut down the effects of stigma on people with HIV and AIDS since the rate of diagnosing is on the addition.
Mentions
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