1. Qian Ceng Gao: The layering of the stigmas of HIV/AIDS, commercial sex work, injecting drugs use and commercial blood donation. Kit Yee Chan

2. Overview ► Background & Conceptualisation ► Method (brief description) ► Results

3. Definitions HIV/AIDS-Related Stigma: “a process of devaluation’” of people living with or associated with HIV/AIDS”. “a process of devaluation’” of people living with or associated with HIV/AIDS”. HIV/AIDS-related Discrimination: “Discrimination follows stigma and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status”. Relations? Stigma (marking/labelling)  Discrimination (action)

4. Why Study HIV-related Stigma and Discrimination in 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

5. ► Asia described as “the next battlefield for AIDS” ► Research gap  a general lack of research on HIV stigma in Asia

6. Study Background ► The Deakin University study of HIV Structural/institutional forms of discrimination (2001-2005)  Studied in China, India, Indonesia, Philippines, Thailand, Vietnam Philippines, Thailand, Vietnam ► Having rules is not enough ► Need to understand HIV stigma as a layered phenomenon

7. HIV Stigma IDU Stigma CSW Stigma MSM Stigma Poverty Stigma Qian Ceng Gao?

8. + =ORAIDSIDU

9. Aims ► A test of methodology ► To disentangle the layering of “HIV/AIDS related stigma” in the health care context; specifically:  How much of the “HIV stigma” is actually attributable to co-stigmas?  What are different strengths of the co-stigmas?

10. ► Survey Design  Survey materials based upon a study by Kelly et al (1987)  Study design and analysis outlined in Reidpath, & Chan (2005)  Vignettes  Judgements on attitudinal scales ► Sample: 360 2 nd year medical students in Guangzhou (Southern China) Method

11. Factors Examined No Disease Leukaemia HIV/AIDS No co-occurring characteristics Blood Transfusion Injecting drug use (IDU) Commercial Sexual Transaction (CST) Commercial blood donation (CBD)

12. Vignettes Wang is a bright young man with many talents. He was considered to be a dutiful son to his parents, and a kind, selfless and responsible person by everyone who knew him. Wang is a bright young man with many talents. He was considered to be a dutiful son to his parents, and a kind, selfless and responsible person by everyone who knew him. Over the past six months, Wang developed a range of health problems including fatigue, physical decline and recurrent infections. He learned from his doctor that he was seriously ill, and his family and friends were said to have difficulty adjusting to his life-threatening illness. Wang was diagnosed with [AIDS or leukaemia]. Over the past six months, Wang developed a range of health problems including fatigue, physical decline and recurrent infections. He learned from his doctor that he was seriously ill, and his family and friends were said to have difficulty adjusting to his life-threatening illness. Wang was diagnosed with [AIDS or leukaemia]. No co-characteristic/blood transfusion/IDU/CSW/blood sale

13. Social Distance ► If you were a friend of Wang’s, would you be willing to continue the friendship at this time? ► Would you allow your children to visit Wang in his home?

14. RESULTS AIDS & IDU

23. AIDS & CST…

28. AIDS & Commercial Blood Donation…

33. Overall Interpretations ► “Unique” HIV/AIDS stigma does not exist ► Variations exist in the layering of AIDS stigma and the different co-stigmas ► Disease focus stigma interventions may have very limited effects ► Understanding the disease does not make the disease less stigmatising

34. What Next? ► Further model building ► Issue of triple stigma? ► Patterns in other contexts? Other populations? ► Reasons underlying the relative stigma scores?

35. Thank You… Email: kit.chan@deakin.edu.au

36. Degrees of Stigmatisation

37. Is AIDS more stigmatising than Leukaemia?

41. ► Consistent with the findings from stigma intervention studies:  E.g. Increasing students’ knowledge levels only moderately increase their acceptance of PLWHA (e.g. South African study, 41% at follow-up, up from 17% at baseline; Khun et al., 1994) ► Survey with youths in Singapore:  “while AIDS education and campaigns may increase knowledge and awareness about HIV transmission, they do not really reduce personal concern about the possibility of infection and the potential stigma associated with working with HIV infected persons” (Lim et al. 1999)

42. Innocent No Disease Leukaemi a HIV/AIDS No co-occurring characteristics Visit CSW IDU Blood Transfusion●●● Sell Blood

43. HIV is more stigmatised than control disease conditions No Disease Leukaemia HIV/AIDS No co-occurring characteristics●●● CST IDU Blood Transfusion CBD

44. Co-stigmas vs Control No Disease Leukaemi a HIV/AIDS No co-occurring characteristics CST IDU Blood Transfusion● CBD??