2. STIGMA AND DISCRIMINATION AND IMPACT ON HIV AND TB Opoku Addo Sarkodie HIV Data Officer National AIDS/STI Control Programme Agona Government Hospital, Agona

3. Introduction
HIV and TB-related stigma and discrimination have sizable impact on
health and are recognized as a major difficult problem on people who are
on ART and TB treatment in Ghana.
Access to ART and TB treatment has increased in Ghana but related
stigma and discrimination are still a major problem despite the increased
access to ART and TB Treatment.

4. What is Stigma and discrimination?
Stigma refers to unfavourable attitudes and beliefs directed toward someone or something.
Discrimination is the treatment of an individual or group with partiality or prejudice.
Socially marginalized people bear heaviest burden of HIV and TB-related stigma and discrimination.

5. HIV and TB-related stigma
Unfavourable attitudes and beliefs toward people living with HIV
and TB, those perceived to be infected, and their families, friends,
social groups, and communities
Stigma is greater when risk of contracting the disease is thought to
be under the individual’s control (e.g., commercial sex workers)

6. HIV and TB-related Discrimination
Community shuns women who decide not to breastfeed because it
is assumed she is HIV or TB infected.
Some Health Workers deny services to person with HIV and TB
Individual loses his/her job when it is known he/she is HIV and TB- infected
Family and children of people who died of HIV and TB are ostracized by community
Individual has difficulty getting a job when revealed he/she is HIV or TB-infected

7. Where Does Stigma Occur?

8. Scopes of the Stigma Experience among people on ART and TB Treatment
Different forms of HIV and TB-related stigma
among people on ART and TB Treatment were
experienced by participants including;
verbal stigma,
social stigma and
perceived stigma (fear of stigma associated with disclosing HIV status) .

9. Scopes of discrimination experience among people on ART and TB Treatment
Clients on ART and TB Treatment experienced various forms of discrimination, including:
relational discrimination,
mistreatment by health care workers,
blame and rejection by spouses and
workplace discrimination.

10. Personal stories from Participants
“At times if you ask health care providers something they do not reply
to your question. They invented to be busy and just neglect us.
Occasionally they use offensive language against us and they are
deferment giving services. They don’t value people on ART and TB
Treatment anymore. When you arrive late to the clinic you are told
that you will be moved closer to where you live . They use it as a way
to threaten us because they know most of us are going away to avoid
discrimination”

11. Personal stories from Participants cont.
“After disclosing my HIV status to my husband, he sudden
left the house and came home later to tell me to pack all my
belongings and go to my relatives to take care of me since l am
the source of the problem. He divorced me a week later when I
went to my relatives”

12. Consequences of AIDS-related stigma and discrimination
It causes human suffering due to:
Loss of employment
Loss of housing
Rejection by family
Hated by community
Deprived of schooling
Deprived of marriage
Restrictions on movement -> Quarantine
Physical and verbal abuse and threats and
Interferes with HIV & TB prevention and treatment services

13. Health Consequences of HIV & TB Stigma
Prevention - afraid to access prevention services and be identified as member of "at risk" group.
- afraid to disclose positive serostatus to sex partner
Treatment - afraid to disclose status to health care staff and not wanting to be seen at "AIDS clinic"
Research - not wanting to identify as member of stigmatized group. Concerns of loss of confidentiality
Care - unwilling to provide care for sick family member. Unwilling to go into AIDS treatment field
Mental health consequences for PWAs: High rates of depression and suicide

14. Human Rights & HIV & TB-related Stigma and Discrimination
Freedom from discrimination is a fundamental human right founded on the principles of natural justice.
Discrimination against people living with HIV & TB or people thought to be infected is a clear violation of human rights.

15. Stigma interventions Few interventions to date
No rigorous evaluations conducted
Research suggests possible directions, but setting-specific formative work needed to ensure that local issues are addressed

16. Reducing HIV & TB stigma Targeting at multiple levels
Policy: There should be Law and policy reforms needed to prohibit discrimination of PWAs and to protect those who are most vulnerable (e.g. sex workers, MSM, women, substance users, ethnic and racial minorities).
Social: There should be Community-based programs, including media (as appropriate in each setting). Work through local NGOs
Institutional: Military, schools, prisons, hospitals, and religious institutions and leaders.

17. Reducing HIV & TB stigma
Families - provide support and education in whatever venue that is possible
Mobilize and support positive people and encourage their involvement in activities and advocacy
Couples - in whatever setting that couples can be reached, including testing and counseling
Individuals - during healthcare visits, testing and counseling and other appropriate venues
Recruit Opinion Leaders - educate and involve them

18. References
 M Mhode (2013), Experiences and Impact of Stigma and Discrimination among People on Antiretroviral Therapy in Dar es Salaam
Maria L Ekstrand, (2011), Center for AIDS Prevention Studies, University of California, San Francisco: Health Consequences of AIDS-related Stigma

19. THANK YOU