1. Jumping over Two Hurdles: Caring for Addicts who live with HIV Dr Ehab El Kharrat President of ISAAC International & Executive Director of Freedom Egypt

2. What is Stigma? To stigmatize is to label someone. To see someone as inferior because of an attribute he or she has.

3. Types of HIV-Related Stigma Self Stigma – Self-hatred, shame, blame (internal). Felt Stigma – Perception or feelings toward PLHAs (external) Enacted Stigma or Discrimination Stigma by Association – The whole family can be affected by stigma. Stigma related to occupation.

4. A Double Stigma Intra venous drug users are stigmatized: seen as selfish, criminals, fools and untrustworthy People living with HIV are stigmatized: seen as perverts, should be avoided, may be contagious, magically harmful and should be avoided

5. Stigmatization and Condemnation The roots of condemnation may be found in the attempt to preserve the majority (the upright) and preserve the purity of the moral message Connecting HIV/AIDS to “committing adultery”, Drugs to “being selfish and callous” The fear of appearing as a liberal or loose person leads religious people to exaggerated firmness Lack of information and misconceptions

6. Roots of Stigmatization With the rise in awareness of the facts the realization that confronting HIV/AIDS requires avoiding labeling, condemnations Confronting A call for love and compassion in action toward vulnerable groups and PLWHA All human beings are sinners: The glory and the fall The balance between affecting behavior change and avoiding stigma e.g. smoking, overeating

7. HIV status If you do not get tested, you are not HIV negative you are only HIV ignorant There is life after addiction There is life after HIV There is life after HIV and Addiction You and Those whom you serve may well be HIV positive

8. Double Denial It can not happen to me I am not like this I can not take it If I am I should not know It will not help me to know

9. Why our clients do not get tested Stigma Denial Discrimination

10. History of Support Groups Groups of friends or colleagues often develop naturally HIV raises many difficult issues and questions Many People living with HIV find support groups can provide information and reduce anxiety about questions

11. Benefits of Support Groups Help individuals to become more confident and powerful Provide a basis for activities organized by their members Make links between people of different backgrounds and increase tolerance and understanding Help share resources, ideas and information Make others in the community aware of the situation faced by people in the group Lead to the creation of a public or political voice for people living with HIV

12. Key benefits Safe space Reduced isolation Providing optimism Learning more Action for change

13. Not Always Easy People cannot have their HIV status known People have economic and other issues that the group cannot meet Group members have different needs and expectations which can lead to conflict and disappointment Group founders/leaders move on, creating some weakness Burn out

14. Ways to Positive changes for people living with HIV Increase knowledge More skills Positive attitudes and beliefs Helpful social and cultural influences Supportive environment –Policy and issues/human rights –Access to materials and services –Economic opportunities –Open environment

15. Causes of Problems for People Living with HIV Lack of Knowledge Lack of Skills Unhelpful attitudes and beliefs Social and cultural pressures Restrictive environment

16. Keys to care for PLWH Regular intake of the medicines When the person needs it Avoid resistance The issue of priority Side effects Motivation Regular testing

17. Keys to care for PLWH Stigma and Myths in and outside the recovery community: Dealing with the stigma Nutrition Healthy lifestyle Discrimination

18. Suggestions for Effective Care to Addicts Living with HIV