"Human Immunodeficiency Virus serostatus disclosure-Rate, reactions, and discrimination": a cross-sectional study at a rural tertiary care hospital.

BACKGROUND: From the moment scientists identified Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), social responses of fear, denial, stigma, and discrimination have accompanied the epidemic. AIMS: To assess the rate of disclosure of HIV serostatus, reactions by the HIV/AIDS patients and their spouse, and discrimination faced by the patients. METHODS: The present cross-sectional study was conducted at Antiretroviral Therapy (ART) center of a rural tertiary care hospital, situated in Marathawada region of Maharashtra state from November 2008 to October 2010. Totally, 801 HIV-positive patients coming to ART center for treatment were included after ensuring confidentiality and taking informed consent. A preformed questionnaire was used to enquire about reaction after diagnosis, disclosure, and discrimination faced by the patients. The data analyzed using descriptive statistics and Chi-square test. RESULTS: The most common immediate reaction by the HIV patients after getting diagnosed as seropositive was fear (593, 74.03%) followed by depression (385, 48.06%) and suicidal thoughts (98, 12.25%). Out of 801 patients, 769 (96%) had spouse and of these maximum number of patients (653, 84.92%) had disclosed HIV status to their spouses. Most common immediate reaction by spouse after disclosure was crime (324, 42.13%) followed by horror (294, 38.23%) and anger (237, 36.29%). Maximum number of patients were discriminated by friends (120, 71.01%) followed by discrimination at workplace (49, 67.12%), by neighbors (32, 56.14%), and by relatives (53, 43.80%). CONCLUSION: Male positives were granted greater acceptance, care, and support by their spouses. More percentage of females discriminated by neighbors, relatives, and friends and at workplace which might be due to factors like customs, morals, and taboos.

Report of the Stigma Research Workshop for the development of scientific consensus papers and field guidelines on health-related stigma, held in Amsterdam, the Netherlands from 11-14 october 2010.

Summary In concurrence with the broad body of literature published on health-related stigma, there is a need for practical field guidance to contribute to the fight against leprosy-related stigma and discrimination. To this end, much can be gained by considering the accumulated knowledge and learned from experience with different stigmatising conditions; primarily HIV/AIDS, disability, tuberculosis, and mental health. Therefore a Stigma Research Workshop was organised from 11-14 October in Amsterdam, The Netherlands. The primary aim of the workshop was to produce scientific papers and field guidelines that could be used to target actions against health-related stigma and discrimination. Keynote presentations were offered by scientists and professionals from different health domains who shared their knowledge, experiences and research findings regarding health-related stigma. Group work was subsequently conducted to work towards agreed outputs on four different themes: i.e. research priorities, measurement, interventions, and counselling. The spectrum of expertise present enabled an interdisciplinary and inter-profession sharing of knowledge and practices. This resulted in the commencement of consensus papers and field guidelines related to the four themes. An evaluation by participants concluded that the workshop had been an informative and worthwhile activity that will strengthen the fight against stigma.

O trabalho cotidiano com a AIDS: as representaçöes dos profissionais em uma unidade hospitalar. Relatório da etapa I: a situaçäo dos profissionais e a problematizaçäo da AIDS / The quotidian work with the AIDS: professional representations in a hospital unit. Report of the first stage: the professional/situation and the AIDS problematic

Relata os resultados do estudo realizado em 1991, no Hospital Emílio Ribas, com a caracterizaçäo do perfil dos profissionais, sua situaçäo de trabalho e a repercussäo da AIDS no trabalho cotidiano; o estudo abrange 227 (97 por cento do total) dos trabalhadores, de todos os grupos ocupacionais, que atuavam diretamente com os pacientes. Alguns resultados confirmaram tendências observadas em outros estudos: a majoritária participaçäo feminina no trabalho; grande capacidade produtiva da força de trabalho de jovem com média de 38 anos; a maioria com jornada completa e com situaçäo salarial bastante defasada do mercado de trabalho. Observa-se dois pólos em relaçäo à escolaridade: 48,5 por cento dos profissionais tinham nível universitário e 34 por cento apresentava até o 1 grau completo. Há uma variedade de crenças religiosas adotadas pelos profissionais, e chama a atençäo a proporçäo elevada de crenças espiritualistas em relaçäo à populaçäo em geral. Os profissionais referem ter recebido orientaçöes ou treinamentos para o desenvolvimento de suas funçöes, com conteúdo fundamentalmente técnico operacional. Säo relatadas dificuldades estruturais de trabalho na instituiçäo, dentre elas, falta de recursos materiais e humanos, má organizaçäo e gerenciamento, baixos salários, carga horária excessiva, falta de apoio psicológico, etc..Neste quadro, os pacientes de AIDS têm sido considerados pelos profissionais como portadores de um comportamento näo adequado (pacientes "agressivos", "näo cooperativos"...). Acredita-se que sem uma intervençäo específica, além do aparecimento e legitimaçäo de um novo estigma em relaçäo a estes pacientes, os profissionais continuaräo sobrecarregados, enfrentando uma jornada de trabalho "penosa", dolorosa para ambos, pacientes e profissionais de saúde.

Ethical concerns about AIDS.

The HIV/ARC/AIDS story continues to unfold. It is both the old, sadly familiar experience of plague and disease, of lepers isolated as unclean, of smallpox decimating the American Indians, of a Black Death sweeping medieval Europe, of the 1918 influenza. It is also a new story, one in which medical scientists rather quickly identified the causative infectious agent but, as yet, have been unable to cure the infection, although some amelioration of the basic course of the illness appear possible if treatment with AZT is begun relatively early. The ethical problems are numerous and constantly change as the understanding of the disease and its potency evolves. The social answers have, after initial delay, received positive action on an official level. On the more personal level of the average American there remains animosity, prejudice, and a deeply rooted fear, the ancient fear of the leper, of the plague victim. The health professionals have also officially responded well to the challenge of AIDS. Personally, as in society generally, there has been a mixed response. We believe that the ethical concerns enumerated in this article will be resolved in favor of persons with AIDS. Nevertheless, the personal, spiritual, emotional, and economic isolation experienced by persons with AIDS and their families challenge us about what kind of society we wish to be. We will ultimately be measured as a civilization by the way in which we treated the least fortunate. America's track record in this regard has been mixed. AIDS presents us with a chance to change.

Aspectos psicosociales del SIDA: estigma y prejuicio / Psychosocial aspects of AIDS: stigma and prejudice

El SIDA, como la lepra o la tuberculosis en otras épocas, es una enfermedad que, por un lado, refuerza algunos prejuicios ya existentes de parte de los "normales" y, por otro, estigmatiza socialmente a sus victimas. Ade· más, esta enfermedad ha contribuido a politizar -Q hacer públicos- aspectos tradicionalmente privados, como el contexto de la relación amorosa -homosexual o heterosexual=, que es una de las principales formas de transmisión de la enfermedad. La transmisión del SIDA supone actos privados con consecuencias públicas. Las politicas sociales orientadas a combatirlo suponen, a la inversa, actos públicos que tienen un impacto en la esfera de lo privado. Junto a este vínculo de lo público con lo privado, se ha abierto un espacio para que ciertos prejuicios y estigmas se acentúen. Consecuentemente, los enfermos de SIDA sufren una doble marginación: biológica, por lo incurable de su mal, y social, por los prejuicios y estigmas que recaen sobre ellos. La investigación sociopsícológica y educativa debe contribuir a eliminar esta última

Epidemics in perspective.

Irrational responses to patient with AIDS, particularly in regards to the transmissibility of HIV (human immunodeficiency virus) are examined from an historical and psychosocial perspective. Although these responses are similar to those reported from past epidemics such as plague and leprosy, they are in direct conflict with our current level of understanding regarding the transmission of this virus. Their genesis may relate to the human penchant to react to illness metaphorically. In order to allay effectively public concern about the transmissibility of AIDS, it is essential to recognize the metaphor associated with venereal disease in general and AIDS in particular.