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  • Anthropology of Global Health

    Portfolio III

    Zachary T. Gavry, MSc Candidate

    Characters and Spaces: 7, 913

    Assignment: You may choose between HIV/AIDS or Diabetes. Using the anthropological findings in the

    articles we read, prepare a so-called "Living with" patient guide that is aimed at helping a patient understand

    how it is to live with HIV/AIDS or diabetes. You may choose to bring in further anthropological studies, and you

    may make it relevant to a patient group in a country of your choice (e.g. living with HIV/AIDS is of course very

    different depending on if you are in Denmark or in India). You will be assessed on your ability to 'translate'

    anthropological insights and findings into a useable patient guide.

    The length of each portfolio should max be 8.000 characters incl. spaces. You can include pictures as well.

  • Living and Coping with HIV stigma in African

    American Populations

    A guide for HIV+ African Americans to make positive improvements in their daily lives by managing HIV stigma.

  • Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.- Martin Luther King Jr., 1963

    Introduction.

    This guide is for African American HIV positive persons living in the United States who either do or do not

    have access to Anti Retroviral Therapy (ART). It should be used for the purposes of highlighting the

    African American burden of HIV, understanding the social dimension and stigma of living with HIV, and

    connecting individuals with some of the appropriate tools they can use to cope with and even combat HIV

    stigma/ serophobia in their daily lives and communities.

    Click here to learn more about serophobia.

    HIV and African Americans.

    HIV is a worldwide disease that receives a lot of attention. Over the past two decades however, a major

    shift has occurred. From the 1990s, little was known about the virus and medicines were in the early

    stages of development with low rates of success. Today, the world has seen an impressive modernization

    of Anti Retroviral Therapy (ART) which can suppress viral load to undetectable levels allowing people

    with HIV [to] enjoy healthy and productive lives (1).

    You can enjoy a healthy and productive life, too!

    Despite this progress, in the United States HIV/AIDS continues to disproportionately affect African

    Americans (2, p. 423). In 2010 for example, African Americans represented 12% of the United States with

    44% of all new HIV cases (age 13+) resulting from this population (3). These numbers are shocking, but

    they are not without hope.

  • A strong biomedical and psychosocial support system means enhanced levels

    of well- being for those living with HIV/AIDS.

    HIV and Sociality.

    Chronic illnesses like HIV usually reflect the view that the meaning of a condition is heavily shaped

    by what people (policy makers, health professionals, affected individuals and their families) think

    they can do about it (4, p.63). In other words, how much we can control HIV shapes the way it is

    viewed by our friends, families, doctors, and societies. However, being diagnosed with HIV means

    being part of a bio-sociality, or better stated, a community of individuals.

    You are part of a community!

    Biosocial theory says that social relations, and identities, are formed on the basis of technologically

    mediated characteristics (4, p. 70). This is a fancy way of saying that your personal identity around HIV is

    related to the type of treatment regimen you stick to. So, a diagnosis of HIV and being on ART does not

    alienate you from others but rather integrates you into a community of other positive individuals who

    understand and share similar experiences. When it comes to the sociality of ART, connections and

    clientship are critical and people who had succeeded in living with HIV emphasized the importance of

    knowing someone who helped them to test and to get onto a treatment program (4, p. 70).

    Can you think of anyone you think should be part of your treatment network?

    Understanding your social resources will be critical for stigma management.

  • HIV and Stigma.

    There are two types of stigma which you may experience as a result of your positive status.

    1. Perceived (felt) stigma; occurs when there is a real or imagined fear of societal attitudes

    regarding [HIV] and creates worry about possible discrimination and prejudice.

    2. Enacted (actual) stigma; refers to experiences of discrimination directed to individuals

    because of specific attributes or conditions that characterize them (2, p. 424).

    Consequences of HIV related stigma are closely associated/ correlated with; (2)

    v Labeling and stereotypes

    v Discriminatory acts and prejudice

    v Social status loss

    v Loss of self-esteem

    v Deterioration of social interactions

    v Depression and anxiety

    v Poor adherence to treatment

    v Financial insecurity

    Sources of stigma can arise from; (2)

    v Family and friends

    v Employers and co-workers

    v Health providers and systems

    v Public policy and societal structures

  • Introduction to Stigma Management. Managing stigma and the negative consequences of it can

    f be divided into three types of strategies.

    1. Reactive; those that involve avoiding or lessening effects of stigma (e.g hiding it or selecting

    individuals to inform)

    2. Intermediate; strategies that are between proactive and reactive

    3. Proactive; those that actually confront the stigma and change the landscape (e.g social

    activism and community engagement) (2, p. 425).

    The next pages provide a list of strategies and tools that you can use to reduce negative effects of HIV

    related stigma.

    There is no single way to suffer; there is no timeless

    or spaceless universal shape to suffering (5, p. 2). In line

    with Kleinmans point, the following examples of coping

    strategies are not for everyone. We encourage you to simply

    read them over, think about them, and then perhaps select

    one or two you think may work best for you. Remember that any strategy you employ is one step closer

    to seeing a stigma free world. Together, we can do this!

    Reactive Strategies. These can help to avoid or lessen effects of stigma for you. (6, p.10-11)

    I. Concealment (keeping your status from others)

    II. Selective Disclosure (telling who you want to and feel like)

    III. Personal Attributional Style (strategies which work for you, e.g distancing oneself from those

    who you know view the disease negatively or may be serophobic)

  • Intermediate Strategies. These can either be self protective or potentially fight stigma within the

    positive community. (6, p.10-14)

    I. Gradual Disclosure (slowly over time introduce the topic or condition to someone)

    II. Selective Affiliation (surrounding yourself with other people who are positive and understand,

    or restricting support networks to specific people)

    III. Challenging Moral Standards (adjusting your moral view of HIV, e.g challenging religious

    convictions about becoming infected and standing up for oneself in the face of opposition)

    Proactive Strategies. These help fight the stigma within the community in an active way. (6, p. 17-20).

    I. Preemptive Disclosure (coming out about your health status at the beginning of social

    relations or in public)

    II. Public Education Strategies (using community engagement, education, and awareness to

    make a difference in the public eye for the HIV community)

    III. Social Activism (taking confidence to the next level by influencing things like HIV public policy

    and funding for research)

    Some other strategies for coping with HIV stigma include (7, p.144-146)

    v Humor (joking about the illness can help make it less scary)

    v Turning to God (for those who identify as religious and seek Gods council)

    v Joining a Support Group (building the social network is key to treatment management)

    v Professional Counseling (formal or informal from health workers)

    v Helping Others (other positive individuals or just other people in need)

    v Getting Educated (learning more about the disease empowers you to act)

    v Changing Your Lifestyle (finding new ways to live after a positive diagnosis)

  • Below are some links of websites intended for the African American community in the fight against

    HIV/AIDS. Please explore them as you wish for more support, education, and inspiration.

    The Black Aids Institute

    The National Minority Aids Council

    Center for Disease Control and Prevention

    National Black Leadership Commission on AIDS

    We hope this guide has helped to let you know about how HIV impacts

    African Americans, the reality of HIV stigma, and some of the various

    options one has for coping and combating HIV stigma today. Finally, we

    encourage you to adhere to your treatment regimen, build your social

    network, and try using one of the strategies available, today!

  • List of References.

    1. World Health Organization Media Centre. HIV/AIDS [Internet]. 2016 [cited 5 January 2016]. Available from: http://www.who.int/mediacentre/factsheets/fs360/en/

    2. Galvan F, Davis E, Banks D, Bing E. HIV Stigma and