portfolio iii, final draft
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Anthropology of Global Health
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
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
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
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