Fear of Casual Transmission of HIV and Refusal of Contact with PLHA

1
Fear of Casual Transmission of HIV and Refusal of
Contact with PLHA
2
Fear of casual contact and stigma

• Fear of HIV infection through ordinary and daily
  interactions with PLHA, even though these
  interactions do not involve exchange of body
  fluids.
• The fear leads into isolation of PHLA in all
  aspects of daily life.
• Many stigma reduction programs aim to increase
  knowledge and reduce fear of infection through
  casual contact as the starting point towards
  reducing stigma.
• Therefore, there is need to measure fear-driven
  stigma.

3
Commonly used indicators

• . would NOT buy food from a PLHA or person
  suspected of HIV/AIDS in a market.
• . would NOT share utensils with a PLHA or a
  person suspected of having HIV/AIDS in a
  household
• .would NOT buy fresh vegetables from a
  shopkeeper or vender if they knew that this
  person has the AIDS virus

• These indicators mention action that
  individuals would take, but do not mention fear
  as the underlying cause.

4
Improved indicator

• Percent of respondents expressing fear of
  contracting HIV from casual contact with PLHA
  (Proposed for field-testing in Tanzania)
• Question
• Please tell me if you are afraid or not afraid
  in response to the following statements..

5
Percent Responding Yes in Fear of HIV Infection
through the Following Channels

• 46.6 of respondents feared HIV infection through
  one of the 12 channels

6
Creating Fear Index
7
Recommendation from the Tanzania field-test
experience

• Need to ask about a range of items
• Ask about specific underlying fear (e.g sweat) of
  HIV infections

8
Progress made, but more work needed..

• The improved indicator captures the fear, - a
  dimension commonly targeted by stigma reduction
  program. Hence programs can use this indicator to
  monitor progress.
• However, the improved indicator does not link the
  fear to stigmatization. The assumption -
  once there is fear stigmatization follows.
• More work is needed to verify this assumption.

9
Values Shame, Blame and Judgment
10
Moral values and HIV/AIDS Stigma

• The tendency to associate moral impropriety to
  HIV/AIDS leads to stigmatization of PLHAs.
• Many stigma reduction interventions aim to change
  attitudes that associate moral impropriety to
  HIV/AIDS.
• However changing moral-based attitudes is a
  challenging and sensitive issue. Achievement of
  changes takes time.

11
Commonly used Indicators

• Percent of people who would judge or blame
  persons living with HIV/AIDS for their illness
• Percent of people who would feel shame if they
  associated with a person living with HIV/AIDS

Each indicator is constructed using several
items/questions The Tanzania team
field-tested these indicators
12
Percent of Respondents Agreeing and Perceptions
of Community Responses to Stigmatizing
Attitudinal Statements
13
Construction of 2 indicators
14
Items Selected

• Shame
• I would feel ashamed if I were infected with
  HIV/AIDS
• I would feel ashamed if someone in my family had
  HIV/AIDS
• People with HIV/AIDS should be ashamed of
  themselves
• Judgment and Blame
• People with HIV/AIDS are promiscuous
• It is women prostitutes who spread HIV in the
  community
• HIV/AIDS is a punishment from God

15
Recommendations from field-testing ..

• Indicators are needed for two dimensions shame
  and blame/judgment
• Construction of each indicator needs at least
  three items.
• Omit positive attitudinal questions/items, they
  do not show adequate variations to support
  analysis.

16
Progress made, but more work needed..

• The 3-items recommended indicators capture
  value-based stigma and can be adapted to measure
  this stigma in different populations to monitor
  progress of programs.
• Further careful phrasing of the stigmatizing
  statements is needed to differentiate the reality
  that may underlie spread of infection from the
  general stigmatization of MARPs.