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  1990’s,  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  Kleinman’s  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  God’s  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 Social Support among African Americans. AIDS Patient Care and STDs. 2008;22(5):423-436.

3. CDC.gov. African Americans | Race/Ethnicity | HIV by Group | HIV/AIDS | CDC [Internet]. 2016 [cited 6 January 2016]. Available from: http://www.cdc.gov/hiv/group/racialethnic/africanamericans/  

4. Whyte S. Chronicity and control: framing ‘non-communicable diseases’ in Africa. Anthropology & Medicine. 2012;19(1):63-74.

5. Kleinman A, Kleinman J. The appeal of experience; the dismay of images: cultural appropriations of suffering in our times. Daedalus. 1996 Jan 1:1-23.

6. Siegel K, Lune H, Meyer IH. Stigma management among gay/bisexual men with HIV/AIDS. Qualitative Sociology. 1998 Mar 1;21(1):3-24.

7. Makoae LN, Greeff M, Phetlhu RD, Uys LR, Naidoo JR, Kohi TW, Dlamini PS, Chirwa ML, Holzemer WL. Coping with HIV-related stigma in five African countries. Journal of the Association of Nurses in AIDS Care. 2008 Apr 30;19(2):137-46.

List  of  Image  References:    

1. Hands/  Community.  http://ecoethonomics.ca/wp-­‐content/uploads/2014/08/8cf5ee70-­‐a593-­‐11e3-­‐8aab-­‐

2d357fcb2a56_AIDS-­‐ribbon-­‐hands-­‐e1408718154633.jpg    

2. Word  Collage.  http://sexpression.org.uk/human-­‐immunodeficiency-­‐virus-­‐hiv/    

3. Ribbon  Wall.  http://america.aljazeera.com/content/dam/ajam/images/articles/iran_hiv120313.jpg  

4. Ribbon  Tree.  http://www.hopehouseaugusta.org/rrr2015/aids-­‐ribbon-­‐tree-­‐2/    

5. Toolkit.  http://www.ask-­‐kalena.com/seo/105-­‐free-­‐seo-­‐resources/attachment/toolkit/    

6. Races  Coming  Together.  http://www.wjhg.com/news/newschannel7today/headlines/A-­‐Day-­‐Of-­‐Fun-­‐And-­‐

Fellowship-­‐For-­‐Community-­‐Appreciation-­‐Day-­‐-­‐328479661.html    

7. Empowerment.  http://sacredstructures.org/might/empowerment-­‐agent-­‐change/    

8. Act  for  Cure.  http://www.tcnj.edu/~borland/2006-­‐aids/cassy2.htm    

9. Red  Ribbon.  http://fvinstitute.com/fvi-­‐sponsors-­‐red-­‐ribbon-­‐week-­‐on-­‐95-­‐9-­‐the-­‐river/