This study explores the effect of gender on HIV-related stigma and discrimination with selected cases from Turkey and examines &lsquo / normalized sexuality&rsquo / (i.e., conformity to sexual norms in Turkish society) as a moderating factor. In this regard, both qualitative and quantitative data collection techniques have been utilized, namely / (i) in-depth interviews with HIV positive women and men with different sexual lives, and (ii) a survey conducted at the University of Istanbul among dentistry students. The main quantitative findings of the research include (i) sexual loyalty of a woman was found as a determinant for HIV-related stigma and discrimination / (ii) female respondents discriminated people living with HIV on the basis of normalized sexuality / and (iii) male respondents discriminated on the basis of sex of the person living with HIV. A surprising secondary finding was that the sexual orientation of an HIV positive male did not significantly affect the amount of discrimination. These quantitative findings were also supported by the qualitative findings and all were analyzed with a gender perspective. Gender norms and sexual behaviors in Turkish society are shaped strongly by the patriarchal power structures, and stigma and discrimination act as control mechanisms to sustain this structure. It is thus argued that the prevailing patriarchal values and norms need to be examined in order to effectively challenge HIV-related stigma and discrimination.

Submitted by Jamile Barbosa da Cruz (jamile.cruz@ucsal.br) on 2016-09-14T18:22:34Z No. of bitstreams: 1 Dissertação Carla revisada (1) (3).pdf: 1472118 bytes, checksum: acaeefb455773b067a80d42aaafe2b21 (MD5) / Approved for entry into archive by Maria Emília Carvalho Ribeiro (maria.ribeiro@ucsal.br) on 2016-09-14T19:34:29Z (GMT) No. of bitstreams: 1 Dissertação Carla revisada (1) (3).pdf: 1472118 bytes, checksum: acaeefb455773b067a80d42aaafe2b21 (MD5) / Made available in DSpace on 2016-09-14T19:34:29Z (GMT). No. of bitstreams: 1 Dissertação Carla revisada (1) (3).pdf: 1472118 bytes, checksum: acaeefb455773b067a80d42aaafe2b21 (MD5) Previous issue date: 2016-03-07 / Este estudo tem como objetivo descrever a vulnerabilidade do paciente com HIV/AIDS e suas estratégias de enfrentamento, a partir da discussão e reflexão em torno das dificuldades vivenciadas por ele em seu contexto social. A epidemia de HIV/AIDS, cada vez mais, atinge populações mais vulneráveis social e economicamente, que não se deparam apenas com questões relacionadas à doença, mas à exclusão social e à pobreza. Por isso, é necessário considerar as transformações dessa epidemia em seu contexto histórico, as dificuldades vivenciadas pelos pacientes com HIV/AIDS, e, principalmente, os significados construídos para enfrentar essa realidade. As pessoas que vivem com HIV/AIDS sofrem constantes violações de direitos, e estão submetidas a diversas formas de desigualdade, preconceito e discriminação, que as deixam em uma condição de mais vulnerabilidade. Para este estudo, foi realizado um estudo de caso, utilizando observação direta, levantamento de dados e entrevista semiestruturada. Ele contém uma análise sobre a construção histórica da doença e uma discussão do conceito de vulnerabilidade como um elemento importante para a compreensão e o enfrentamento da epidemia, a partir da ampliação em torno da dimensão social, no sentido de contribuir para a diminuição do impacto do HIV/AIDS na vida dessas pessoas e a consolidação de seus direitos. Diante disso, o atendimento da pessoa com HIV/AIDS não pode se limitar apenas à distribuição de medicamento como grande mote da política de HIV/AIDS, pois é necessário, também, que se contemplem as condições gerais dessa pessoa de vulnerabilidade, através de uma atuação mais ampla e intersetorial de políticas públicas que favoreça o seu fortalecimento. / This study has the objective to describe the vulnerability of HIV/AIDS patients and their coping strategies, from the discussion and reflection on the difficulties experienced by this patient within its social context. The epidemic of HIV/AIDS affects more and more populations which are economically and socially vulnerable, who are not faced only with issues related to the disease, but social exclusion and poverty. Thus it is necessary to consider the epidemic changes in its historical context, the difficulties experienced by patients with HIV/AIDS, and especially the meanings built to face this reality. Fighting AIDS implies combat all forms of inequality, prejudice and discrimination, since people living with HIV/AIDS suffer constantly rights violations, which leaves them in a state of more vulnerability. A case study was conducted using direct observation, data collection and semi-structured interview. Brought an analysis of the historical construction of the disease, the discussion of the concept of vulnerability, as an important element for understanding and combating the epidemic, from the expansion around the social dimension, in order to contribute to reducing the impact of HIV/AIDS in their lives and consolidation of law. Thus, the care of these people can not be limited only to drug distribution as a major theme of HIV/AIDS policy, as it needs also covering the general conditions of this vulnerable person, through an extensive and cross-sectorial acting public policy that favors the strengthening of the person with HIV / AIDS.

Most children born HIV positive live longer and have more healthy lives since the advent of Anti-Retroviral Therapy (ART), together with the accessibility of Anti-Retroviral Drugs (ARV) to persons living with HIV. However, some of those children find themselves in need of care due to abandonment, orphanhood and / or neglect. In South Africa such children may enter the formal Child and Youth Care System and be placed in centres such as Epworth Child and Youth Care Centre. Due to the complex nature of the consequences of such disclosure or non-disclosure of HIV positive children’s status to them, social service workers are posed with a dilemma. In the absence of clear guidelines and policy around such disclosure, the children concerned may be unaware of their HIV positive status, despite being on a medication regime. The aim of the study was to explore the perceptions of social service workers regarding disclosure of HIV status to children born HIV positive living at Epworth Child and Youth Care Centre in Lambton, Ekurhuleni, South Africa. The study was located within a qualitative research paradigm, and utilised a purposive stratified sample of 15 social service workers form various occupational groupings recruited from Epworth Child and Youth Care Centre. A semi-structured interview schedule was employed as the research tool, with in-depth one-on-one interviews being adopted as a method of data collection. Thematic content analysis was used to analyse the data collected during the interviews. The main findings of the study were that HIV status disclosure is viewed as a complex but essential process as it reinforces children’s ability to adhere to medication regimes and to dispel anxiety and suspicion within themselves and around their status; that non-disclosure may lead to poor or coerced adherence and strains the relationship between the children and the social service workers. Disclosure of children’s HIV positive status can be viewed as complex as it presents both positive and the negative. Recommendations relate to community educative and awareness programmes, policy and practice changes regarding disclosure and none disclosure of children’s HIV positive status, as well as future research.

No description available.

Master of Science / Department of Family Studies and Human Services / Karen S. Myers-Bowman / Today the HIV/AIDS epidemic is one of the many crises families may face. Many people have died of the disease while others are still living with it. At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS, with 24-27% undiagnosed and unaware of their HIV infection. The Centers for Disease Control (CDC) estimates that approximately 40,000 persons become infected with HIV each year (CDC, 2007). Stigmatization and discrimination related to HIV/AIDS is one of the many challenges that individuals and families affected by the disease face. They are unable to get employment, are denied health care, cannot access services in their communities and sometimes lose respect and power as a result of stigma. Stigma and discrimination also have been recognized as one of the main obstacles to HIV/AIDS, testing, prevention and treatment and yet little has been done to combat it. Stigma and discrimination is not only experienced by people living with HIV/AIDS but their family members, close friends, service providers and people that work with them also are stigmatized by association. This report highlights the need for family life educators to expand HIV educational programs to include issues on stigmatization and discrimination. It identifies some of the reasons why people stigmatize, the ways which stigma and discrimination are expressed and the impacts it has on individuals and their family members. Using Bronfenbrenner’s ecological model of human development, this report identifies the need to look at HIV-related stigma and discrimination as a societal problem rather than individual problem, and presents implications for education programs for the general public.

In this study, a model of cognitive behavioural therapy (CBT) was developed, implemented and assessed. The aim of this model is to assist HIV-positive women in dealing with internalised and enacted stigma. Since much of the research about therapies developed to deal with HIV-related stigma so far has been done within a western frame of reference, in the current study a model was developed to suit the local South African situation. Women were specifically targeted as they are more vulnerable to HIV/AIDS and are disproportionately affected by the epidemic. Because of culturally determined gender roles, women are not always in a position to take control of their sexual health. Furthermore, because of the negative experiences of HIV diagnosis, the stigma has a negative impact on women’s behaviour. As a result, there is a need for a therapeutic model to assist HIV-positive women in changing the experience of internalised stigma and discrimination. A CBT approach was used in therapy to challenge the women’s dysfunctional beliefs, to change their automatic thoughts and to promote more realistic adaptive patterns of thinking. All of these aimed to assist them in dealing with stigma. Eight therapy sessions (one a week for eight weeks) were planned for each of the women. This research was conducted in two phases. In Phase 1, data was gathered about the experiences of HIV-positive women to gain an understanding of their experiences of HIV-related stigma and discrimination. Various sources of information were used to identify not only the relevant themes contributing to the individual’s experience of internalised stigma, but also possible ways to change them. These sources included a study of the available literature, the researcher's own experience and focus group discussions with other psychologists in practice, and interviews with five HIV-positive women (in the form of case studies). Five women living with HIV/AIDS, who were experiencing difficulties in dealing with stigma, were recruited at Witbank Hospital, where they were interviewed and asked to complete five psychometric instruments. The researcher scrutinised the data gained from the psychometric scales to assess the validity of the instruments to identifying the feelings of the participants the researcher observed in the interviews. Rubin and Rubin's (1995) method was used to analyse the data. The findings that emerged from Phase 1 were used to identify common themes to be addressed in the intervention, for example feelings of powerlessness, feelings of guilt, behavioural implications of stigma, the experience of the reaction of others and uncertainty about the future. These themes were used as guidelines and were adapted according to the specific needs of each of the women seen in therapy so as to address negative feelings and behaviour. Phase 2 focused on the implementation and evaluation of the cognitive behavioural model. A purposive sampling technique was used for this study. The model was tried out with ten HIV-positive women who served as the experimental group. A quasi-experimental design was used, involving a pre-and post-test and a control group consisting of ten other women identified at the same hospital. The scores that the experimental group and the control group obtained before the intervention were compared to verify that the two groups were comparable prior to the intervention. Post-test scores were compared to investigate differences between the groups after the intervention. The process notes of the therapy sessions were analysed by means of qualitative analysis to understand the reactions of the women in therapy. This contributed to the researcher’s understanding of the appropriateness and effectiveness of various therapeutic techniques used with the experimental group. Findings of this research indicate that, when compared to the control group, the experimental group not only experienced less depression, internalised stigma and negative coping, but also higher levels of self-esteem and positive coping after having participated in eight therapy sessions. The study further revealed that being HIV positive and trying to cope with stigma and discrimination involve diverse experiences for women, although there are common themes for all participants. It was recommended that the intervention be altered in future use in the following ways: Those techniques that were found to be more effective with the majority of women (positive cognitive reframing, teaching of coping strategies, homework assignments, decatastrophising and assertiveness training) could probably be used with success in similar conditions. Only the techniques that worked well should be used, and care should be taken not to use too many techniques. Each client should be given the time to question the evidence for her automatic thoughts and to draw her own conclusions about her situation, feelings or thoughts and to grasp the cognitive strategies, rather than to bombard her with many different techniques. The therapist should also relate more to the individual client and adapt the model to her context, rather than to implement the model rigorously. / Thesis (PhD)--University of Pretoria, 2009. / Psychology / unrestricted

Doctor of Philosophy / Department of Family Studies and Human Services / Karen S. Myers-Bowman / The purpose of this study was to conduct a phenomenological inquiry into the impact HIV/AIDS-related stigma has on People Living with HIV/AIDS (PLHA) and their family members in Ghana and the overall relationship family members have with PLHA. The study explored the concept of stigma in the Ghanaian context, ways in which it is expressed, factors influencing HIV- related stigma and its consequences on both PLHA and their family members. Strategies that PLHA and their family members consider for effective HIV- related stigma prevention were also explored. The study further explored some of the gender- biased nature of HIV- related stigma in Ghana. Data was gathered qualitatively through interviews with five PLHA and their discordant family members. Interviews were transcribed and translated into English, coded and analyzed. After inductively establishing themes and categories, final confirmatory analysis was deductively established, by using the Bronfenbrenner’s ecological model and Symbolic interaction theory to affirm the authenticity and appropriateness of the inductive content analysis. The study found that HIV- related stigma begins with serostatus disclosure. Stigma is manifested in myriad contexts including the family, community, healthcare institutions and gender. The major factors influencing stigma are insufficient knowledge of HIV transmission, fear and misconception of HIV created by the media, cultural and religious factors as well as poverty. Family members experienced similar stigma as PLHA, such as loss of jobs, loss of social network, loss of identity and self stigma. However extreme impacts such as suicidal thoughts were only experienced by PLHA. The impact of HIV- related stigma is worst for women because of beliefs and values relating to gender- role expectations. While women accept and support their husbands when they have HIV/AIDS, women are often neglected and abandoned by their husbands. To address this stigma, participants suggested house to house education, financial support from the government, revision of educational content especially discontinuation of negative images of HIV/AIDS used by the media. Implications for this study in the areas of research, practice and policy are provided.

The phenomenon of stigmatisation in the transmission of HIV/AIDS was highlighted in this study, and considered from a social constructionist perspective. The lived experiences of 20 participants were explored in the context of a stigma reduction programme. Perceived meanings attached to stigma, and its influence on participant behaviour was revealed through narratives. The influence of the programme on participant meaning making and perceptions was also revealed, and found that the meaning of stigma remained unchanged, and therefore stigma was not reduced. Not discounting the therapeutic platform of the programme in enabling co-construction of new perspectives which enabled coping mechanisms for participants in dealing with their circumstances. It is recommended that studies such as this be used to assist future stigma reduction programmes to identify their roles in meaning making regarding stigma, with the premise in mind that if meaning shifts, experiences will shift. / Psychology / M.A (Psychology)

The phenomenon of stigmatisation in the transmission of HIV/AIDS was highlighted in this study, and considered from a social constructionist perspective. The lived experiences of 20 participants were explored in the context of a stigma reduction programme. Perceived meanings attached to stigma, and its influence on participant behaviour was revealed through narratives. The influence of the programme on participant meaning making and perceptions was also revealed, and found that the meaning of stigma remained unchanged, and therefore stigma was not reduced. Not discounting the therapeutic platform of the programme in enabling co-construction of new perspectives which enabled coping mechanisms for participants in dealing with their circumstances. It is recommended that studies such as this be used to assist future stigma reduction programmes to identify their roles in meaning making regarding stigma, with the premise in mind that if meaning shifts, experiences will shift. / Psychology / M.A (Psychology)

Against the background of evidence that HIV-AIDS has had and continues to have an enormous impact on all South African schools, a need has arisen for HIV -AIDS policies and programmes to be effectively implemented in all schools. In this study, a qualitative methodology was used to evaluate policy implementation in the North West province. Data was gathered by means of field notes, observation and interviews with management and educators. The study found that although principals and educators are knowledgeable about HIV -AIDS, there is a tendency to discriminate against infected educators, particularly in terms of educator workload. This study also revealed that educators fear being accidentally exposed to HIV -AIDS infected blood, despite the guidelines given in the National HIV -AIDS policy and the availability of emergency first aid kits. The key thought emerging from this study is that not all schools are able to deal effectively with HIV -AIDS and that schools urgently need to plan or implement their own policies in this regard. School-based HIV-AIDS policies can only be successful if they take cognisance of local contextual issues and involve the three spheres of influence in the lives of educators and learners, namely, the sphere of the school, the sphere of family life and the sphere of the community. / Sociology / M.A.(Social and Behavioural Studies in HIV-AIDS)