Stigma and Discrimination of Living with HIV in Middle-Aged People - Literature review Example

Stigma and discrimination of living with HIV in middle aged people There is no doubt that a lot of research has been carried out on HIV and AIDS, given the impact that it brought to all communities in the world. The advent of time has seen significant improvement on management of HIV and AIDS yet discrimination and stigma on those affected is still reported in many parts of the world. HIV and AIDS affect people from all walks of life, young and old alike. In course of time, there have been numerous initiatives to discourage discrimination against people infected with HIV. It is important to research on to discrimination and stigma on the middle age members of the society who suffer from the HIV virus. Stigma is defined as; the impression that makes one think that other people do not want or like them because of any given condition that they have that makes them unique. The term has its origin from the Greek where it was given a negative implication and was associated to social misfits. Stigma is divided into self-stigma, institutional and public stigma. Public stigma are the ideas that the general public harbour regarding ascertain group of people. Self-stigma relates to the personal attitudes that arise from real or perceived thoughts as result of a condition. Institutional discrimination refers to policy frame works within organization. It follows that these organizations, through policies and strategies, could encourage stigmatization. Discrimination on the other hand refers to the actual ill-treatment of a certain category of people because of the condition that sets them apart from the rest of the larger group. According to UNAIDS (2014) it is estimated that 4.2 million people around the globe are living with HIV. Sub-Saharan Africa accounts for 60% of all the cases with approximate 2 million of the cases being people more than 50 years old. Furthermore, 13% of the people with HIV are more than 50 years. Research has revealed that the vulnerability among the middle age adults I high and is constantly on the rise. For example in USA, in 2001 the middle aged people living with HIV was 17% but that rose to 30% by 2008. In this respect, it is clear that HIV and AIDS continue to affect the middle aged people. With the increase in the incidence rate comes stigma and discrimination (UNAIDS 2014). Nichols et al., (2002) carried out research on stigma and discrimination among widowed women living with HIV/AIDS in society and concluded that discrimination was evident in that category. Similar findings were found by Green, (2009), Biggs, (2012) and (Sourny, 2012) who delved on discrimination at the work place. In light of the above, there is need to establish the effects of the disease on middle aged members of society who are living with the HIV and AIDS. The point of difference here, as opposed to Collier et al., (2011) is that this study will generalise on all adult people, including men and women. A research carried out by NCB, (2012) in relation to the effects of HIV and society looks at the occurrence of the disease and sexual activity among the affected people. The study outlined that people suffering from the disease are more sexually active compared to their counterparts who do not suffer from similar conditions. While this study will look at the general effects of the disease on affected middle aged people, stigma and discrimination are the driving factors behind the various probes made in the course of the study. Issues relating to stigma and discrimination among middle aged people living with HIV/AIDS have remained largely unexplored by writers and researchers. This subject is very relevant to the authors field of study, and the long term goal is to become a HIV specialist nurse in the future. The reason for this research seeks to explore this field in relation to middle aged people suffering from the disease. The following specific objectives are expected to be fully addressed in this literature review: • To find out the trend in the number of middle aged people living with HIV/AIDS for the period 2000 and 2014. • To establish the different forms of discrimination among older people living with HIV/AIDS. • To determine how stigma is expressed towards people over 50years old living with HIV/AIDS. • To outline the causes of stigma and discrimination towards people living with HIV/AIDS. The analyses in this literature are expected to provide a good and Suitable ground to inform decision making processes on how to control stigma and discrimination against older members of society who are living with HIV/AIDS. In this way the research will add knowledge to the existing frameworks by highlighting the various forms of stigma and discrimination as expressed in society, in relation to older members of society who are suffering from the disease. By pointing out the various forms of discrimination towards HIV infected individuals, this research is expected to be of great importance to various Healthcare Institutions and other policy bodies in drawing policy frameworks to help promote ethics and reduce stigma and discrimination among various members of the society. Barnett & Whiteside (2006) argue that this category like other categories affected by this disease are more susceptible to other life conditions such as mental illness and psychotic illness that arise from the scrutiny that society predisposes them to. In that regard, is clear that the conditions get worse; additional conditions normally lead to additional challenges in the lives of these individuals further complicating their lifestyles. According to UNAIDS, (2014) observations, the occurrence of HIV/AIDS in the lives of mature people make them more susceptive to contracting several other diseases that can further make them socially withdrawn from the society or rather experience effects that makes them feel socially alienated from the society in which they live. This effect increases the vulnerability of middle aged people to more pressure associated to stigma and discrimination. It is self-evident that the group is predisposed to more risk and as the risk levels increase so doe’s stigma and discrimination. The trends of ageing and HIV/AIDS This group like other people suffering from other conditions such as cancer and diabetes have problems accessing health care because the conditions reduce their ability to work and get stable income health care provision is related to the level of income and this means that failure to have good healthcare means doom for this group. In course of time, the situation worsens because HIV translates to AIDS that come with worse chronic conditions and this further increase the burden on this people. On the same note that comes with more stigma and discrimination to this group of people. USA, UK, China, Australia and Japan register the highest number of people living with HIV between the years 2010 and 2014. However, the lowest number of people living with the disease was found to reduce considerably among the developing nations, Africa recording the lowest number. These statistics are contrasted with those of middle aged people where the reverse is true. A research conducted by Atchley&Barusch, (2004) on the prevalence of the condition in the African continent, Asia and Latin America indicated that the most affected people in these regions fall between the ages of 15 and 35. The lifespan of those contracting HIV in African countries was found to be shortest owing to several factors including poor living conditions, poor nutrition, poor economic backgrounds and neglect by relatives, friends and the government. Such conditions make these people die at an early age compared to their counterparts in the developed nations who enjoy the best care services (Macallan, 2013). The significance of this finding is that it gets to show that in countries where the life span is higher after contracting the virus, the victims are more likely to suffer from more bouts of stigma and discrimination in the course of their life span. In this regard, in developed countries like the USA compared to Africa an individual is likely to encounter more number of days of stigma and discrimination because they are more likely to live longer Delpech, (2013) research indicates that many people live under very poor conditions due to their inability to fend for themselves. About 19% of all adults live under abject or near abject poverty. However, the number of older people affected by the pangs of poverty is represented to be unbalanced across the world. The effects have been found to be highest among black women, especially those living in Africa and Latin America. About 54% of black women living alone are living below the poverty line. On the other hand, only about 29% of people living with HIV around the world (majority from the developed world) are living among their relatives and are actively involved in various activities. (AIDSMAP, 2012).Drisko(2004) discovered that the level of discrimination and stigma are proportional to the cases reported. This means that any region that has a high number of cases is more likely to have more cases of discrimination and stigma. On the same note, as the level of poverty increases, stigma and discrimination correspondingly increase. It follows that the poverty compounded with discrimination reduces the life span of the infected people. The same research has shown that in countries that have high racial tensions that relate to skin colour and other prejudices like tribe and religion are more likely to have increased cases of discrimination b tackle both the prejudice directed to members of their individual community as well as those directed to them because of their condition. It follows that, a person living in a racially charged society faces more discrimination and stigma. Different forms of stigma and discriminatory grounds have been established among people living with HIV/AIDS around the world. The most common of these identified by the Samson and Siam, (2011) include discrimination at workplace for various reasons like the fear of contagion, homophobia, violation of confidentiality rights of the individuals living with the disease among others. Some of these factors have been discussed in the subsequent sections of this paper for further insight. Heckman (2006) notes that stereotyping is the most common form of social discrimination practiced against people living with HIV and other diseases around the world. The most common stereotyping factors are; attitudinal based on ageing and sexuality of the individuals concerned. In this regard, society expects older members to behave in a manner that expresses their knowledge about the disease, since they are more experienced compared to their young counterparts. This is generally due to the fact that middle aged people are more knowledgeable and experienced about various diseases and illnesses that affect people in society (Heckman, et al., 2006). Heckman further avers that people believe that middle aged people should be more socially responsible and behave in a manner that does not lead them to contracting the disease as compared to the younger generation. In this regard, they are expected to provide a proper guideline on the best ways of living free from sexually transmitted infections. The younger generation is considered to be more sexually active in society given their age. The majority of people believe that the most common cause-factor for HIV/AIDS is based on having unprotected sex with infected partners. Given the societal avoidance based on the stereotype that they must have misbehaved and subsequently got infected with the virus, most of those infected with virus are shunned away. These beliefs are the major causative agents to the aspects of discrimination through stereotyping, experienced among members who are living with HIV/AIDS in various regions of the world (Millett, 2011).The condition of this group make them victims of separation that is related to discrimination because of the condition many HIV/AIDS patients have had to endure for a long period of time. Since most of the infected persons fear the wrath of the society, they prefer to be left alone. Whereas loneliness is, itself, not discrimination, it further compounds the problems of these people and that could hasten their death. Most individuals have already experienced loneliness as the most severe battle; they have to fight every time. Many are weak and unable to do most of the jobs that require strength or long working hours. As a result, they are often left at home, just to sit back and do nothing or just very little. During the time when many people are out for work in various destinations, HIV positive people feel the pain of staying home alone (Landau & York, 2004). The majority of mature men and women who are HIV positive feel alone, separate and isolated from the rest of their family and friends. These people prefer to wallow in their own misery alone rather than face a harsh society outside (Lowther, 2012). Many publications have revealed findings that are consistent with above theme. The bottom line is that loneliness is brought about by the fear of those infected to mingle with the rest of the society because of the societal preconception or their own fear; like of the society, these people harbour the societal serotype before and after contracting HIV .For instance, Wyrod, (2013) highlights a large number of males living with HIV/AIDS have to undergo more severe loneliness and sometimes even alienation from the other members of their own societies. A growing body of literature has focused on this fact highlighting various issues relating to cases of alienation and loneliness that many middle aged individuals undergo around the globe (AVERT, 2014) and (Earnshaw and Kalichman, 1999). The HIV patients interviewed by Atchley&Barusch, (2004) 86% said that the most common form of discrimination that they are afraid to interact with the rest of the society and would rather be alone in the house. In this case the loneliness itself is not discrimination but an outcome of inability to interact with the rest of the society. As a result of self -discrimination and stereotype some of the victims indicated the fear of dying alone and that nobody understands their condition. Fear of falling ill while alone formed the bulk of fear factors that the majority of the people have had to contest with. Stigmatisation of individuals living with HIV/AIDS around the globe today is among the various factors which are considered as the most recognisable challenges facing the field of nursing care Drisko (2004) contends that, it has become very difficult to offer appropriate care to people living with HIV/AIDS due to the many cases of stigma either self-inflicted (implicit stigma) or forced on them by other people (explicit stigma). As a result the number of people stigmatised has been escalating at a higher rate than before. Statistics show that one out of five middle aged men and women living with the disease are stigmatised in various ways. Out of these, about 6% of them indicated signs that can be rated as high levels of severity {SHIVA, 2013). While it is true that these people suffer from a wide range of stigmatisation closely linked to their conditions, we can argue that these conditions are often exacerbated by the social gradation of society at large in which they live. These stem from the misconception and exaggeration of their status by society based on stereotyped information and assumptions from various sources. As Churcher, (2013) observed, severe stigmatising reactions towards individuals living with HIV/AIDS occurs in many countries and nations across the globe (DH, 2011). Stigma is real and has highly devastating consequences to the affected patients. It is common that individuals living with HIV/AIDS say: "people with HIV/AIDS are bad and so I am bad too"(Doyal&Doyal, 2013). Implicit and explicit stigma In order to fully understand the concept of stigma among middle aged people living with HIV/AIDS in different parts of the world, it is important to explore this subject by addressing the two forms of stigma mentioned earlier in this text (implicit and explicit stigma) and how they affect the individuals living with HIV/AIDS. Implicit stigmatic conditions arise as a result to middle aged people living with HIV/AIDS looking down upon themselves based on the observations and reactions of people surrounding them. This makes these people feel unwanted and unfit in society, thereby isolating them from the rest of the population. Implicit stigma is self-inflicted and has a lot of negative impacts on individuals living with HIV/AIDS. It is true that any form of healthcare service requires the care provider and the people undergoing the treatment process to co-operate with each other so that the entire procedure is successful. The patient has to open up to his or her relevant nurse by expressing their conditions, as they change with time. This will allow the medical practitioner to administer the right care for the various stages of illness (Streeting, 2011) Implicit stigmatic conditions on individuals living with HIV/AIDS makes the expression of their health conditions very difficult to observe as patients tend to behave in a manner that does not actually reflect their current condition. This makes it rather difficult for healthcare professionals to provide the best care for these individuals. Explicit stigmatising is a form of stigma which comes from the general public and is more oriented to the various misconceptions and stereotypical beliefs that people hold about individuals living with HIV/AIDS. It is very true that middle aged people living with HIV/AIDS can develop mental illnesses. They are often alienated by the general public based on these ideas. In many occasions stigmatised individuals face a lot of discrimination from the public. Chalk, (2014) in his article titled, "HIV and stigma: the media challenge", indicates that this alienation makes them loose their self-esteem as a result of their acceptance in society. This is what actually contributes to self-stigma and is what makes the administration of care to the patients quite difficult and thus leading to deterioration of their mental conditions in most cases. Society needs more education and training on how to help patients living with HIV/AIDS to provide better care by improving their self-worth rather than reacting negatively towards them. Self-stigma inflicts both negative attitudes on individuals living with HIV/AIDS towards themselves as well as a low self-esteem. Stereotypical and judgmental terms such as "weird" and "people with infectious disease" are still used to refer to patients living with HIV/AIDS by many people. This happens more in multiethnic regions where people living with HIV/AIDS are segregated away from those without HIV/AIDS for the fear of contracting the disease from them or just phobia (Barnett and Whiteside, 2006). Stigmatisation characteristics have spread to the workplaces where some people with HIV work. The Department of Health, (2005) notes, people who knew and related with these people before contracting the disease, sometimes desert these individuals making them feel lonely and abandoned in their places of work. Statistics show that 61% of people living with HIV are out of the job market (OECD, 2014). This is almost equal in number to the other category of those with depression, in most cases, considered to be unable to work; those with major depression comprise about 40% to 60% (Drisko, 2004). The 20 to 35 % of HIV/AIDS positive patients are having anxiety disorders and are as well jobless, according to a study by Reynolds, (2006). The 80 to 90 % of HIV patients are also noted to be suffering from schizophrenia and are also out of the job market as stipulated by the study (BHIVA, 2010) and (Expert Advisory Group on AIDS, 2010). The absence of a stable job for HIV patients makes it very difficult for them to afford proper lifestyles due to insufficient funds available. This overly interferes with their care provision mechanisms further deteriorating their conditions (Atchley&Barusch, 2004). A survey which was conducted in the United States in 2006 showed that more than 50 percent of employers are willing to employ individuals living with HIWAIDS. A quarter of employers that were interviewed during this survey responded that they would dismiss from work any employee who fails to disclose his or her health conditions (NAT, 2014). Atchley and Barusch, (2004) notes that such kind of sigma may often result in the individuals concluding that they are potentially unemployable, revoking the feeling of self-inferiority among these individuals (this is the onset of implicit stigmatisation which has been addressed prior in this text). Among the few individuals living with HIV/AIDS who were lucky to have been in employment, they were given positions which were not adequate to their skills set and qualifications, paying less money than employees with similar jobs. Only 10% of these patients in work were found to be attending counselling sessions with healthcare professionals to help alleviate and properly manage their conditions. These were done without the knowledge of the rest of employees in the workplace, not even management were aware of the disclosure of their status. Approximately 90% of HIV patients in the job market fear attending counselling sessions with experts as this can disclose their HIV status being known to other employees (UNAIDS, 2014) The end result of this is the deterioration of the health condition of the individuals in question. It is based on these grounds that Department of Health, (2011) notes, patients living with HIV/AIDS should be given proper attention in relation to economic stability to help them afford proper care. This offers the first step to solving their mental problems and alleviating their conditions. Despite the attempts made by various medical institutions and research bodies to help alleviate the conditions of middle aged people living with HIV, people continue to live under the influence of periodic illnesses that limits their ability, living and interacting fully in society. Today, HIV infections are an emerging issue in all socioeconomic spheres, including higher income communities, middle income groups as well as the lowest income groups in the communities around world. Attempts have been made and are being made by various humanitarian research bodies to find out relevant means of helping affected people wing with HIV to recuperate their living conditions despite the challenges that are compounded with subjection to stigma and discrimination (Soumyadeep, 2012) However, Bourne et al (2012) recorded that such attempts have been met with various obstacles including physical health factors (comorbidities, HIV related symptoms, mortality and survival as well as other opportunistic infections such as Tuberculosis), poor mental state (including neurocognitive impairments, psychological distractions), effects on effective social participation (lack of social support, stigma and disclosure of private conditions). In addition to the above mentioned factors, Fidler, (2013) adds that other health hurdles that are continuously being met by service providers are related to the provision of antiretroviral therapies (adherence to the antiretroviral drugs response and seeking alternative treatments) problems with health care services (health care access and hospitalisation) and risks in sexual health (including sexual risk behaviours, sexuality and problems related to sexually transmitted infections). Attempts are being made by various agencies concerned to try and alleviate the conditions of people living with HIV in regard to the factors discussed above. The aspects of discrimination, stigma and the influence of psychotic disorders are among the key factors that many people living with HIV/AIDS have to contend with. These are discussed in the subsequent sections of the paper. Research has indicated that over 50% of the people living with HIV develop HIV infections that are related to neurocognitive impairments as well as mental disorders (NICE, 2011). This is mainly associated with the feeling that ones death is definite after a given period of time the adverse effect of that state of paranoia is worsened if a person does not have close friends and family to encourage them. Therefore any real or perceived discrimination and stigma that this group may have worsens that condition (Churcher,2013) However, the introduction of antiretroviral therapies has elongated the lifespan of the patients with HIV. However, the drugs alone are not sufficient in themselves with regard to preventing neurocognitive impairments among those with asymptomatic neuropsychological impairments, as well as HIV linked neurocognitive disorders these people need to feel loved and adored within the society and that cannot come about if they feel stigmatised or discriminated against because of their condition. Research has demonstrated that affection towards sick people helps them recover quicker; the same would apply to victims of HIV and AIDS. Intensive research is being undertaken in the context of ageing and work due to the fact that the mind can considerably affect peoples ability to work and engage in social activities, inhibition of their response to medication, as well as affecting their daily living conditions. This means that if a person’s mind has negative energies, which would impact on their day to day activities. In this light victims of HIV and AIDS are highly likely to be affected because if the preconceived idea that people do not like them. This happens whether or not the discrimination and stigmatization are actually real or just perceived (NAT, 2014). According to Carter, (2010), cognitive functioning is closely associated with a host of medical and psychotic factors among them; demographic characteristics, severity levels of HIV infections, issues relating to substance abuse. York, (2004) established the association between the aspects of ageing and HIV infection on the neurocognitive status by relating these to the everyday functioning capabilities between young people infected with the disease and middle aged people. The results were then compared with those without the disease to establish a clear picture of the functional differences at all stages. The findings indicated that people over 50 years old in employment consistently performed poorly in their respective areas of specialisation. Out of the ten neuropsychological and functioning tests conducted in the inquiry, the middle aged patients living with HIV performed poorly in eight to nine of them. Various participants in such inquiries have cited difficulties working in highly competitive situations and relating to their individual workmates an integral hindrance to their performance. The significance of the findings above relate to fact that discrimination and stigmatization could lead to psychological and mentally challenge that could either force victims to engage in substances such as drugs. In turn, that would worsen their ability or relate with other member of the society as well as hinder their normal operations (Roxby, 2013) An increasing number of publications are being produced to focus on the various coping strategies adopted by different people infected with the disease and the challenges to live with the virus. The main factors of concern in relation to these factors is to try and establish ways of minimising negative impacts of the disease to their conditions under three basic categories: disease coping, practical coping, and emotional coping mechanisms. With regard to emotional coping, it has been delineated that provision of adequate education on the effects and occurrence of HIV among the middle aged patients helps in alleviating their conditions and promoting their wellbeing. This is because they are equipped with the necessary skills and knowledge on how to effectively manage their conditions by accepting it and moving on with it (Macallan, 2013). However, even as focus shifts in encouraging the victims to accept the conditions and move on, the rest of the society has a role to play; those who surround the victims should make them feel comfortable devoid of any forms of discrimination and stigma In essence, education is found to play a very important key role in raising awareness on the status of the matter and improving the quality of life for the various individuals infected and affected by the disease. Alldis (2009), notes that education raises both practical and emotional coping mechanisms. The emphasis should be to educate both the patients and the immediate community. Once the community learns to live with these people without subjecting them to any kind of discrimination, they are likely to integrate well and go on their daily affairs without any fear of stigma of discrimination. Stigma and discrimination of middle aged people living with HIV in society is not a new area of study. Various kinds of discrimination and forms of stigma have been noted by different individuals around the globe. On many occasions, HIV/AIDS has been associated with younger members of the society given the fact that they are the ones considered to be more sexually active by the society in which they live. It is, therefore, unusual to finding mature people infected with a "young peoples disease-HIV". Coupled with the fact that HIV is mainly associated with the primary cause of having unprotected sex with infected partners, middle aged patients are expected to be more aware of the risks and these aspects, since they are considered socially responsible members of society (Millett,2011) As a result, different manifestations of stigma and discrimination have been identified towards middle aged people living with HIV/AIDS. Attempts have been made to help these people cope with their situations amidst the challenges they face. 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