Abstract #269  -  The impact of antiretrovirals on HIV stigmatisation in Northern Thailand
Authors:   Presenting Author:   Ms Julie Pannetier - UMR CEPED Paris Descartes-INED-IRD
Additional Authors:
Aim: HIV/AIDS is widely recognised as one of the most stigmatising diseases, resulting in negative impacts on the health and well being of People Living With HIV/AIDS (PLWHA). Thailand faces a generalized HIV epidemic, with most infections occurring through heterosexual transmission. The North is the most affected area (prevalence: 2.5%). The objective was to examine the impact of antiretroviral therapy (ART) on three dimensions of stigmatisation as they relate to : (1) perpetuating domination and exploitation (keeping people down); (2) ensuring norm enforcement (keeping people in); (3) and avoiding diseases (keeping people away; Phelan et al., 2008). For this paper, we assessed the impact of ART on disease avoidance.
Method / Issue: The forms and levels of stigmatisation were evaluated from both the PLWHA and the general population perspectives. Data were derived from a life event survey, LIWA (Living With Antiretrovirals-ANRS12141), carried out in 2007-2008 among all HIV-infected adults receiving ART in four community hospitals in northern Thailand (n=513). We performed a logistic regression analysis to assess the factors associated with stigmatization experienced by PLWHA. In addition, we analysed the attitudes towards PLWHA in a control group composed of randomly selected people in the general population of same age, sex and place of residence (n=500).
Results / Comments: general population of same age, sex and place of residence (n=500). Results: Quantitative analyses indicated a relatively low level of reported experiences of stigmatisation by PLWHA (35%). A low level of negative attitudes towards PLWHA (20%) was reported by the controls, although the majority of them linked HIV-infection with “bad behaviours” (63%). The level of proximity between the general population and HIV-infected people is high: 43% of the controls reported been “close”, i.e. family related or intimate friend, to someone infected and 38% having concretely taken care of a PLWHA. We observed that disclosure avoidance as coping strategy in case of anticipated stigma, was not an option for most of the patients because of the presence of visible HIV symptoms or a partner known to have died from AIDS, signaling their HIV status. Indeed, most PLWHA (80%) reported that people from their living area were aware of their infection. Experiences of stigmatisation were associated with a poorer health status before starting ART or the presence of lipodystrophy—mostly sunken cheeks, a visible side effect of ART recognised within the community—. Women, more involved in community activities, were more likely to report self-exclusion or to experience stigmatisation attitudes than men. In the general population, fear of contagion remained perceptible, expressed by the avoidance of HIV-infected people “recognizable” through their physical appearance.
Discussion: In Thailand, the wide access to ART under the universal health coverage may partly explain the low level of HIV stigmatization as it relates to “disease avoidance” . Physical appearance of the patients was the main determinant of stigmatization. Therefore, ART, allowing the recovery of a healthy physical appearance, clearly reduces stigmatisation. However, this positive effect is jeopardized by the development of lipodystrophies. Early access to HIV testing and treatment, and careful management of ART visible side effects should further decrease the level of stigmatization.
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