Manifestations of Discrimination Related to HIV/AIDS

Up to 126 children die before their first birthday. Children who survive, not only in Mali but also in most African countries and other poor countries in Asia and Latin America, are at risk of severe malnutrition compared to children in rich countries (IMF, 2006).

Discrimination and Stigma are two concepts that always go together, and there are similarities and differences between them.

Discrimination is an attitude of disrespect towards a person or thing. Discrimination is the behavior of an individual or group towards another person or group in a prejudiced manner. Discrimination is often defined in terms of “human rights” and other rights, including rights in the areas of health care, employment, the legal system, social welfare and family life.

Thus, social stigma is expressed in terms of attitudes, while discrimination is expressed through actions or behaviors. Discrimination is a way of expressing discriminatory ideas, whether intentional or unintentional. Social stigma and discrimination are two related concepts. Individuals who are stigmatized may experience discrimination and violence related to human rights. Discriminatory ideas can cause a person to act in a way that denies access to services or benefits to others.

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Stigma and discrimination can manifest at the individual, family, friends, community, and health care provider levels or at the government level.

Stigma and discrimination often occur against vulnerable groups based on gender (male chauvinism), age (old people are easily discriminated against in modern families), economic status (stigma and discrimination against the poor), occupation (stigma and discrimination against manual workers), health status (stigma and discrimination against people with illnesses, disabilities, etc.).

In the health sector, social stigma and discrimination often occur against people with infectious and incurable diseases such as tuberculosis, syphilis, leprosy, etc. However, stigma related to HIV/AIDS is the most obvious and powerful.

HIV/AIDS stigma is a disrespectful attitude towards others due to suspicion or assertion of their HIV status.

Today, HIV/AIDS is not only the greatest health challenge but also the greatest human rights challenge. People living with HIV/AIDS bear the burden of social stigma and discrimination. Fear of HIV/AIDS leads to stigma and discrimination, which in turn hinders HIV prevention and the provision of treatment, care and support services to people living with HIV and their families. HIV/AIDS-related stigma is increasingly seen as the greatest challenge to efforts to reduce the spread of the epidemic at the community, national and global levels.

Stigma is often directed not only at people living with HIV but also at behaviours believed to lead to HIV infection. A person living with HIV is often

Other people or groups/communities attribute the cause of the disease to prostitution or drug injection.

People considered to be on the margins of society, such as the poor, homosexuals, people who inject drugs, and sex workers, often bear the brunt of HIV/AIDS-related stigma. People living with HIV are often labeled as belonging to these groups, even though they may or may not be members of these groups.

2.1.7.4. Manifestations of discrimination related to HIV/AIDS

Family and community level: Physical isolation/stay away from people with HIV at home (e.g., separate living arrangements); or reluctance to make contact (e.g., ignoring, reluctant to shake hands, not wanting to talk, etc.); limiting access to spouses, children, and relatives of people with HIV/AIDS; limiting sharing/combining daily household utensils, toilets, dining rooms, etc.; limiting opportunities to go to public places, entertainment, sports, etc.; denying/rejecting the wish to have a funeral according to normal rituals (usually cremation).

At the health care service level: Reluctance to interact with people with HIV/AIDS, treatment delays, slow service (e.g., long wait times, repeated appointments and treatments); refusal to admit patients for care/treatment; transferring patients between doctors/hospitals; delaying or refusing surgery; requiring HIV testing before surgery and during pregnancy; early discharge; refusal of treatment despite having insurance.

At work: Reluctantly communicating with people with HIV/AIDS; requiring HIV testing during the recruitment and employment process; requiring people with HIV/AIDS to change jobs without any valid reason; forcing them to write a resignation letter.

2.1.7.5. The impact of stigma and discrimination on health

Stigma and discrimination limit individuals’ access to health care and other services, thereby increasing the risk of transmitting disease to others. In many cases, people who need information, education and advice will not benefit from these services even though they are available.

Stigma and discrimination lead to social isolation. People who are stigmatized and discriminated against will be isolated, looked down upon, despised and separated from their families, communities and society.

Stigma and discrimination limit social inclusion and social support for individuals.

Stigma and discrimination lead individuals to engage in risky behaviors such as: people suspected of having HIV will be afraid of being discriminated against and stigmatized so they avoid getting tested or people diagnosed with HIV/AIDS will be afraid and avoid going to the hospital for treatment; people with HIV/AIDS do not tell their sexual partners, spouses or injection partners about their health status.

Unequal wealth, unequal opportunities AIDS orphans in South Africa whose parents died of AIDS, after one or both parents died, they had to fend for themselves with extreme exhaustion, severe humiliation, and expensive medical treatment, the situation of these children is worrying. The United Nations Children's Fund (UNICEF) said that in 2003 there were about 12.3 million AIDS orphans. From 2005 to 2010 there were about 8 million AIDS orphans. In 2016 there were about 1.5 million AIDS orphans in South Africa.

An entire generation of South Africans will grow up being raised by grandparents or other family members, who are themselves at high risk of malnutrition, abuse and disease. Worst of all, they will grow up in circumstances where their basic rights to food, clothing, housing and care are often not guaranteed.

Education From an educational perspective, it makes sense to keep children in school, even if it is just to equip them with the skills they need to escape poverty. Being in school is important. It allows children to integrate into the norms and customs of society, giving them the confidence and capacity to participate more fully in society. Without such integration, children are vulnerable and easily exploited through being forced into joining street gangs, criminal networks or armed groups.

Avoiding infection The most urgent priority is to ensure that children orphaned by parents with HIV/AIDS do not become infected themselves. However, children orphaned by parents with HIV/AIDS are at risk, because of the fear of HIV/AIDS, people often think that the children of those who died of AIDS must have the disease, so they try to avoid, humiliate or exploit them. Some children orphaned by parents with AIDS are not even allowed to go to school or health stations, because people are afraid of their presence.

The plight of AIDS orphans shows how the vicious cycle of stigma can be perpetuated, and how social isolation or exclusion (especially at a young age) can prevent the accumulation of assets and limit the ability to maintain participation in networks to escape poverty.

Culture There are many definitions of culture and its components. Culture is the set of understandings, beliefs and behaviors among certain social groups, through the process of learning and transmission from one generation to the next. Culture is the set of values, attitudes and behaviors of particular social groups. This definition emphasizes the cultural specificity of different social groups. The components of culture include:

• Values: What is considered important, necessary, desirable, pursued and sought after by society. Values often become the goals of behavior and activities that people seek to achieve.

• Norms: These are the standards and regulations that society uses to evaluate, judge and regulate the behavior and activities of members in society. Cultural norms have the function of encouraging and forcing behavior in the sense that if done correctly, it is considered "normal" and praiseworthy, but if done wrong or violated, depending on the severity, it will be punished.

It is necessary to distinguish between "unwritten" standards in the form of teachings and implicit regulations that are not recorded in writing and "written" standards recorded in laws and legal documents that are recognized and enforced by the social community.

Customs, habits, language, ideology, ethics, religion, science, art, etc. are all components of the structure of culture. Importantly, from the sociological perspective, health always contains factors that have a clear impact on health behavior through the concept of health, about health care and protection, and ways to prevent disease. Therefore, one of the tasks of health sociology is to study the characteristics and nature of the relationship between culture and health, emphasizing the direction of impact from culture to health.

Culture and Health Culture plays an important role in defining health and illness: Health and illness are culturally based. This means that not all regions and parts of the world have the same definition of what is considered sick and what is considered healthy. Health and illness are not as absolute as we think. Around the world, each culture provides/equips with normative guidelines/values, through which members of that culture use/apply to determine whether they are sick or not.

Cultural differences are reflected in the behavior of social groups and all influence health beliefs, perceptions and behaviors as well as the way health services are used by the health system. The issue is not only how individuals understand health and illness, but also how the perceptions, attitudes and behaviors of society crystallized in culture always impact in certain ways on individual health and community health.

Health is a social phenomenon, with social causes, originating from the lifestyle, activities, thoughts, and feelings of each individual in society. Individuals' perceptions, attitudes, and behaviors always have certain impacts on their health.

Factors influencing health include biological factors (such as genes, age, gender, etc.), behavioral/lifestyle factors, and social factors (poverty, inequality, stigma and discrimination, culture, etc.). These factors all have different levels of impact on health, and evidence is still needed to show the impact of factors or groups of factors on health.

However, social conditions such as social structures have an impact on health and disease. These impacts are not indirect but are the underlying causes of health problems. These conditions are interrelated in the process of affecting health. For example, through many studies, it has been shown that poverty is the cause of many diseases (poor countries often have higher rates of disease and death than rich countries). Poverty is at risk of leading to inequality and discrimination because the poor are one of the groups that are more vulnerable and are more stigmatized and discriminated against than the rich. In addition, cultural factors are a "lens"

reflects stigma and discrimination in society. Sociocultural factors influence not only the health choices of individuals, but also the availability and distribution of these choices among social groups.

2.1.7.6. Social determinants of health

The analysis of social determinants of health is based on the important premise that if everyone had the same health status (or even the same disease status), then social factors would not be mentioned as factors affecting health. However, in reality, health and disease vary and differ from person to person, from social group to social group, and from population to population.

As mentioned in the sociological approach to health, social factors influencing health are considered as conditions that lead to changes in the health status of an individual or a social group. These conditions are external to the individual, determine the behavior of the individual or social group, contributing to increasing or decreasing the health status of that individual or social group.

The identification of social determinants of health has attracted the attention of many researchers in the health field. However, the list of social determinants of health is quite extensive, without complete consensus. This is understandable due to the diversity and complexity of social relationships as well as the differences in space and time in which research is conducted. For example, the report of the Toronto Department of Health (1991) mentioned risks such as poverty, low social status, social isolation and dangerous working conditions, and polluted environment. The WHO report on social determinants of health identified 10 important factors, including: social inequality, stress, childhood, social isolation, employment, unemployment, social support, drug addiction, food, and transportation.

However, all views agree: social factors affecting health are social factors outside the individual, affecting the health of the individual or group and to some extent these social factors can be changed.

Describes the social conditions that directly influence risk factors (e.g., poverty, lack of social support) and that immediately lead to risk behaviors (e.g., tobacco use, alcohol abuse). Risk conditions and risk behaviors increase physical and psychosocial risk factors, which in turn lead to many preventable health problems and deaths. Social groups are affected by risk conditions, and risk behaviors that lead to poor health outcomes. For example, unemployed people are a social group that is more likely to live in poor conditions and be socially marginalized than other social groups. This makes unemployed people more likely to engage in

risky behaviors such as drug addiction. Therefore, they are at high risk of disease and premature death. Risky social conditions, risky behaviors and risk factors tend to be integrated, linked, closely related to each other and have different levels of impact on different social groups.

Social inequality

In a society, lower social status groups tend to have lower life expectancy. Health policy needs to focus on addressing the economic and social determinants of health.

The economic and social circumstances of poverty affect health throughout a person’s life. People in the lowest social classes are twice as likely to suffer ill health and die prematurely as those in the highest social classes. Health inequalities occur across society, so that people in the middle class are also more likely to suffer ill health and die prematurely than those in the highest social classes.

Research in England and Wales (1997–1999) showed that there were differences in life expectancy between different occupational groups. These differences were caused by physical and psychological factors, which played an important role in influencing the majority of illnesses and deaths. These factors could include: having no assets, not having an education in childhood, working in unsafe conditions, living in poor housing conditions...

Policy recommendations:

Life spans are marked by many transitions: the emotional and material changes of childhood, the transition from primary to secondary education, the entry into the workforce, moving out of the home, changing jobs and facing the risk of job loss, and finally retirement. Each of these changes can create favorable or unfavorable circumstances that affect people’s health. Those who have experienced unfavorable conditions in the past are often at the highest risk of health problems in subsequent stages. Welfare policies therefore provide not only safety nets but also support to compensate for the disadvantages individuals experienced in earlier stages.

Good health is associated with lower rates of illiteracy and unemployment, increased security and improved housing quality. People who have a good social role in economic, cultural and social life tend to have better health than those who face unsafe conditions, social isolation and deprivation.

Stress

Stressful situations make people feel depressed, anxious and unable to cope with stress. Stress affects health and can lead to death.

Psychological and social circumstances can cause stress over a long period of time. Persistent anxiety, feelings of insecurity, feelings of being unappreciated, social isolation and lack of control over work and family life have a profound impact on the health of individuals. Psychological risks accumulate over a lifetime and increase the risk of mental ill health and mortality. Prolonged feelings of anxiety and lack of support can be destructive to an individual’s life.

Why do psychological factors affect physical health? In emergencies, the hormonal and nervous systems respond to physical threats by producing responses such as increased heart rate, mobilization of energy reserves, blood flow to the muscles, and heightened sensations. Both the cardiovascular and immune systems are affected. This effect is not serious if the stress does not occur frequently, but if it occurs frequently, people are susceptible to the risk of infection, diabetes, high blood pressure, heart attack, stroke, depression, or aggression.

Policy suggestions:

Although clinical interventions targeting the biological changes that occur as a result of stress can achieve some results, a focus on macro-level factors is needed to mitigate the major causes of chronic stress.

The quality of the social environment and the physical and natural environment at school, work, etc. are always important factors affecting health. Organizations that make members feel that they belong, participate in common activities and feel valued always make members healthier than those in places where people feel isolated, ignored, exploited and taken advantage of.

Governments need to recognise that the social welfare system needs to focus on meeting both material and psychological needs. Governments need to support families with young children, encourage community activities, reduce social isolation, enhance financial and physical security, and improve stress coping skills through education and rehabilitation.

Childhood

Research and intervention programs show that the foundation for adult health depends on the early childhood and prenatal stages. Children who are slow to grow and lack emotional care are at increased risk for physical health and reduced cognitive abilities in adulthood.

During pregnancy, unfavorable living conditions will affect the development of the fetus due to malnutrition, maternal stress, alcohol and tobacco abuse, drug addiction, lack of exercise and prenatal care. The development of the fetus in such conditions will cause health risks throughout the child's future life.

Policy suggestions:

The health risks that children face during their development are greater among children living in socio-economically disadvantaged settings, and these risks can be effectively reduced through prenatal, intra-natal and postnatal care; school health benefits; and improved parent and child education. Such health and education programmes will have direct benefits by increasing parents’ awareness of their children’s needs and their ability to access information about health and development. Policies to improve primary health outcomes should focus on the following:

• Improve general education levels and create equal access to education to improve the health of mothers and children in the long term;

• Provide good nutrition, health education, preventive facilities and economic and social resources during pre-pregnancy, throughout pregnancy and after birth, to improve fetal growth and development and reduce the risks of disease and malnutrition in young children;

• Ensure that a strong parent-child relationship is established. This relationship does not only take place at home. It is also a strong relationship between parents and schools, to increase parents' knowledge of their children's cognitive and emotional needs, to encourage their children's cognitive and social development, and to prevent child abuse.

Social isolation

Poverty and social isolation have serious impacts on health and mortality. The risk of living in poverty tends to be higher for certain social groups.

Absolute poverty – the inability to meet the basic needs of life – persists even in Europe’s richest countries. Social groups such as the unemployed, ethnic minorities, migrant workers, disabled people, refugees and the homeless are most at risk of falling into absolute poverty. Relative poverty refers to people who are poorer economically than the majority of people in society.

Poor people have limited access to housing, education, transportation and social participation. They are excluded from society and treated unfairly, leading to poor health and increased risk of death. The stresses of living in poverty affect health throughout the lifespan from conception, infancy and old age. In many countries, about a quarter of the population and a higher proportion of children live in absolute poverty.

Social isolation leads to racism, discrimination, stigma, hostility and unemployment. Such living conditions lead to limited participation in education and training, services and public activities. They suffer losses

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