Social aspects & Vulnerability

of HIV/AIDS

By Emily Muchina
Emily Muchina 8th October 2018
 Role Substance Abuse In The Rapid
Spread Of HIV/AIDs

Emily Muchina 8th October 2018

 Role Of Alcohol & Substance Abuse In The Rapid Spread Of
HIV/AIDs
• Alcohol consumption has both direct and indirect consequences. Direct
consequences relate to alcohol’s effect on one’s body, both physically and
mentally.
• Indirect consequences include behavioral changes arising from the impaired
physical and mental state. The result is the inability to make rational decisions,
leading one to take risks that one is less likely to take when sober.
• HIV infection is substantially associated with the use of contaminated or used
needles to inject drugs such as heroin.

Emily Muchina 8th October 2018

 Role Of Substance Abuse In The Spread Of HIV/AIDs

• Early initiation of sexual activity. Under-age drinkers are at particularly high

risk because they are more likely to be sexually active at an earlier age, to
have sexual intercourse more often and to lack the skill to negotiate safe sex
especially where older partners are involved.
• Impairs one’s judgment and lowers inhibitions, putting one at risk of serious
health and social consequences.
• May engage in risky sexual behaviors (e.g., unprotected sex; sharing of sex
toys; multiple sexual partners, sexual assault including by intimate partners,
handling body fluids and body waste;) for the purpose of obtaining substances,
money while under the influence of substances, or while under coercion.
Emily Muchina 8th October 2018
 Role Of Substance Abuse In The Spread Of
HIV/AIDs
• The risk of becoming a victim of sexual assault increases when one is
under the influence of substances.
•  Sex with high-risk partners (e.g., injection drug users, prostitutes), and
sex with infected partners

Emily Muchina 8th October 2018

 Role Of Alcohol & Substance Abuse In The
Rapid Spread Of HIV/AIDs
• Substance abuse can also make the effects of HIV worse for people who
already have HIV.
• Being less responsive to HIV prevention programs
• Makes it difficult to follow HIV treatment plan (non-adherence to
treatment).
• Alcohol abuse can contribute to health conditions such as liver disease
that have an impact on the progression of HIV infection.

Emily Muchina 8th October 2018

 Role Of Alcohol & Substance Abuse In The
Rapid Spread Of HIV/AIDs
• Placing the client in substance abuse treatment along a continuum of care
and treatment helps minimize continued risky substance-abusing
practices.
• Reducing a client's involvement in substance-abusing practices reduces
the probability of infection

Emily Muchina 8th October 2018

Socio-Cultural Factors Influencing
Vulnerability to HIV

Emily Muchina 8th October 2018

 Marriage:

• Gender inequality in marital relations, especially in sexual decision-making,

increases vulnerability to HIV transmission.
• Marriage, which greatly increases women’s sexual exposure, has in itself become
a risk factor for women and girls in many countries, for example it is more
dangerous for a woman to getting married to a polygamous husband in the name
of inheritance or culture.
• The dramatic rise in the frequency of unprotected sex after marriage is driven by
the implications of infidelity or distrust associated with certain forms of
contraception such as condoms, a strong desire to become pregnant, and an
imbalance in gender power relations.
• Infidelity and unfaithfulness in monogamous marriages.
Emily Muchina 8th October 2018
 Polygamy:
• Polygamy operates to create concurrent sexual networks within marriage
between multiple wives and their husband, and in addition to any extra-
marital sexual contacts the spouse may have.
• For example In luo community, polygamy is widely accepted with no
room to HIV testing and condom use before picking on a new wife.

Emily Muchina 8th October 2018

 Early Marriage:
• Young girls have softer vaginal membranes which are more prone to tear,
especially on coercion, making them susceptible to HIV and other STIs.
• Older husbands are more likely to be sexually experienced and HIV
infected.

Emily Muchina 8th October 2018

 Multiple Sexual Partners:
• Gender inequality and patriarchy (social structures where men take
primary responsibility and dominate in their households) encourage
multiple sexual partners for men inside and outside of marriage, while
women are required to be faithful and monogamous.

Emily Muchina 8th October 2018

 Gender-based Violence:
• Violence has many facets.
• Within the household this can include battering by an intimate partner, marital
rape, dowry-related violence, and sexual abuse.
• Violence outside the home can include rape, sexual abuse, sexual harassment
and assault.
• Various social, cultural, and religious norms produce and reinforce gender
inequality and the stereotypical gender roles that underpin gender-based
violence.
Emily Muchina 8th October 2018
 Harmful Cultural and Traditional
Practices:
• Harmful cultural practices such as;
• widowhood-related rituals,
• sexual cleansing and
• female genital cutting heighten the risk of HIV transmission.

Emily Muchina 8th October 2018

 Stigma and Taboos:
• Cultural stigma and taboos (social bans), especially related to sex and
sexual activities, increase men’s and women’s vulnerability to HIV.
• The taboos associated with sex and knowledge of sex act as barriers to
seeking knowledge of HIV prevention and to providing the treatment care
and support needed by those infected and affected by HIV.

Emily Muchina 8th October 2018

 Religion:
• The majority of religiously tailored belief systems condemn premarital sex,
contraception including condom use, and homosexuality.
• Catholic church in Kenya for example it does not encourage condom use among
its congregation and up to now. This pose a serious challenge to preventing the
spread of HIV in the communities where they operate.
• Some religions also advocate a submissive role for women, foster gender
inequality in marital relations, and promote women’s ignorance in sexual matters
as a symbol of purity.

Emily Muchina 8th October 2018

 Religion:
• The sexuality and gender stereotypes constructed by religion can inhibit
prevention efforts and increase vulnerability to HIV infection.
• Denunciation of HIV infection as sinful, play a significant role in
generating HIV- and AIDS-related stigma which increases vulnerability.
• Religion pray for faith healing thus some become stop or default taking
ART treatment.
• Religion denounce homosexuality which tend to fuel stigma against those
who engage in same sex behavior, thus indirectly increasing their
vulnerability to HIV
Emily Muchina 8th October 2018
 HIV/AIDS-related Stigma and
discrimination

Emily Muchina 8th October 2018

 HIV-related stigma and discrimination
• HIV-related stigma and discrimination exist worldwide, although they
manifest themselves differently across countries, communities, religious
groups and individuals.
• People often exhibit contradictory beliefs or behaviors. For example;
 A person who is opposed to stigmatization or discrimination may
simultaneously belief that PLWHA indulged in immoral behaviors, deserve
what they get, or are being punished by God for their sins
 A person who claims to know that HIV cannot be transmitted through casual
contact may still refuse to buy food from a vendor who is HIV-infected or
allow his family to use utensils once used by PLWHA.
Emily Muchina 8th October 2018
 HIV-related stigma and discrimination
• Stigma refers to unfavourable attitudes and beliefs directed toward
someone or something
• Stigmatization reflects an attitude
• HIV/AIDS-related Stigma refers to all unfavorable attitudes and beliefs
directed towards people living with HIV/AIDS (PLWHA) or those
perceived to be infected, and towards their loved ones, close associates,
social groups and communities.

Emily Muchina 8th October 2018

 HIV-related stigma and discrimination
• Discrimination is the treatment of an individual or group with partiality
or prejudice.
• Discrimination is an act or behavior
• Unfair and unjust treatment of an individual based on the basis of the:
 real or perceived status or attribute (e.g. medical condition)
 belonging, or being perceived to belong, to a particular group
• Discrimination is often defined in terms of human right and entitlements
in various spheres, including health care, employment, the legal system,
social welfare and reproductive and family life. Stigmatized individual
Emily Muchina 8th October 2018
may suffer discrimination and human right violations
 Why stigma around HIV and AIDS
• The fear surrounding the emerging HIV epidemic in the 1980s
persists today. This fear, coupled with many other reasons, means
that lots of people believe:
• HIV and AIDS are life-threatening conditions associated with death
• HIV is associated with behaviors that people disapprove of (like
homosexuality, drug use, sex work or infidelity) Key affected
populations are groups of people who are disproportionately affected
by HIV and AIDS, such as men who have sex with men, people who
inject drugs and sex workers.
Emily Muchina 8th October 2018
 Why stigma around HIV and AIDS
• HIV is only transmitted through sex, which is considered a taboo subject
in most cultures
• HIV infection is the result of personal irresponsibility being infected with
HIV is the result of moral fault (such as infidelity or 'deviant sex') that
deserves to be punished
• Inaccurate information about how HIV is transmitted, creating irrational
behaviour and misperceptions of personal risk.1

Emily Muchina 8th October 2018

 Effects of stigma and discrimination on
people’s life’s
• Physical and social isolation
• Loss of relationships
• Gossip & Verbal Abuse
• Loss of livelihood
• Loss of housing

Emily Muchina 8th October 2018

 Effects of stigma and discrimination on
people’s life’s
• Rejection by peers
• Loss of reputation
• Violence
• Denial or sub-standard health care
• Internalized stigma

Emily Muchina 8th October 2018

 Effects of stigma and discrimination on HIV
prevention, control and management
• An unwillingness to take an HIV test means that more people are
diagnosed late, when the virus may have already progressed to AIDS. This
makes treatment less effective, increasing the likelihood of transmitting
HIV to others, and causing early death.
• Fear of stigma and discrimination as the main reason why people are
reluctant to get tested,
• Disclose their HIV status and
• Take antiretroviral drugs.
Emily Muchina 8th October 2018
 Effects of stigma and discrimination on HIV prevention,
control and management
• Discourages women from accessing antenatal care(ANC) services
• Prevent people from receiving HIV testing and , as a result, PMTCT services
• Discourages women from discussing their HIV status & disclosing results to
their partner(s)
• Discouraging women from accepting PMTCT interventions e.g., HAART
therapy & prophylaxis for opportunistic infections
• Discourages the use of recommended PMTCT safer infant- feeding practices
• Confers secondary stigmatisation on the child
Emily Muchina 8th October 2018
 Human rights issues
• Freedom from discrimination is a fundamental human right
• Discrimination on the basis of HIV/AIDS status, actual or presumed, is
prohibited by existing human rights standards
• Discrimination against persons living with HIV/AIDS (PLWHA), or those
thought to be infected, is a clear human rights violation

Emily Muchina 8th October 2018

 Destigmatization
• This means to remove the stigma or the negative classification labeled on
the infected people such that they are not neglected; are not seen as very
bad or irresponsible; can freely talk about AIDs and create awareness.

Emily Muchina 8th October 2018

 Destigmatisation
VCT is a major strategy that is used in destigmatization;
• through counseling pre and post points are both an entry point
• to care and
• an opportunity to reinforce prevention messages and promote
affirmative/positive living

Emily Muchina 8th October 2018

 Destigmatization
• Community interaction and focus group discussions
involving people living with HIV and members of
populations vulnerable to HIV infection;
• Use of media, including advertising campaigns,
entertainment designed to educate as well as to amuse
and integration of non-stigmatizing messages into TV
and radio shows;

Emily Muchina 8th October 2018

 DESTIGMATIZATION
• Engagement with religious and community leaders, and
celebrities;„Inclusion of non-discrimination as part of
institutional and workplace policies in employment and
educational settings;
• Peer mobilization and support developed for and by people
living with HIV aimed at promoting health, well-being and
human rights
Emily Muchina 8th October 2018
 Conclusion

“Do not judge, or you too will be judged. For in the same
way you judge others, you will be judged, and with the
measure you use, it will be measured to you”.

Emily Muchina 8th October 2018

 Thank you

Emily Muchina 8th October 2018