Conceptual Framework

Stigma and discrimination created an undermining effect to the People

Living with HIV. The stigma created an impact to the society in a manner that

they disassociated themselves to the PL HIV. The stigma not only weakens the

body of the PL HIV but it also affects the way of their life in the community, the

way people think about them and their capacity to work which in turn affects

their capability to secure employment, to communicate with other people without

fear of judgment, and to live just like any people living with a disease whether

HIV or not. HIV Stigma and Discrimination in the World of Work: Findings from

People Living with HIV Stigma Index (2018) also said that HIV-related stigma

may manifest as internalized stigma, where people have a generalized fear of

discrimination occurring and modify their behaviors accordingly. Or, more often

than not, it manifests in the discriminatory practices of employers, co-workers,

clients and customers. Often, these manifestations intersect to exacerbate

stigma and discrimination. People living with HIV experience discrimination and

bias enacted by others and may restrict their employment and educational

activities and goals to protect their dignity and safety HIV Stigma and

Discrimination in the World of Work: Findings from People Living with HIV

Stigma Index (2018).

According to the Health Belief Model of Charles Abraham and Paschal

Sheeran (2016) Demographic characteristics such as socio-economic status,

gender, ethnicity, and age were known to be associated with preventive health-

related behaviour patterns as well as differential use of health services. Socio-

economic status was associated with health-related behaviour patterns.

Demographic and socio-economic characteristics could not be modified through

health education but it was hypothesized that other potentially modifiable

individual characteristics associated with health-related behavior patterns could

be changed through educational interventions. Beliefs provide a crucial link

between socialization and behavior (Abraham and Sheeran, 2016). Thus, the

way people see HIV and the People of HIV as having lived an immoral life and

could be changed through educational intervention when we modify the way we

perceive the disease by removing the stigma and discrimination attached to it by

way of education and awareness conducted by health experts.

Abraham and Sheeran (2016) also said that beliefs are enduring individual

characteristics that shape behaviour and can be acquired through primary

socialization. Beliefs are also modifiable and can differentiate between individuals

from the same background. If persuasive techniques can be used to change

behaviour-related beliefs and such interventions result in behaviour change, this

provides a theoretical and practical basis for evidence-based health education

(Abraham and Sheeran, 2016). Therefore, the common belief of the society that

People Living with HIV acquired such disease through living an immoral life such

as prostitution and/or frequent change of sexual partner, or drugs through

injections can be modified by persuasive technique such as education. With the

growing population of People Living with HIV education is the most viable means

of educating the community of the causes and effects of HIV, how it can be

prevented and how an individual should take care of themselves. On the other

hand, education can remove the barrier between PL HIV and the Non PL HV

Community. It will eradicate of if not, make a less judgmental and more

accepting community so that PL HIV would overcome the disease and be able to

cope with the drastic change in their health and most importantly in their life i.e

their relationship with their family and the community.

Under the United Nations Declaration of Commitment on HIV AIDS, under

No. 11 of the Declaration which specifically states that “Recognizing that poverty,

underdevelopment and illiteracy are among the principal contributing factors to

the spread of HIV/AIDS and noting with grave concern that HIV/AIDS is

compounding poverty and is now reversing or impeding development in many

countries and should therefore be addressed in an integrated manner” and No.

13 which states that “Noting further that stigma, silence, discrimination, and

denial, as well as lack of confidentiality, undermine prevention, care and

treatment efforts and increase the impact of the epidemic on individuals,

families, communities and nations and must also be addressed”. Thus the United

Nations also believe that illiteracy has a great impact with the growing number of

the PL HIV, thus education is the key to reducing the numbers and by removing

the barrier due to the stigma and discrimination attached to having HIV Aids the
Government and Advocated would be able to reach their goal in breaking the

Stigma.92

The Philippine by adopting the generally accepted principle of

international law as part of the law of the nations, also passed RA 8504 or
“Philippine AIDS Prevention and Control Act of 1998” which primary goal is to
educate its citizen regarding such disease and how it can be prevented by
instituting nationwide HIV Aids Education Program under the Section 2 (a) which
states that:

Section 2. Declaration of policies. – Acquired Immune Deficiency Syndrome

(AIDS) is a disease that recognizes no territorial, social, political and economic
boundaries for which there is no known cure. The gravity of the AIDS threat
demands strong State action today, thus:

(a) The State shall promote public awareness about the causes,
modes of transmission, consequences, means of prevention and
control of HIV/AIDS through a comprehensive nationwide
educational and information campaign organized and conducted
by the State. Such campaigns shall promote value formation and
employ scientifically proven approaches, focus on the family as a
basic social unit, and be carried out in all schools and training
centers, workplaces, and communities. This program shall involve
affected individuals and groups, including people living with
HIV/AIDS.

In line with HIV prevention, the Philippines also protects PL HIV by making sure

their rights are not abridged by recognizing their rights to equal opportunities to

work and education clearly stated in the Philippine AIDS Prevention and Control

Act of 1998 Secs. 35 and 36 states that:

Sec. 35. Discrimination in the workplace. – Discrimination in

any form from pre-employment to post-employment, including

hiring, promotion or assignment, based on the actual, perceived

or suspected HIV status of an individual is prohibited. Termination

from work on the sole basis of actual, perceived or suspected HIV

status is deemed unlawful.

 Section 36. Discrimination in schools. – No educational

institution shall refuse admission or expel, discipline, segregate,

deny participation, benefits or services to a student or prospective

student on the basis of his/her actual, perceived or suspected HIV

status.

Aside from the growing number of People Living with HIV, the psychosocial and

psychological aspects of the stigma attached to HIV is a problem that we should

not turn a blind eye to. People Living with HIV faces problems such as having to

hide their status or they are afraid to check themselves hence, they could

transmit the disease to another person. The psychological effects of HIV AIDS

according to Aggarwal (2008) arises in individual’s mind when tested positive for

HIV is about longevity of life, fears related to illness, stigma in the society, family

acceptance and job insecurity. When they start feeling guilt, and shame leading

to low self-esteem (Vikas Aggarwal, 2008). The society views HIV AIDS as

having an immoral life, prostitution or being gay. This makes a barrier between

PL HIV and the community and between the community and various groups in

the society. Aggarwal (2008) also noted that societies play a major role in how

HIV/AIDS is perceived. Cultural differences will impact how societies react to the

disease and what forms stigma and discrimination. When stigma and discrimi-

nation are strong, they are easily be internalized by PLHA, causing severe pain

and suffering and leading to self-induced isolation from society. Families may

also be considered responsible for it. Social stigmas inhibit proper medical

treatment. A good education level helps to understand the disease more

thoroughly. In a study, education was found to be an important predictor of

knowledge level in HIV patients. Majority of subjects held positive attitudes

towards Acquired Immuno Deficiency Syndrome. Education and marital status

determined attitudes. It is important to state that knowledge is a double-edged

sword. More detailed knowledge about HIV/AIDS may influence attitude

adversely.

Stigmatization associated with AIDS is underpinned by many factors,

including lack of understanding of the illness, misconceptions about how HIV is

transmitted, lack of access to treatment, irresponsible media reporting on the

epidemic, the incurability of AIDS, and prejudice and fears relating to a number

of socially sensitive issues including sexuality, disease and death, and drug use.

Stigma can lead to discrimination and other violations of human rights, which

affect the well-being of people living with HIV in fundamental ways. Not only is

HIV-related discrimination a human rights violation, but it is also necessary to

address such discrimination and stigma in order to achieve public health goals

and overcome the epidemic. Responses to HIV and AIDS can be placed along a

continuum of prevention, care and treatment, and the negative effects of stigma

and discrimination can be seen on each of these aspects of the response. Ideally,

people should be able to seek and receive voluntary and confidential counseling

and testing to identify their HIV status without fear of repercussions. Those who

test HIV-negative should receive prevention counseling so as to be able to stay

negative. Those who test HIV-positive should receive available treatment and
care, and prevention counseling to protect others from infection and themselves

from reinfection. People living with HIV and AIDS should be able to live openly

and experience compassion and support within their communities. Their open

example personalizes the risk and experience to others, thereby aiding

prevention, care and treatment efforts.

SOCIETY

• Negative
Perceptions
• Negative • Freedom
Judgements • Self
• Lost of trust confidence
STIGMA EDUCATION • Seek Medical
Attention
• Prevention
• HIV (of spreading
• negative the virus)
Awareness
reactions
(E.G • Sex
prostitution Education EFFECTS
HIV PATIENT • Health
, SMS, anal
Education • Self care
sex)

• anxiety
• fear of
judgement
• depression
• loss of hope

FIGURE 1 (Research Paradigm)

Figure 1 shows the social stigma which affects the society and especially

the HIV/AIDS patient’s. The stigma refers to the negative reactions such as

disassociation from society, discrimination and which separates the patients to

the society. Due to the stigma a barrier was made between the society and HIV

patients. The society associated HIV/AIDS to living an immoral life, prostitution

and being gay which lead to lost of trust to the HIV Community. On the other
hand, due to the stigma attached to having HIV/AIDS fear has become a

hindrance for individuals to check their status or people living with HIV keep the

disease secretly and not seeking medical attention and worst they don’t know

that they have HIV. HIV does not only weakens the body, the immune system of

an individual affected but it also affects the psychosocial and mental health of

people living with HIV, AIDS or STD deteriorates due to depression, fear or

anxiety.

The diagram shows how the society or the community and people living

with HIV may remove the barrier, through education. HIV Education is vital in

raising awareness and understanding regarding HIV/AIDS, its causes and effects

and the effects of the stigma attached to having HIV/AIDS to the people living

with HIV in relation to their psychosocial and mental health. Raising awareness

through education such as sex education, health education, medical or health

symposiums and forums about HIV/AIDS and self care the society would be able

to remove the stigma and prevent the disease. It would also set people living

with HIV free from hiding therefore would avail medical treatment, Through HIV

Counseling and Testing, the HIV/AIDS prevention approach would result to

reduction of HIV-related discrimination or the stigma, HIV prevention knowledge,

compliance with health care recommendations and decrease of HIV, AIDS and

STD rates.