Mauritius People Living with HIV Stigma Index Report 2013

110 Pages·2013·2.26 MB·English

by  Divya Dethier

People Living with HIV
Stigma Index Report
3
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Published!by:!
National!AIDS!Secretariat!
th
5 !Floor,!Fooks!House!
Bourbon!Street,!Port!Louis!!
Mauritius!
!
Website:!ccmBmauritius.org!
Email:
Abbreviations(
!
AIDS! ! Acquired!Immunodeficiency!Syndrome(
ART! ! Antiretroviral!Therapy!
CIG! ! Centre!Idrice!Goomany!
GIPA! ! Greater!Involvement!of!People!Living!with!HIV!and!AIDS!
GNP+! ! Global!Network!of!People!Living!with!HIV
HIV! ! Human!Immunodeficiency!Virus!
ICW! ! International!Community!of!Women!Living!with!HIV/AIDS!
IPPF! ! International!Planned!Parenthood!Federation!
MSM! ! Men!who!have!Sex!with!Men
NAS! ! National!AIDS!Secretariat
NDCCI! ! National!Day!Care!Centre!for!the!Immunosuppressed
NGO! ! NonBGovernmental!Organization
PILS! ! Prévention!Information!Lutte!contre!le!Sida
PLHIV! ! People!Living!with!HIV
PMTCT! ! Prevention!of!MotherBToBChild!Transmission
PWID! ! People!Who!Inject!Drugs
SPSS! ! Statistical!Package!for!Social!Science
SRH! ! Sexual!and!Reproductive!Health
STI! ! Sexually!Transmitted!Infection
UNAIDS! Joint!United!Nations!Programme!on!HIV/AIDS
UNGASS! United!Nations!General!Assembly!Special!Session!on!HIV/AIDS
!
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2(|(People(Living(with(HIV(Stigma(Index:(Mauritius(
Acknowledgements"
!
The!National!AIDS!Secretariat!would! like! to! thank!the!UNAIDS! for! the! financial!and! technical!
support!that!made!this!study!possible.!
!
The! implementation!of! the!People!Living!with!HIV!Stigma! Index! in!Mauritius!would!not!have!
been!possible!without!the!dedicated!work!of!a!large!team!of!people.!These!included!the!team!
at! the!National! AIDS! Secretariat,! the! interviewers,! and! the! international! consultant,! Andrew!
Doupe.! I!wish!to!particularly!mention!the!contribution!of!Divya!Dethier,!an! intern!at!the!NAS!
and!a!Fulbright!scholar,!who!actively!contributed!at!every!step!of!the!study.!
!
These!individuals!lead!the!process!of!implementing!the!work!on!behalf!of!a!larger!partnership!
–!making! it! an! endeavour! by! people! living! with! HIV,! their! networks,! and! communities.! The!
partnership! was! coordinated! by! a! steering! group! comprising! the! National! AIDS! Secretariat,!
Ministry! of! Health! and! Quality! of! Life,! Mauritius! Prisons,! Vivre! Plus,! PILS,! Lacaz! A! and!
Chrysalide.!
!
We!would!like!to!acknowledge!the!support!of!the!Ministry!of!Health!and!Quality!for!assistance!
in!data!entry!and!quality!control.!!
!
Most! importantly!we!would!like!to!acknowledge!the!invaluable!role!of!people! living!with!HIV!
who!participated! in! this! study,!whether! as! interviewers!or! interviewees.!We! thank! them! for!
their! time! and! for! sharing! their! stories.! We! trust! that! these! findings! will! contribute! to!
improving!the!health!and!quality!of!their!lives!and!that!of!people!living!with!HIV!in!general.!
!
!
!
Dr.!Amita!Pathack,!
National!AIDS!Coordinator,!
Prime!Minister’s!Office
3"|"People"Living"with"HIV"Stigma"Index:"Mauritius "
Contents(
Abbreviation..s.......................................................................................................2
Acknowledgements ................................................................................................3
List(of(Figures .........................................................................................................6
List(of(Tables...........................................................................................................8
Executive(summary ................................................................................................9
Introduction .........................................................................................................15
Background .................................................................................................................... 15
Country!context ............................................................................................................. 15
About!the!civil!society!response .................................................................................... 19
Objectives....................................................................................................................... 19
Methodology.................................................................................................................. 20
Study!limitations!and!challenges.................................................................................... 23
What!is!in!this!report?.................................................................................................... 25
Section(1:(Background(characteristics(and(household(composition.......................27
1.1!Gender!and!age ........................................................................................................ 27
1.2!Length!of!time!living!with!HIV .................................................................................. 28
1.3!Relationship!status ................................................................................................... 28
1.4!Sexual!activity........................................................................................................... 29
1.5!Key!populations........................................................................................................ 30
1.6!Education ................................................................................................................. 31
1.7!Employment ............................................................................................................. 31
1.8!Income...................................................................................................................... 33
1.9!Household!size ......................................................................................................... 34
1.10!Location.................................................................................................................. 34
1.11!Food!security .......................................................................................................... 34
Section(2:(Experience(of(stigma(and(discrimination...............................................37
2.1!Experience!of!HIVBrelated!stigma!and!discrimination.............................................. 37
2.2!Access!to!accommodation,!work,!education!and!health!services............................ 42
2.3!Internalized!stigma................................................................................................... 47
2.4!Rights,!laws!and!policies........................................................................................... 51
2.5!Effecting!change....................................................................................................... 53
Section(3:(Experience(of(testing,(disclosure,(treatment(and(having(children..........57
3.1!Testing!and!diagnosis ............................................................................................... 57
3.2!Disclosure!and!confidentiality .................................................................................. 59
3.3!Treatment ................................................................................................................ 65
4(|(People(Living(with(HIV(Stigma(Index:(Mauritius(
3.4$Having$children......................................................................................................... 67
Section!4:!Qualitative!questions...........................................................................71
4.1$Testing$and$diagnosis ............................................................................................... 71
4.2$Disclosure$and$confidentiality .................................................................................. 72
4.3$Treatment ................................................................................................................ 73
4.4.$Having$children........................................................................................................ 74
Conclusions ..........................................................................................................75
Recommendations................................................................................................81
Annex!1:!People!Living!with!HIV!Stigma!Index:!Kreol!morisien ..............................87
Annex!2:!Stigma!Index!Results!Validation!Meeting!List!of!Participants................100!
Annex!3:!Chronological!Key!Steps!in!the!Local!Implementation!Process...............101!
Disclaimer………………………………………………………………………………………………………….105!
Endnotes……………………………………………………………………………………………………………106
! ! 5!|!People!Living!with!HIV!Stigma!Index:!Mauritius
L ist(of(Figures(
Figure!1:!Epidemiological!trend!among!PWID’s!compared!to!others!in!newly!detected!HIV!cases!
from!2000!to!2012(
Figure!2:!HIV!epidemic!geographic!distribution!
Figure!3:!Age!distribution!of!respondents,!disaggregated!by!gender!
Figure!4:!Length!of!time!living!with!HIV!(i.e.!since!diagnosis)!
Figure!5:!Relationship!status!of!the!respondents!
Figure!6:!Number!of!years!in!relationship!(n=219)
Figure!7:!Sexual!activity!of!respondents!
Figure!8:!Whether!respondents!were!sexually!active!or!not,!disaggregated!by!relationship!
status!
Figure!9:!Respondents’!education!level!(n=392)!
Figure!10:!Respondents’!employment!status,!disaggregated!by!gender!
Figure!11:!Respondents’!employment!status,!disaggregated!by!key!population!
Figure!12:!Monthly!income!of!respondents!
Figure!13:!Food!insecurity!levels!in!participants’!household!in!the!past!month!
Figure!14:!Stigmatization!and!discrimination!experienced!in!the!past!12!months!
Figure!15:!Respondent’s!perceived!reasons!for!being!stigmatized!and!discriminated!against!in!
the!last!12!months!
Figure!16:!Perpetrator!of!physical!assault!(n=71)!
Figure!17:!Other!reason!for!experienced!stigma!and!discrimination!(n=263)!
Figure!18:!Experience!of!stigma!and!discrimination!in!relationships!as!a!result!of!respondent’s!
HIVBpositive!status!during!the!last!12!months
Figure!19:!Reasons!respondents!felt!stigmatized!and!discriminated!against!
Figure!20:!Forced!to!change!place!of!residence!or!unable!to!rent!accommodation!in!last!12!
months!(n=395)!
Figure!21:!If!employed,!how!often!lost!a!job!or!other!source!of!income!in!last!12!months!
(n=140)(
Figure!22:!In!the!last!12!months,!refused!employment!or!work!opportunity!because!of!HIV!
status!(n=195)!
Figure!23:!In!the!last!12!months,!frequency!job!description!or!nature!of!work!changed,!or!been!
refused!promotion!because!of!HIV!status!(n=140)!
Figure!24:!In!the!last!12!months,!dismissed,!suspended!or!prevented!from!attending!an!
educational!institution!because!of!HIV!status!(n=359)!
Figure!25:!In!the!last!12!months,!respondent’s!children!have!been!dismissed,!suspended!or!
prevented!from!attending!an!educational!institution!because!of!the!respondent’s!HIV!status.!
(n=366)!
Figure!26:!Denial!of!health!services,!including!dental!care,!because!of!HIV!status!in!the!last!12!
months!(n=388)!
Figure!27:!Feelings!experienced!by!PLHIV!because!of!their!HIV!status!
6(|(People(Living(with(HIV(Stigma(Index:(Mauritius(
Figure!28:!Feelings!experienced!by!PLHIV!because!of!their!HIV!status,!disaggregated!by!gender!
Figure!29:!Decisions!made!in!the!last!12!months!because!of!HIV!status!
Figure!30:!Things!done!and!decisions!taken!by!respondents!because!of!their!HIV!status,!
disaggregated!by!gender(
Figure!31:!Fear!of!gossip,!verbal!insults,!physical!harassment!and!physical!assault
Figure!32:!Fear!of!gossip,!verbal!insults,!physical!harassment!and!physical!assault,!
disaggregated!by!gender
Figure!33:!Number!of!respondents!who!had!their!rights!violated!
Figure!34:!Reasons!for!not!trying!legal!redress!for!an!abuse!of!rights!(n=25)(
Figure!35:!Type(s)!of!organization(s)!that!respondents!know!could!go!to!for!help!if!experienced!
stigma!
Figure!36:!Recommendations!of!respondents!regarding!what!organizations!should!to!do!
address!HIVBrelated!stigma!and!discrimination!
Figure!37:!Reason!for!getting!tested!for!HIV!(n=392)!
Figure!38:!Nature!of!decision!for!being!tested!(n=387)!
Figure!39:!Types!of!HIV!test!counselling!received!(n=388)!
Figure!40:!Whether!and!in!what!manner!HIV!status!of!respondents!disclosed!
Figure!41:!Feel!pressure!from!other!PLHIV!or!PLHIV!networks/groups!to!disclose!status!
Figure!42:!Pressure!from!people!not!living!with!HIV!to!disclose!HIV!status!
Figure!43:!Healthcare!professional!ever!told!other!people!about!HIV!status!without!consent!
Figure!44:!Participants’!knowledge!of!confidentiality!of!medical!records!
Figure!45:!Perceived!reactions!to!disclosure!
Figure!46:!Aggregated!responses!of!select!groups’!reaction!to!respondent’s!HIV!status!
Figure!47:!HIV!disclosure!as!an!empowering!experience!
Figure!48:!Respondent’s!selfBdescription!of!health
Figure!49:!Respondents’!health!status,!disaggregated!by!gender(
Figure!50:!Ever!received!counselling!about!reproductive!options!since!diagnosis,!disaggregated!
by!gender(
Figure!51:!Health!care!professional!ever!advised!a!respondent!not!to!have!a!child!since!
diagnosis,!disaggregated!by!gender!
Figure!52:!Health!care!professional!coerced!respondent!into!being!sterilized!since!diagnosis,!
disaggregated!by!gender(
Figure!53:!Ability!to!obtain!ART!conditional!on!the!use!of!certain!forms!of!contraception,!
disaggregated!by!gender!
Figure!54:!ART!during!pregnancy!for!PMTCT!
!
( ( 7(|(People(Living(with(HIV(Stigma(Index:(Mauritius
L ist(of(Tables(
Table!1:!Respondents!disaggregated!by!key!population!and!gender(
Table!2:!Respondents’!employment!status!
Table!3:!Number!of!children!and!youth!in!household!who!are!AIDS!orphans!
Table!4:!Reason!for!being!forced!to!change!place!of!residence!or!unable!to!rent!
accommodation!(n=92)!
Table!5:!Denial!of!access!to!family!planning!and!sexual!health!services!because!of!HIVBpositive!
status!
Table!6:!Type!of!support!provided!by!respondents!to!other!PLHIV!
Table!7:!Areas!which!respondents!felt!they!could!influence!decisions!
!
8(|(People(Living(with(HIV(Stigma(Index:(Mauritius(
Mauritius(

Executive(summary(
Stigma! is! widely! recognized! as! a! barrier! to! accessing! HIV! prevention,! treatment,! care! and!
support.! People! living! with! HIV! experience! various! forms! of! stigma! that! impact! upon! their!
ability! to!make! use! of! services! and!make! positive! choices! about! their! health! and! lives.! This!
study!by!the!National!AIDS!Secretariat!(NAS),!Prime!Minister’s!Office,!in!partnership!with!civil!
1
society! organisations ,! aimed! to! collect! information! on! stigma! and! discrimination! affecting!
people!living!with!HIV!in!Mauritius.!The!specific!objectives!were!to:!
• Measure! the! types! and! extent! of! HIVBrelated! stigma! and! discrimination! at! the!
individual,! family,! community! and! national! levels! (i.e.! a! baseline! study)! to! be! able! to!
measure!change!over!time.!
• Explore!experiences!of!internal!stigma!and!the!effect!this!has!on!decisionBmaking.!
• Explore!perceived!stigma!and!discrimination! in!relation!to!access!to!work,!health!(e.g.!
HIV!testing,!treatment!and!SRH!services)!and!education.!
• Explore!the!knowledge!of!people!living!with!HIV!of!existing!HIVBrelated!legislation!and!
policies.!
• Identify!the!extent!to!which!HIVBpositive!people!are!informed!of!their!rights!and!access!
mechanisms!for!rights!violations.!
• Use! results! to! involve!people! living!with!HIV! through!advocacy!and!empowerment! to!
define! and! shape! policies,! interventions! and! programmes! which! meet! the! specific!
needs!of!HIVBpositive!people.!
(
Methodology(
This! study!used! the!People! Living!with!HIV! Stigma! Index!developed!by!GNP+,! ICW,! IPPF!and!
UNAIDS! to! undertake! interviews,! following! the! standard! methodology! as! described! at!
www.stigmaindex.org.!!
In!addition,!respondents!were!asked!qualitative!questions!on!barriers!to!accessing!services!and!
specific!issues!faced!by!people!living!with!HIV.!
The! study! was! undertaken! between! March! and! April! 2013,! and! involved! a! sample! of! 399!
people!living!with!HIV!residing!in!the!island!of!Mauritius.!
!
Respondent(sample(
Nearly!two!thirds!of!the!sample!was!male!(62.7%,!n=250),!approximately!a!third!were!female!
(32.8%,! n=131)! and! a! small! portion! was! transgender! (4.5%,! n=18).! Over! one! third! of!
respondents!(38%,!n=153)!were!aged!30B39!years,!and!another!third!(34%,!n=134)!aged!40–49!
years.!Ten!percent!were!aged!25B29!(n=39),!another!10%!were!50!years!of!age!or!older!(n=40),!
( ( 9(|(People(Living(with(HIV(Stigma(Index:(Mauritius