HIV Stigma and Discrimination - by Johan Obbes

A huge part of the South African government’s new ACTS program which is to replace the current Voluntary Counselling and Testing system, will address one of the biggest obstacles in our fight against HIV/Aids…Stigma and Discrimination. This makes us think, how many times do we actually create a system which actually contributes to the very problem it is meant to curb.

It is so easy for us to create an in-group and an out-group in every sector of life, religion, culture, language, sexuality, race and illness, yet we don’t always realise that this classification of groups are the very thing that breeds stigma. Currently HIV testing is associated with clients going into a specific demarcated room in most clinics and hospitals, which highlights the question – Why do we separate HIV testing from other screening tests? It is in fact just another chronic disease!

AIDS-related stigma and discrimination remain the greatest obstacles to people living with HIV infection or AIDS. Stigma and discrimination increase people’s vulnerability, isolate them, deprive them of their human rights, care and support, and worsen the impact of infection. Stigma and concerns about discrimination are the main reason why people do not come forward to have an HIV test, to access antiretroviral drugs, to adopt safe feeding methods for their babies, or to change high-risk sexual behaviour.

But stigma and discrimination do not arise in a vacuum. They emerge from and reinforce other stereotypes, prejudices and social inequalities relating to gender, nationality, ethnicity and sexuality. They also feed into activities that are criminalised such as sex work, drug use or even sex between men. “Stigma, discrimination and human rights violations form a vicious circle, legitimising and spurring each other” (UNAIDS, 2002:67):

The following efforts should be implemented worldwide to fight stigma and discrimination (UNAIDS 2002:67).

-      Leaders at all levels and in all walks of life should be encouraged to visibly challenge and act against the many forms of HIV-related discrimination and to spearhead public action.

-      People living with HIV/AIDS should be actively involved in the response to the epidemic.

-      Violations of human rights should be monitored, people should be able to challenge discrimination, and institutions should be designed to safeguard human rights.

-      Governments should take urgent action to protect women’s property and inheritance rights, and to protect children against sexual exploitation.

-      A legal environment able to support the fight against discrimination should be created.

-      Prevention and treatment, care and support services should be accessible to all.

By showing their own support and responsibility to care for all people, regardless of their health or social status, health care professionals can act as role models for others in helping to combat stigma, discrimination and the isolation of people living with HIV/Aids. Prevention strategies will become far more successful if and when HIV is treated like any other disease, and when people feel safe to be open about their HIV status. However, health  care professionals can become advocates for acceptance and care only if they look inward and first examine their own beliefs, values, assumptions and attitudes towards HIV/Aids This can be done individually or in groups by asking and reflecting on the following questions (WHO, 2000a:6-5)

-      What fears of misunderstandings do I have?

-      How might these fears or misunderstandings affect my work?

-      Where do these fears or misunderstandings come from?

-      How can I overcome these fears or misunderstandings in order to provide care, support, counselling, education, and advice in the prevention and care of HIV/Aids?

-      What influence do I have on others who care for people infected and affected by HIV/Aids?

-      What is my role in providing and promoting safe, moral and ethical care to people living with HIV and their loved ones, caregivers and communities?

Health care professionals should also think about and listen to the “language” they use when they speak: prejudiced language may alienate them from their target group. While saying “He caught AIDS” and “He has AIDS” may mean the same thing, the first sentence is loaded with negative meanings that betray the implicit attitudes of the speaker. (Such negative meaning may be that AIDS is something over which we the, innocent, have no control, something that we “catch” from “them” – the contaminated “others”.) People often say “He is HIV” instead of “He is HIV positive”. A sentence constructed like this implies an identity with the virus, i.e. the person is the virus, instead of the person has the virus.

AIDS educators should always be careful not to use sexist language. Always to refer to he and him in the context of HIV/Aids may imply that men are always the “guilty” party. Victimising language should also be avoided. “She suffers from AIDS” one should rather say “She lives with AIDS” or “She is HIV positive”. Rather than referring to “rape victims” use positive language and refer instead to “rape survivors”. Be careful not to fall in the trap of using prejudiced or discriminatory language. If you refer to people with HIV infection as “those people”, you are clearly dividing the world into two groups: the innocent, healthy us, and the guilty diseased them.

While we all sometimes thing in terms of stereotypes, we should make every effort to be aware of our own stereotypes so that we can root them out and thus avoid offending others and hurting feelings. If we interact with members of a stereotyped group, we will quickly learn to recognise our own prejudices and eliminate them. The irrational and often exaggerated fears associated with HIV/Aids can be directly addressed through educational programmes base on sound medical, social and psychological knowledge. To be successful, such programmes must be sustained and supported over time. Prevention strategies will continue to be compromised if fear, ignorance, intolerance and discrimination against HIV-positive people persist. Health care professionals have a responsibility to help “normalise” HIV in the communities where they work so that modes of transmission and prevention can be addressed without the emotional and attitudinal values that are currently getting in the way of open dialogue. Counsellors and other health care professionals should not only advocate for Universal Precautions, but also for universal tolerance and knowledge about HIV/Aids.

Having said all this, we should challenge ourselves with some introspection by asking – How much do I really know about HIV/Aids? Or better yet – Am I contributing to the stigma or am I contributing to the solution?


Written by Johan Obbes - Exerts from this article was taken from 'HIVAIDS Care & Counselling, A multidisciplinary Approach; Alta van Dyk, Fourth Edition'

True Self vs. False Self - by Johan Obbes

Many neurologists, philosophers, and everyday people propose that we each have a self. There has been rich and raucous debate across centuries and cultures about what that is.

In various religions we find quite a discussion on the concept of the True Self versus the False Self, yet many of us hear these terminologies but don’t fully comprehend that it is not something that is exclusive to religious settings but also something which we use in Psychology & Counselling and an awareness development (both in ourselves and our clients) which can be very useful in our therapy rooms.

Lao Tzu, in his Tao Te Ching, says "Knowing others is wisdom. Knowing the self is enlightenment. Mastering others requires force. Mastering the self requires strength”.

The question then presents itself; what is the True Self and what is the False Self?

The philosophy around the two was probably made known by Donald Woods Winnicott (7 April 1896–28 January 1971), an English pediatrician and psychoanalyst who was especially influential in the field of object relations theory. “We were taught in this society - as in any codependent culture - to look outside to define ourselves and give us a feeling of worth.  We have worth if we are better than others.  We are validated in comparison to others, for being: smarter than, richer than, prettier than, more talented than, having better grades than, etc., etc.  This empowers the illusion of separation and feeds the fear of not being good enough. “

The False Self, refers to certain types of false personalities that develop as the result of early and repeated environmental failure, with the result that the true self-potential is not realized, but hidden. This idea appears in many papers and is fully presented in "The theory of infant-parent relationship" (Winnicott, 1965).

The False Self many a times are then strengthened by the repetitive messages which we receive from our cultures, families, religions or other environments where the messages of “to be good enough you have to conform to XYZ” sometimes swim around us like piranhas in the Amazon.

When repeated traumas occur very early in development, the infant experiences extreme dread or primitive agony, and psychosis may result. To such a parent, who fails to meet the infant's gesture and substitutes one of their own, the older and more integrated infant responds in a compliant fashion. In this way the infant may develop a false self that builds up a set of relationships based on compliance or even imitation, the potential true self being unrealized and hidden.

If our early-childhood nurturing is enough, we seem to automatically develop a personality subself which acts like a naturally-talented orchestra leader, athletic coach, or chairperson. This subself has clear, realistic wide-angle, long-range vision. S/He consistently makes healthy, balanced minor and major decisions based on the dynamic input of our basic senses.

In this best case, our complex evolving network of neural computers is directed and coordinated each moment by this highly-skilled true Self (capital S). When that happens, children and adults report feeling a mix of grounded, calm, purposeful, focused, optimistic, strong, up, content, alert, aware, alive, resilient, centered, resilient, secure, potent, and compassionate. Remember the last time you felt a blend of these?

Enter the (Protective) False (Pseudo) Self

But... if very young children experience significant lack of holistic nurturing their personalities (brains) seem to develop a different kind of self (small s). Their true Self seems or blocked from developing and directing their actions by other well-meaning but limited, impulsive and personality subselves who want to run the show.

False-self formation and dominance is normal, widespread, and promotes survival vs. growth. It's like a distrustful, disgruntled violinist, tuba player, and lead tenor pushing their talented conductor off the podium and fighting over who will lead the orchestra.

We tend to think that we are the same person we were five years ago. Though we have changed in many respects, the same person appears present as was present then. We might start thinking about which features can be changed without changing the underlying self. Some philosophers and psychologists denies that there is a distinction between the various features of a person and the mysterious self that supposedly bears those features. When we start introspecting, we are never intimately conscious of anything but a particular perception; man is a bundle or collection of different perceptions which succeed one another with an inconceivable rapidity and are in perpetual flux and movement.

In conclusion I think that this a topic which can be processed over and over in our minds, speculated about and researched in more depth. The journey will eventually then lead us to the point of how deep does the rabbit hole go? Personally I think that as with all personal growth journeys the first point will be the awareness. Becoming aware of a false self in us, will help us in the search for that ever elusive True Self.

Article Written by Johan Obbes