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Open Access Accessing Health Services While Living With HIV: Intersections of Stigma Accéder aux services de santé quand on vit avec le VIH/sida : la stigmatisation en tant que conjonction de facteurs

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Abstract:

AIDS stigma has serious consequences. This study explored those practices within health-care organizations that persons with HIV perceive as stigmatizing. It used an exploratory, descriptive design using a participatory action research approach. Interviews and focus groups were conducted with 16 Aboriginal and 17 non-Aboriginal persons living with HIV as well as with 27 health-care providers. The AIDS stigma perceived by many participants often intersected with other forms of stigma, related to behaviour, culture, gender, sexual orientation, or social class. In addition, policies at the organizational level contributed to AIDS stigma and at times intersected with stigma at the individual level. Participants' experiences of stigma and discrimination were shaped by the organizational policies (universal precautions, models of care) and design (physical layout) under which care was provided. Several paradoxes associated with secrecy, health-care settings, and the layering of stigma emerged in the reported experiences.

French
La stigmatisation associée au VIH/sida a de lourdes conséquences. Nous avons cherché à examiner les pratiques qui, au sein des établissements de santé, sont perçues comme étant stigmatisantes par les personnes vivant avec cette maladie. De nature exploratoire et descriptive, notre étude s'inscrit dans une approche de recherche-action participative. Nous avons mené des entrevues et des groupes de discussion auxquels ont participé 16 Autochtones et 17 non-Autochtones vivant avec le VIH/sida, ainsi que 27 prestataires de soins de santé. La stigmatisation ressentie par de nombreux participants se conjugue souvent à d'autres facteurs qui accentuent cette perception, et qui sont associés au comportement, à la culture, au sexe, à l'orientation sexuelle ou à la classe sociale. On a constaté également que les politiques organisationnelles contribuaient à la stigmatisation et qu'elles se conjuguaient parfois aux facteurs individuels. Les expériences de la stigmatisation et de la discrimination sont façonnées par les politiques organisationnelles (précautions universelles, modèles de prise en charge) ainsi que par l'aménagement (la disposition matérielle) des lieux où sont dispensés les soins. On a relevé dans les témoignages des participants un certain nombre de paradoxes relatifs au respect de la vie privée, au cadre de prestation des soins et à la conjonction des facteurs de stigmatisation.

Keywords: ACCESS TO CARE; AIDS; CHRONIC ILLNESS; HEALTH SERVICES; HIV ABORIGINAL

Document Type: Research Article

Publication date: September 1, 2009

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