Assignment Code: MSWE-001/TMA/2022-23

Course Code: MSWE-001

Assignment Name: HIV/AIDS: Stigma, Discrimination and Prevention

Year: 2022-2023

Verification Status: Verified by Professor

Answer all the five questions. All questions carry equal marks. Answers to question no. 1 and 2 should not exceed 600 words each

Q1) 'HIV has not remained as an epidemic only, rather has become a developmental concern.' In the light of this statement, discuss the social and economic implications of HIV&AIDS in India.

Ans) There is currently enough epidemiological proof that social variables significantly increase the vulnerability to HIV infection with regard to transmission dynamics. Poverty, migration, awareness levels, infrastructure, and state capability are important ones. Let's explore these elements in greater detail in relation to HIV/AIDS.

1) One of the most powerful forces driving people to engage in hazardous behaviours which serve as a prerequisite for HIV infection is poverty. Poverty is a significant factor in increasing people's risk of contracting HIV due to a number of preventing factors.

a) First, by limiting access to resources like knowledge and services, poverty sharply increases people's susceptibility.

b) Second, women are forced to sell sex in order to survive due to a lack of resources.

c) Thirdly, poverty sets off a domino effect that results in illiteracy, a lack of skills, underemployment and unemployment, ignorance, and restricted access to resources for development.

d) Fourth, poor people leave their communities in search of greater opportunities for employment.

2) Migration: People frequently move to urban areas in quest of improved employment opportunities. Many push factors, such as poverty, landlessness, poor agricultural productivity, marginalisation, lack of employment and growth possibilities, domestic or community conflict, political turmoil, natural disasters, war, terrorism, and others, contribute to migration.

3) Migration may be prompted by HIV/AIDS: Due to the stigma and discrimination they experience, the lack of adequate health facilities, and the absence of or difficult access to treatment, people living with HIV/AIDS may be forced to migrate or leave their communities.

4) Utilization of Health Services: Many migrants are in an undetermined situation, with no authorization to remain or to work in the host nation, and they constantly worry about being sent back. Any interaction with the government, even when it is for health-related reasons, raises suspicion since people are more afraid of being reported to the police.

5) Social Service System: A weak public health system accelerates the spread of STIs and HIV, which is a seemingly unrelated but significant relationship between the health infrastructure and HIV transmission.

6) Role of Mass Media: Two decades ago, the primary goal of messaging was to increase public understanding of how AIDS was spread, and they accomplished this by instilling fear with phrases like AIDS kills. PLHA conceal their sero-status and even abandon "safe" behaviours, infecting others in the process.

7) Human Trafficking: Over the past few decades, human trafficking has dramatically expanded in South Asia. Evidently, trafficking occurs for a variety of reasons, including forced labour, organ transplantation, organised begging, adoption, sex work, forced marriage, and so forth. Organized networks, recruiters, family members, parents, guardians, and husbands are the major types of traffickers.

8) Disasters:Despite appearing unrelated, disasters increase HIV vulnerability. Floods, cyclones, droughts, earthquakes, and landslides are frequent occurrences in India. 65 percent of the country's landmass is vulnerable to earthquakes, 40 million hectares are at risk for flooding, and the country's 8000 km of coastline is subject to two cyclone seasons.

9) Tourism: Tourism destinations receive millions of visitors each year from both domestic and international locations. Even though tourist destinations are hubs for significant socioeconomic activity, they are frequently also high-risk areas for HIV transmission. Studies have demonstrated that risky behaviours are frequently related with tourism.

10) People/Occupations with High Mobility: High mobility is a need for employment in the armed forces, corporate communities, and a number of new era jobs as a result of globalisation. In order to escape feelings of loneliness, frustration, alienation, insecurity, and the like, these people must be away from their family for longer periods of time and may engage in forced, casual, or commercial sex. These population groups are likewise experiencing an increase in unnatural sexual habits. All of these circumstances put the people involved at a high risk of contracting HIV.

Q2) What are the challenges of communication in context of awareness and prevention of HIV/AIDS in India? Elaborate with suitable examples.

Ans) Professionals from a variety of professions have made significant progress in comprehending the epidemic since HIV was first identified in 1981. Research for a treatment for AIDS is ongoing, and work is also being done to create a vaccine to prevent it. Because of their dedication, governments all over the world have established specific organisations to investigate the issue, adopt regulations, and carry out programmes aimed at reducing the pandemic. There has undoubtedly been some success.

The AIDS-afflicted can now live better lives because to considerably more effective medication regimens. Many governments also encourage the high expense of the drugs. Given the circumstances, the greatest choice for combating AIDS is prevention. Understanding the behaviours that communication techniques are addressing is necessary to comprehend the enormous difficulty that these methods face in the case of HIV and AIDS. The majority of them include sexual behaviours that are personal and private, repeated, and habitual, that satiate physiological and psychological demands, which are banned in most civilizations, and that are moralised and condemned by society.

When seen in their historical and cultural contexts, these behaviours are ones that are influenced by deeply ingrained cultural norms and frequently include interactions between unequal parties. It is by no means an easy effort to bring about change in these. It calls for a deep grasp of the social context in which they occur as well as a group-specific strategy. The success of any HIV prevention plan can only be determined when there is an effective response, as those involved in HIV prevention are well aware. When targeted groups alter their behaviour, there is typically no instant advantage to be seen, and the majority of the changes that need to be made are not personal.

They either require the assistance of a different partner or the provision of services and goods. Reaching out to population groups that are challenging to reach through traditional media means is another issue facing communication specialists. Some of these demographics in need of unique treatments include migratory communities, truck drivers, and commercial sex workers. Peer educators have been successful in many of these instances in making the desired impact. Global experience demonstrates that in a small number of nations, early preventative measures have successfully lowered HIV prevalence rates. Uganda is said to have been the first nation to lower its HIV prevalence rates. The political resolve to combat HIV/AIDS and open, efficient communication are partly responsible for this accomplishment.

Researchers have emphasised the need for a methodical approach in HIV/AIDS preventative communication techniques. Because programme creation takes a lot of time and money, it is crucial to eliminate ad hoc methods and give all intervention tactics a scientific foundation. Accordingly, strategic communication would incorporate a number of components, including the extensive use of data, careful planning, stakeholder input, creativity, high-quality programming, and linkage to other programme aspects. Programs would undoubtedly have a better likelihood of success if they were developed using data. The aims now need to be more defined, even though they could be expanding condom use and improving awareness.

Creating communication techniques to reduce HIV and AIDS is a difficult endeavour. It must have a strong data base and be able to rely on theoretical ideas. Additionally, research is required for every stage of the planning, developing, monitoring, and assessment of a programme. This would facilitate mid-course corrections and increase the efficacy of interventions in terms of cost. The information produced by research on media access and use is also quite helpful.

Q3) Answer any two of the following questions in about 300words each: 10x2

a) Explain the role of gendered power relations in accessing information related to HIV/AIDS.

Ans) Kofi Annan, the then-UN Secretary General, stated very correctly that AIDS today has a female face.

Gender roles and relationships both directly and indirectly affect HIV infection susceptibility:

1. Biological Vulnerability: Due to the larger mucosal surface area of the vagina being exposed during heterosexual sex as well as the fact that semen has a higher concentration of HIV than vaginal fluid, women are physiologically more susceptible to HIV infection than men.

2. Marriage as Vulnerability: More than four fifths of HIV-positive women in the world, according to research, got the disease through their spouses or other close companions.

3. Socio-Demographic Factors: These risks are further exacerbated by some sociodemographic characteristics. Women's understanding of HIV is impacted by factors like illiteracy and media exposure.

4. Gendered Power Relations and Information Accessibility: Women are typically less aware or misinformed about the transmission of HIV infection and its prevention due to cultural taboos on sex-related topics. According to data, 95 percent of Indian women are unaware of all the strategies to avoid HIV/AIDS.

5. Economic Vulnerability: Women's economic dependency on men, which also leads to a disproportionate allocation of economic resources to their detriment, is a hallmark of patriarchal social structures. When it comes to HIV/AIDS, women have to labour harder to pay for the infected male family members' medical expenses while putting off and ignoring their own treatment needs.

6. Violence and Vulnerability: The reality of many women's life is that HIV susceptibility and vulnerability to domestic violence coexist; HIV status enhances vulnerability to violence, and domestic violence directly and indirectly exacerbates HIV vulnerability. Most frequently occurring without the use of condoms, sexual coercion or violence in marriage makes women more susceptible to STIs and HIV. It should go without saying that aggressive sexual practises like rape greatly increase the risk of developing a STI or HIV because they frequently cause lacerations or tears in the vagina.

7. Access to Health Care Services: Females have poorer access to health care, particularly HIV/AIDS services, than their male counterparts because of certain sociocultural reasons. The main causes are the secrecy surrounding sex difficulties, the fact that women cannot access services, and the fact that they frequently dismiss and ignore their health issues which, in the case of HIV infection, can be deadly and decrease a person's lifespan.

b) What are rights of the child suffering from HIV/AIDS.

Ans) In the context of HIV/AIDS, the United Nations Convention on the Rights of the Child lays forth guidelines for lowering child infection risk and safeguarding children from prejudice due to their actual or perceived HIV/AIDS status. The best interests of the children must be promoted and taken into consideration by the government.

They can apply the suggested framework for human rights:

1. To increase the protection of people with HIV/AIDS against discrimination, states should incorporate HIV/AIDS in their disability laws.

2. HIV-prone children are profiled.

3. Take extra precautions to prevent and lessen the effects of HIV/AIDS brought on by forced prostitution, trafficking, sexual exploitation, inability to negotiate safe sex, sexual abuse, drug use for injection, and harmful traditional practises.

4. It is important to protect children's rights to life, survival, and development.

5. It is important to respect children's right to privacy and secrecy about their HIV status. This acknowledges that HIV testing should be done voluntarily and with the participant's informed consent, which should be sought as part of pre-test counselling. If the children's legal guardians are involved, they should take the child's viewpoint into consideration if the youngster is old enough or mature enough to have it.

6. Social benefits like social security and social insurance should be available to children.

7. Children should have access to resources for HIV/AIDS education, prevention, and information. The social, cultural, political, and religious barriers that prevent children from accessing these should be eliminated.

8. Regardless of their HIV/AIDS status, all children should have access to education and information about HIV/AIDS prevention in and out of the classroom.

9. Children should have access to health care services and initiatives, and obstacles to access that underprivileged populations face in particular should be eliminated.

10. Children should have suitable living conditions.

4. Answer any four of the following in about 150 words each: 5x4

a) What are the facts and myths associated with HIV/AIDS?

Ans) Around the world, there are a number of different myths about HIV and AIDS. Here are some of the more common ones:

1. To get sick oneself, "you would have to sip a pail of infectious saliva." Yuck! This myth is common. Saliva contains modest enough amounts of HIV to not cause infection. You won't get sick if you consume a lot of saliva from an HIV positive person.

2. HIV can be cured by sex with a virgin. This urban legend, which is prevalent in some parts of Africa, is completely false. The fallacy has led to many young girls and children being raped by HIV-positive men, who frequently infect their victims. Rape is a serious crime and would not solve anything.

3. "Only homosexual guys, black people, young people, etc., experience it." This rumour is untrue. Most persons who contract HIV did not believe they would ever have the disease. They were shown to be erroneous.

4. "HIV may penetrate latex." There have been rumours going around that the condom-making latex contains 'holes' that the virus can fit through. This can't be. The truth is that latex prevents conception by blocking sperm and HIV.

b) Discuss the epidemiological aspect of HIV in the Indian context.

Ans) The information we have at our disposal restricts the picture we can paint of the HIV/AIDS epidemic. As of now, the only comprehensive national population-based data available to track the epidemic is the AIDS case reporting system of the Centres for Disease Control and Prevention. Reports of AIDS patients are just the clinical tip of the iceberg of the impacts caused by HIV infection, despite the fact that data are important in assessing disease prevalence and incidence.

HIV seroprevalence surveys are useful for describing the size of the epidemic, but because they include patients whose date of infection is uncertain, they have limited ability to describe the disease's current trend. Data on HIV incidence are much more useful for tracking the progression of the epidemic right now. Nevertheless, these statistics are of limited relevance for extrapolating to other specialised communities or to the total U.S. population because HIV infection is not reportable in all states and because the majority of HIV research have not used representative samples. Data from HIV surveillance are likewise of little use in predicting the trajectory of the epidemic.

c) Enlist skills and characteristics of a counsellor with special reference to HIV/AIDS.

Ans) The skills and characteristics of a counsellor with special reference to HIV/AIDS are as follows:

Skills of a Counsellor

1. Listening and Empathy: The ability of the counsellor to show empathy is the most crucial aspect of effective listening. When a counsellor establishes a relationship with a client and shows empathy, a rapport is built that allows the client to confide in the counsellor and express his deepest emotions.

2. Questioning: Without a doubt, asking questions is a crucial part of the counselling process. A thorough understanding of the client's circumstances is helpful, as is determining the client's clinical condition.

3. Silence: The core of the communication process is effective communication. Without needing to say it, the counsellor’s other key tool is quiet.

4. Non-Verbal Behaviour: More than half of the communications we have are nonverbal, according to Mehrabian. So, throughout the counselling process, all facets of nonverbal communication become important.

Characteristics of a Good Counsellor

1. Be proficient in his client's language in order to deduce what is being left unsaid and accurately interpret subtleties in communication.

2. Recognise the culture to which the client belongs; failing to do so may cause the counsellor to misinterpret the client's diverse behaviours.

3. Possess charisma and personality, and he need to make his client feel confident and respected.

4. Having a lot of life experience; without it, it's hard to give the client's problems and behaviour the right perspective or give them the right advice.

5. Be reasonably competent and mature to comprehend the client's problems, create an effective management strategy, and implement it; without these qualities, one may exercise bad judgement while counselling clients.

d) How stigma and discrimination associated with people living with HIV/AIDS impede the efforts of caregivers.

Ans) Because it is by nature non-supportive, a stigmatising social environment creates difficulties at all stages of this cycle. HIV-related discrimination and stigma impair preventive efforts by causing people to be apprehensive about getting tested for the virus, learning how to lower their risk of contracting it, and changing their behaviour to be more cautious lest this raise questions about their HIV status.

People tend to believe they are not at risk of contracting HIV because of the secrecy surrounding the disease and the fear of prejudice and stigma that it inspires. People living with HIV and AIDS are also considerably less likely to receive care and assistance due to the stigma and discrimination associated with them. Even people who are not afflicted themselves but are connected to the infected, such as partners, kids, and carers, experience stigma and prejudice. The stigma and discrimination connected with the disease unnecessarily worsen the personal pain that comes with it.

5 Write short notes on any five of the following in about 100 words each: 4x5

a) Symptomatic HIV Infection

Ans) The person may experience flu-like symptoms in the early stages of HIV infection, which are comparable to glandular fever and include body aches, rashes, and enlarged lymph nodes. After a few days, the patient seems to improve. HIV-positive individuals first have mild ailments like rashes, mouth infections like oral thrush, weight loss, persistent fever, night sweats, a lack of energy and excessive fatigue, easy bruising and bleeding, and protracted diarrhoea. The term "AIDS Related Complex" or "the period of active HIV infection" are two terms that are sometimes used to describe this symptomatic disease phase.

b) Hunter Theory

Ans) The "hunter" idea is the one that is most frequently accepted. In one case, chimpanzees were killed and eaten, or their blood entered cuts or wounds on the hunter, causing SIV cpz to spread to humans. SIV would typically have been fought off by the hunter's body, but on a rare occasions, it adapted to its new human host and became HIV-1. This hypothesis would be supported by the observation that there were several distinct early strains of HIV, each with a slightly different genetic make-up. Every time the virus was transferred from a chimpanzee to a man, it would have developed in a slightly different way within his body, producing a distinct strain.

c) Palliative Care

Ans) One of the most recent approaches used by social workers worldwide to care for the infected is hospice and palliative care. Incorporating social work ideas and practises into the management of patients with advanced HIV infection and AIDS through hospice and palliative care has long been a goal of social workers, and they have been effective to this point. Hospice and palliative care, however, have a murky past with HIV/AIDS. Accepting hospice and palliative care was once seen to be equivalent to "giving up." Then, as early 1990s death rates rose, hospice and palliative care started to gain a little more acceptance.

d) National AIDS Control Organization

Ans) Female sex workers are one of the groups in India with the highest risk of contracting HIV, according to the National AIDS Control Organization, which has created tailored interventions. Through peer-led community outreach, referrals for STI treatment, and empowerment activities like advocacy, education, crisis management, and "ownership" of preventive services by FSWs, these seek to increase HIV awareness and encourage safer sex practises.

The Sonagachi Project is the most famous FSW intervention in India. The Sonagachi Project, based in Calcutta since 1991, studies variables affecting communities, groups, and individuals. Sex workers were identified as essential partners in community initiatives that placed a strong emphasis on political lobbying. Peer outreach staff who build ties with FSW were used in group-level interventions. The outreach staff asked about the FSWs' immediate health issues, offered assistance in addressing them, distributed condoms, and HIV information, and gave FSWs treatment for STIs.

e) Community Care

Ans) The Indian System of Medicine, Ayurveda, has been practising community care for thousands of years. In accordance with this concept, patients get treatment and assistance in hermitage-style settings, providing an ideal setting for them to live a life devoid of prejudice and hatred. The Sisters of the Missionaries of Charity previously opened a centre that has been running since 1995 to provide AIDS patients with community care.

The following are some uses for community care facilities:

1. It serves as a platform to respond positively to criticism.

2. It is managed as a component of a comprehensive, economical healthcare system.

3. Between hospitals, home-based care systems, and community-based care systems, it acts as a middleman.

4. It encourages a communal reaction to the factors causing HIV infection.