Mauritius - People Living with HIV Stigma Index

Transcription

People Living with HIV
Stigma Index Report
3
Mauritius(
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Published!by:!
National!AIDS!Secretariat!
5th!Floor,!Fooks!House!
Bourbon!Street,!Port!Louis!!
Mauritius!
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Website:!ccmBmauritius.org!
Email:[email protected]!
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©!2013!!
!
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
!
!
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(
Abbreviations .........................................................................................................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
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
List(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!
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,!
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
List(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!
!
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),!
(
(
Stigma(Index(
seven!percent!(n=28)!aged!20B24!years,!and!about!1%!(n=5)!were!aged!18B19.!!
!
Nearly!40%!of!respondents!had!been!living!with!HIV!either!for!1B4!years!(38.8%,!n=153)!or!for!
5B9! years! (39.3%,! n=155)! and! over! 10%! had! been! living! with! HIV! between! 10! and! 14! years!
(12.7%,!n=50).!Over!one!third!of!respondents!were!married!or!cohabiting!and!currently!living!
with! their! partners! (34.1%,! n=136)! with! 21%! of! respondents! (n=82)! either! being! in! a!
relationship! but! not! living! with! their! partners! (14%,! n=55),! or! married! or! cohabiting! but! the!
spouse! or! partner! is! temporarily! away! from! the! household! (7%,! n=27).! Over! 40%! of!
respondents!(45.4%,!n=181)!were!single!(unmarried,!divorced!or!widowed).!Two!thirds!(n=271)!
reported!being!sexually!active.!
!
Mauritius!has!a!concentrated!epidemic!and!the!sample!was!in!large!part!representative!of!this.!
In!terms!of!ever!belonging!to!a!key!population,!about!60%!of!respondents!identified!as!PWID!
(60.9%,! n=243)! and! over! 40%! reported! being! an! exBdetainee! (41.4%,! n=103).! Around! 15%!
identified! as! a! sex! worker! (n=63),! 12%! as! MSM! (n=48)! and! less! than! one! quarter! did! not!
identify!as!belonging!to!any!key!population!(23.1%,!n=92).!
!
Respondents!in!general!had!low!education!levels!(64.8%,!n=254),!high!rates!of!unemployment!
(55%,!n=224),!and!nearly!40%!reported!food!insecurity!(39%,!n=144).!On!average!there!were!
2.7! persons! living! in! a! respondent’s! household! at! the! time! of! the! survey! and! at! least! 17%! of!
respondents! (n=68)! reported! living! alone.! A! little! over! half! the! respondents! have! children!
(54.1%,!n=216),!20!of!whom!have!at!least!one!HIVBpositive!child,!and!31!of!whom!reported!at!
least! one! AIDS! orphan! in! their! household.! Underlining! the! socioBeconomic! disadvantage!
evident!among!the!sample,!96.9%!of!respondents!(n=383)!report!a!monthly!income!under!the!
median!of!MRU!Rs!14!640!(USD!468)2.!
!
Major(findings(
Major!findings!concerning!the!experiences!of!PLHIV!in!specific!areas!are!outlined!below!with!
the!full!findings!presented!in!the!Conclusions.!Overall,!the!study!shows!that!HIVBrelated!stigma!
and! discrimination,! most! notably! high! levels! of! internal! stigma! as! well! as! discrimination! in!
healthcare! settings,! is! ongoing! and! acts! as! a! barrier! for! PLHIV! to! access! HIV! prevention,!
treatment!and!care!services!in!Mauritius.!With!a!concentrated!HIV!epidemic,!many!PLHIV!face!
layered!stigma,!related!to!their!perceived!or!actual!belonging!to!one!or!more!key!population!
groups.!
!
GIPA,(social(and(economic(empowerment(
In! addition! to! low! socioBeconomic! status,! respondents! exhibited! significant! psychosocial!
effects,! for! example,! high! levels! of! internalized! stigma3! and! fear! about! the! ways! they! were!
perceived! and! treated! in! the! community4! and! in! relationships5.! Some! 30%! of! respondents!
Mauritius(
reported! feeling! suicidal! in! the! last! 12! months6.! Internal! stigma! also! results! in! decisions! to!
isolate! socially7! and! impede! access! to! health! care,! education! and! employment8.! Only! 33!
respondents!reported!no!internal!stigma,!representing!8.3%!of!the!sample.!
!
In! general,! disclosure! of! HIV! status! was! positive! and! extensive.! Nearly! half! of! respondents!
described! disclosing! their! HIV! status! as! an! empowering! experience! (48.9%,! n=195)! and!
approximately! 90%! reported! that! they! had! not! felt! pressured! to! disclose! their! HIV! status! by!
others.!More!than!80%!of!respondents!reported!disclosure!of!their!HIV!status!to!their!spouse!
or!partner!(86.7%),!other!adult!family!members!(82.2%),!other!PLHIV!(85.2%)!and!health!care!
workers! (89.4%).! However,! 10%! of! respondents! had! not! disclosed! their! status! to! their!
permanent! partner! (n=21)! and! a! further! 18.3%! had! not! disclosed! to! injecting! drug! partners!
(n=38).! Slightly! more! than! 10%! respondents! (12.3%)! said! the! reaction! of! different! groups! of!
people!was!discriminatory!or!very!discriminatory.!!
!
The!most!common!experience!of!stigma!in!the!previous!12!months,!being!gossiped!about,!was!
reported!by!over!half!of!respondents9.!Approximately!one!in!five!respondents!reported!having!
been! verbally! insulted/harassed/threatened! (26%,! n=105);! physically! harassed! and/or!
threatened!(22%,!n=85);!and/or!physically!assaulted!(18%,!n=72)!at!least!once!in!the!last!year.!
Of!these,!66%!(n=69),!52%!(n=44),!and!44%!(n=31),!respectively,!reported!that!this!was!due!to!
their!HIVBpositive!status,!in!whole!or!in!part.!Female!respondents!were!twice!as!likely!to!report!
physical!assault!as!male!respondents,!and!nearly!40%!of!sex!workers!(n=25)!and!16%!of!PWID!
(n=39)!reported!being!assaulted.!
!
In! relation! to! HIV! statusBrelated! discrimination! experienced! in! relationships:! 20.3%! of!
respondents! had! experienced! sexual! rejection! (n=81)! and! 10.3%! reported! psychological!
pressure!or!manipulation!by!a!spouse!or!partner!(n=!41).!Approximately!40%!of!respondents!
feel! that! HIVBrelated! stigma! and/or! discrimination! is! due! to! people! being! afraid! of! being!
infected! by! them! or! due! to! people! not! being! aware! of! how! HIV! is! transmitted.! Reasons! for!
discrimination,!other!than!HIV!status,!included!being!a!PWID!(n=!137),!an!exBdetainee!(n=70),!
sexual!orientation!(n=51)!or!being!a!sex!worker!(n=40).!
!
Participants!exhibited!modest!involvement!in!various!forms!of!personal!support10:!one!in!five!
was! involved! in! PLHIV! support! groups! and! networks11,! and! less! than! 10%! involved! in!
programmes!or!projects!assisting!PLHIV12.!Over!40%!of!respondents!did!not!know!of!a!source!
of!support!if!experiencing!stigma!(42.6%,!n=170),!but!nearly!10%!of!respondents!(9.3%,!n=37)!
indicated!they!had!already!sought!help!from!an!organization.!The!most!widely!known!sources!
of!support!were!Vivre!Plus!and!PILS13.!
!
Over!one!quarter!recommended!either!advocating!for!the!rights!of!all!PLHIV!(28.6%,!n=114)!or!
raising! the! awareness! and! knowledge! of! the! public! about! AIDS! (26.6%,! n=106)! as! the! most!
important!thing!organisations!should!do!to!address!stigma!and!discrimination.!!
(
(
Stigma(Index(
!
Health(services,(including(in(prisons(
Respondents’! selfBassessed! health! status! is! relatively! poor,! with! over! half! (57.1%! n=228)!
indicating! that! their! current! health! was! ‘fair’! or! ‘poor’.! Over! 40%! of! respondents! (41.3%,!
n=237)!reported!taking!a!HIV!test!just!to!know!their!status,!while!over!a!third!(35.2%,!n=138)!
were! offered! testing! when! accessing! health! services,! including! upon! hospital! admission,!
methadone!centre,!during!pregnancy!or!by!an!outreach!caravan!(NEP!or!PILS);!and!a!quarter!
upon! entry! into! prison! (23.5%,! n=92).! Fewer! than! 10%! (7.1%! n=28)! were! referred! for! HIV!
testing!when!already!symptomatic.!
!
The! findings! underscore! a! consistent! pattern! of! denial! of! the! rights! of! PLHIV! in! health! care!
settings14,! including! SRH! rights15.! Prevention! of! motherBtoBchild! (PMTCT)! services! provide!
generally! appropriate! services,! with! small! exceptions16.! Internal! stigma! among! respondents!
affects! access! to! health! care:! 25.1%! of! respondents! (n=100)! had! avoided! going! to! a! hospital!
and!20.4%!(n=80)!had!avoided!going!to!a!local!clinic!when!needing!care.!
!
Legal(and(human(rights(
The!highest!levels!of!discrimination!were!reported!in!access!to!health!care!(28%,!n=122)!and!
accommodation.! During! the! previous! 12! months,! over! 10%! of! respondents! (13.6%,! n=54)!
reported! having! been! subjected! to! one! or! more! discriminatory! practices! by! governmental,!
legal,! and/or! medical! institutions.! The! most! common! form! was! denial! of! health! or! life!
insurance! (6.3%,! n=25).! Disclosure! of! a! respondent’s! HIV! status! without! their! consent! was!
uncommon.!
!
Seeking!redress!for!rights!violations!appears!not!to!be!a!viable!option!for!most!respondents.!Of!
53! respondents! experiencing! rights! violation! in! governmental,! legal,! and/or! medical!
institutions,!only!17%!(n=9)!had!tried!to!get!legal!redress.!Further,!of!25!respondents!who!had!
not!sought!legal!redress,!15!felt!that!the!process!was!too!bureaucratic!and!four!had!little!to!no!
confidence!in!the!outcome.!!
!
At! the! policy! level,! over! 40%! of! respondents! (40.9%! n=163)! had! been! involved! in! efforts! to!
develop!HIVBrelated!legislation,!policies!or!guidelines,!and!nearly!90%!(89.5%,!n=357)!felt!able!
to!influence!policies,!laws!and!programmes!at!either!local!or!national!levels.!This!engagement!
is!reflected!in!over!half!of!respondents!(57.5%,!n=227)!knowing!of!the!Mauritian!HIV!and!AIDS!
Act!2006,!of!whom!41%!(n=93)!had!read!or!discussed!it.
Recommendations(
Recommendations!were!drafted!at!a!stakeholders!meeting!held!at!the!Goldcrest!Hotel,!Quatre!
Bornes,!26!April!2013,!at!which!the!results!of!the!Stigma!Index!were!presented!and!discussed.!
Recommendations! were! made! in! the! following! areas:! GIPA,! social! and! economic!
Mauritius(
empowerment;! health! services,! including! in! prisons;! and! legal! and! human! rights.!
Recommendations! address! the! policy,! systems! and! service! delivery! levels.! In! addition,! a!
number! of! follow! up! smallBscale! studies! are! recommended.! Major! recommendations! are!
outlined!below!with!the!full!recommendations!presented!in!the!Recommendations(section.!
1.(GIPA(Social(and(Economic(Empowerment((
•
•
•
•
•
Disseminate! the! findings! of! this! study! to! government,! civil! society,! UN! agencies! and!
donors.!
Advocate! with! the! Ministry!of! Home! Affairs,! Ministry! of! Social! Security,! and! National!
Empowerment!Foundation!to!cater!for!the!specific!needs!of!the!most!vulnerable!(i.e.!
key!populations)!
Support!the!ongoing!active!participation!of!PLHIV!in!the!development!of!laws,!policies!
and!guidelines,!and!in!providing!communityBbased!services!and!support17.!
Integrate! Positive! Health,! Dignity! and! Prevention! programs18! at! all! levels! (i.e.! policy!
through! Behaviour! Change! Communication! Committee,! and! systems! and! service!
delivery!through!NGOs).(
Reinforce! public! awareness! of! HIV! through! updated! education! and! mass! media! (e.g.!
TV,!radio!and!SMS)!campaigns,!and!through!implementation!of!the!Behaviour!Change!
Communication! strategy,! using! the! message:! ‘le! sida! est! une! infection! comme! les!
autres.’!
(
2.(Health(Services(
• Develop! an! action! plan! to! adapt! services! to! the! needs! of! PWID,! young! people,! and!
people!in!prisons.!
• Address! human! resources! constraints! through:! increased! health! personnel! in! the!
NDCCI! to! improve! service! quality;! policy! development! for! prevention! of! burnout!
among! health! care! workers,! including! task! shifting! and! task! sharing;! communication!
strengthening! and! encouragement! of! referral! between! doctors! in! the! NDDCI! and!
•
•
•
•
public!hospitals.!
Develop! and! support! stigma! and! discrimination! monitoring! systems! in! health! care!
settings.!!
Increase! communication,! awareness! and! sensitisation! on! HIV! prevention,! treatment,!
care!and!support!and!other!blood!borne!viruses!for!dentists!and!related!staff.!
Institute! a! system! of! prison! patient! appointment! cards! in! conjunction! with! improved!
logistics!(e.g.!private!and!confidential!consultation!rooms)!to!improve!service!quality!in!
prisons.!
Train!and!educate!all!prison!staff!on!HIV,!STIs!and!blood!borne!infections,!along!with!
the! provisions! of! the! Mauritian! HIV! and! AIDS! Act! 2006! and! Equal! Opportunities! Act!
2008.!
(
(
(
(
Stigma(Index(
3.(Legal(and(Human(Rights(
• Advocate!with!the!Ministry!of!Home!Affairs!to!take!steps!to!align!policing!with!public!
health!efforts!targeting!vulnerable!groups.!
• Review! drug! useBrelated! laws,! including! the! Dangerous! Drugs! Act! 2000,! and!
regulations19.!
•
•
•
Review! and! reform! laws! and! protocols! on! drug! use! in! prisons! in! line! with! UN!
guidance20.!
Train! police,! particularly! the! hierarchy,! on! public! health! efforts! targeting! vulnerable!
groups!and!the!role!of!law!enforcement!in!enabling!these!interventions.!
Establish!broadBbased!legal!aid!services!to!meet!the!needs!of!PLHIV,!women!and!young!
people! as! well! as! key! populations,! including! men! who! have! sex! with! men,! migrant!
workers,!people!who!use!drugs,!detainees,!sex!workers!and!transgenders.!
!
The! National! Strategic! Framework! 2013B2016! details! the! plan! to! address! issues! relating! to!
stigma! and! discrimination.! In! light! of! the! results! of! the! Stigma! Index! study! in! Mauritius,! the!
specific! recommendations! listed! above! will! be! undertaken! as! part! of! Impact! 3! of! the! NSF,!
21
which!aims!to!eliminate!HIVBrelated!stigma!and!discrimination. !
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Introduction(
Background
Stigma! is! widely! recognized! as! a! barrier! to! accessing! HIV! prevention,! treatment,! care! and!
support.!Much!of!what!is!known!about!HIVBrelated!stigma!and!discrimination!is!anecdotal!or!
fragmented.! People! living! with! HIV! experience! stigma! B! both! internal! and! external! B! that!
impacts!their!ability!to!optimally!make!use!of!intervention!services.!Strategies!to!address!HIVB
related!stigma!are!not!well!understood,!impacting!the!quality!and!accessibility!of!programmes!
and! service! delivery.! A! betterBinformed! and! evidenceBbased! understanding! of! stigma! and!
discrimination! is! required! in! order! to! provide! effective! services! that! take! into! account! the!
realities!of!stigma!faced!by!PLHIV.!
!
Stigma(Index(
22
The! People! Living! with! HIV! Stigma! Index ! (Stigma! Index)! is! the! result! of! a! partnership!
between:!
•
•
•
•
GNP+!(the!Global!Network!of!People!Living!with!HIV).!
ICW!(the!International!Community!of!Women!living!with!HIV).!
IPPF!(The!International!Planned!Parenthood!Federation).!
UNAIDS!(Joint!United!Nations!Programme!on!HIV/AIDS).!
!
The! Stigma! Index! is! an! international! collaborative! project! that! aims! to! develop! an! evidence!
base! to! broaden! understanding! of! the! extent! and! forms! of! stigma! experienced! by! PLHIV! in!
different! countries.! It! is! a! survey! tool! to! describe! HIVBrelated! stigma! faced! by! PLHIV,!
supported! by! a! user! guide,! process,! and! an! international! partnership! to! ensure! that! local!
implementing! partners! are! able! to! take! advantage! of! well! developed! guidance! in! order! to!
conduct!the!study!ethically!according!to!agreed!standards,!and!to!address!any!reliability!and!
validity!concerns.!It!utilizes!participatory!and!operational!research!methodologies.!
!
The!Stigma!Index!was!designed!to!fill!this!gap!not!only!within!the!Mauritian!context,!but!also!
to! contribute! to! global! understanding! of! stigma! and! its! consequences.! This! study! will!
contribute!to!these!efforts.!It!makes!use!of!inferential!analysis,!aims!to!increase!advocacy!and!
to! build! the! evidence! base! to! inform! policy! and! programme! changes,! addressing! HIVBrelated!
stigma.!
!
Country Context
During! the! 1990s,! there! were! very! few! people! diagnosed! HIVBpositive! in! Mauritius.! As! from!
2000,! HIV! and! AIDS! registered! cases! doubled! each! year,! reaching! a! peak! of! 921! people!
diagnosed! HIVBpositive! in! 2005.! HIV! incidence! reached! a! plateau! in! 2006! with! an! average! of!
(
(
Stigma(Index(
540!people!diagnosed!HIVBpositive!annually!until!a!downward!trend!began!in!2011,!marked!by!
a!drop!to!401!observed!cases!(Figure(1).!HIV!prevalence!is!estimated!to!be!0.97%!(confidence!
intervals!0.6%!B!1.96%23)!with!an!estimated!8!000!people!living!with!HIV.!At!the!end!of!2012,!
5_508! people! had! been! diagnosed! HIVBpositive,! including! 4! 375! males! (79.4%)! and! 1! 133!
females!(20.6%).!
!
1000!
921(
Total(cases(
900!
PWID(
Others(
800!
847!
700!
600!
546(
542(
525(
500!
538(
548(
387!
400!
437!
457!
466!
400!
568(
415!
401(
320(
273!
300!
225(
200!
100!
0!
98(
151!
149!
50( 55(
49(
1!
51(
4!
151(
84(
14! 77(
68(
74(
76(
109(
148(
153(
128(
169(
2000! 2001! 2002! 2003! 2004! 2005! 2006! 2007! 2008! 2009! 2010! 2011! 2012!
!
Figure!1:!PWIDs!compared!to!others!in!newly!detected!HIV!cases!from!2000!to!2012
!
General!Population!
The!HIV!epidemic!in!Mauritius!is!concentrated.!Prevalence!among!pregnant!women!attending!
antenatal! care! is! estimated! at! 0.4%! (note! that! 95%! of! pregnant! women! are! tested! for! HIV),!
while!prevalence!is!above!5%!among!key!populations.!HIV!prevalence!among!pregnant!women!
aged!15B49!has!remained!between!0.4%B0.5%!since!2009.!This!data!has!been!used!as!a!proxy!
indicator!for!HIV!prevalence!among!young!people!aged!15B24!years.!!
!
Key!Populations!
Data! from! Integrated! Behavioural! and! Biological! Surveillance! (IBBS)! surveys! indicated! that!
prevalence! rates! are! 51.6%! among! a! group! of! 10! 000! people! who! inject! drugs! (PWID)! in! the!
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Port! Louis! region! (2011)24,! 22.3%! among! an! estimated! population! of! 9! 125! sex! workers!
(2012)25,! 28.4%! among! 2! 675! prison! inmates! (2012)26,! and! prevalence! of! 20.0%! for! an!
estimated!population!of!8!000!MSM!(2010)27.!
!
Since! 1987,! injecting! drug! use! was! the! reported! route! of! transmission! in! 73%! of! people!
diagnosed! HIVBpositive28.! Following! the! introduction! of! harm! reduction! measures! in! 2006,!
prevalence!among!PWID!has!steadily!decreased!to!reach!47.2%!of!reported!diagnoses!in!2012.!
People! who! inject! drugs! suffer! from! high! levels! of! stigma! and! discrimination:! 72%! of! PWID!
reported! ever! having! been! refused! a! service! because! of! their! injection! drug! use29.! Stigma! by!
police! and! health! care! officers! is! the! most! common! source! of! experienced! stigma.! Although!
the!Needle!Exchange!Programme!has!been!implemented!for!over!five!years,!many!PWID!still!
report! sharing! needles,! and! almost! half! of! the! sample! reported! that! they! purchase! their!
needles! from! pharmacies30.! The! government! introduced! the! Methadone! Substitution!
Programme! (MST)! in! 2006,! as! part! of! the! Harm! Reduction! package,! including! in! places! of!
detention.!At!present,!5!500!clients!are!in!the!MST!programme.!
!
HIV! epidemics! in! Mauritius! are! linked.! Mapping! of! HIV! cases! shows! a! concentration! in!
economically! deprived! areas! such! as! suburban! regions! in! which! sex! work! and! drug! use! are!
more!prevalent,!focused!around!the!capital!of!Port!Louis!(Figure(2).!
(
(
Stigma(Index(
Figure!2:!HIV!epidemic!geographic!distribution!in!Mauritius!in!2011!
!
The! IBBS! among! female! sex! workers! (2010)! found! that! 40%! of! the! sex! workers! also! inject!
drugs31.!Sexual!and!drug!using!networks!within!these!subpopulations!are!likely!to!overlap!and!
constitute! a! “bridge! population”! to! the! general! population.! In! particular,! sex! worker! clients!
and!partners!of!PWID!(sexual!and!drug!partners)!comprise!the!major!demographics!of!bridging!
populations.!!
!
Female!sex!workers!have!limited!access!to!treatment!for!sexually!transmitted!infections!(STIs)!
due! to! stigmatization,! resulting! in! increased! biological! susceptibility! to! HIV! infection.! Low!
knowledge! of! HIV! and! STIs,! low! condom! use! and! the! high! numbers! of! sexual! contacts! by!
female! sex! workers! with! both! paying! and! nonBpaying! partners! increases! the! risk! of! HIV!
transmission!to!sex!partners,!and!from!these!sex!partners!to!the!general!population.!
Mauritius(
(
Although!homosexuality!is!largely!tolerated!in!Mauritius,!men!who!have!sex!with!men!(MSM)!
remain! hidden! because! of! social! stigma! and! discrimination.! Among! MSM,! there! is! a! bisexual!
concurrency! rate! of! 35%32.! High! levels! of! high! risk! sexual! behaviour(s),! low! condom! use! and!
high! numbers! of! sexual! contacts! reported! by! MSM! increase! the! risk! of! HIV! transmission! to!
their! male! and! female! sex! partners.! Low! knowledge! of! HIV! and! STIs,! injecting! drug! use,! and!
stigma! and! discrimination! are! additional! factors! that! significantly! increase! HIV! transmission!
risk!among!MSM!populations.!
!
HIV4related!death!
As! of! December! 2012,! the! total! number! of! known! AIDSBrelated! registered! deaths! was! 674.!
There! has! been! an! annual! average! of! 52! deaths! between! 2005! and! 2009,! with! 93! deaths!
reported!in!2010,!dropping!to!54!in!2012!(Figure(1).!
!
Access!to!treatment!
The! Government! of! Mauritius! provides! ART! free! of! charge! to! eligible! PLHIV.! In! 2012,! 1! 527!
adults!and!children!were!taking!ART.!Additionally,!95.5%!of!pregnant!women!received!ART!for!
PMTCT33.!!
!
About the Civil Society Response
The!Ministry!of!Health!and!Quality!of!Life!began!the!AIDS!response!in!Mauritius!in!1987!and!
organized!civil!society!involvement!began!in!1996!when!Prévention,!Information!Lutte!contre!
le! SIDA! (PILS)! was! founded.! By! 2001,! the! number! of! diagnosed! HIVBpositive! people! had!
doubled!to!over!280,!and!in!2002,!Vivre!Plus,!the!Mauritian!Network!of!People!Living!with!HIV,!
and! RAVANE+,! the! Indian! Ocean! Network! of! People! Living! with! HIV! was! launched.! In! 2012,!
Vivre! Plus,! an! NGO! for! PLHIV,! was! officially! registered! as! a! nongovernmental! organization!
(NGO).!
!
The! civil! society! response! also! includes! other! NGOs! that! help! key! affected! populations,! for!
example:!Chrysalide!supports!women!in!difficulty;!Lacaz!A!is!a!day!centre!that!provides!food,!
lodging! and! assists! homeless! people! and! other! in! difficulty;! VizaG! supports! the! transgender!
population,! Collectif! ArcBenBCiel! supports! men! who! have! sex! with! men;! and! Kinouete! assists!
exBdetainees!in!social!reintegration.!!
!
Objectives
The! purpose! of! this! study! was! to! collect! information! on! stigma! and! discrimination! against!
people!living!with!HIV!in!Mauritius.!!
(
(
Stigma(Index(
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)!so!as!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.!
!
In! addition,! the! process! of! implementing! the! Stigma! Index! is! intended! to! be! an! empowering!
one! for! PLHIV,! networks! and! local! communities! –! a! critical! ingredient! for! ensuring! that! the!
Greater!Involvement!of!People!Living!with!HIV/AIDS!(GIPA)!Principle!is!fulfilled.!Ultimately,!the!
Stigma! Index! process! supports! the! collective! goal! of! PLHIV! networks! and! partners,! including!
government,! communityBbased! organisations,! activists! and! PLHIV,! to! reduce! HIVBrelated!
stigma!and!discrimination.!
!
Methodology
Study!Coordination!
The! National! AIDS! Secretariat! (NAS),! Prime! Minister’s! Office,! led! this! baseline! Stigma! Index!
study.! A! steering! committee,! including! representatives! from! NAS,! Ministry! of! Health! and!
Quality!of!Life,!and!civil!society,!including!Vivre!Plus,!PILS,!Lacaz!A!and!Chrysalide,!guided!the!
process.!!
!
Study!Population!and!Sampling!
The! study! population! was! PLHIV! 18! years! or! older! in! Mauritius,! employing! snowball! and!
respondentBdriven!sampling.!The!target!sample!size!of!400!people,!300!men!and!100!women,!
reflects! the! sex! ratio! of! the! Mauritian! epidemic.! In! addition,! targeted! sampling! was! used! to!
ensure!that!PLHIV!who!do!not!access!health!or!psychosocial!services,!transgender!PLHIV,!and!
PLHIV! who! are! not! part! of! any! key! population! were! included.! Interviewees! were! sourced!
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though!local!NGOs,!including!Vivre!Plus,!PILS,!Chrysalide,!Lacaz!A,!Centre!Idrice!Goomany!(CIG),!
Kinouete!and!VizaG,!as!well!as!through!interviewers’!personal!networks.!
!
The!final!sample!size!was!399!people,!including!250!male!(62.7%),!131!female!(32.8%)!and!18!
transgender!(4.5%).!!
!
Interviewers!
Eleven!interviewers!were!recruited!from!local!NGOs,!including!CIG,!Kinouete,!VizaG,!PILS!and!
Vivre! Plus.! A! general! call! for! nominations! was! made! to! NGOs! and! local! networks,! seeking!
literate! HIVBpositive! people,! preferably! with! experience! in! interviewing! and/or! social! work,!
interested! in! participating! in! the! Stigma! Index! study.! Eleven! interviewers! with! the! requisite!
skills!were!selected!and!trained!on!HIVBrelated!stigma,!the!Stigma!Index!questionnaire!and!its!
administration,! confidentiality,! etc.! during! a! twoBday! training! session! led! by! NAS! on! 7B8!
February! 2013.! Additionally,! a! field! supervisor! was! selected! from! among! the! interviewers! to!
oversee!the!data!collection!process.!!
!
Ethical!Considerations!
Prior! to! implementing! the! Stigma! Index! study,! approval! was! sought! and! obtained! from! the!
National!Ethics!Committee!of!Mauritius,!Ministry!of!Health!and!Quality!of!Life.!!
!
Questionnaire!
This! study! used! the! People! Living! with! HIV! Stigma! Index! Survey! Questionnaire! for! the!
interviews,! and! followed! the! guidance! provided! in! the! People! Living! with! HIV! Stigma! Index!
User! Guide! for! organization! and! training! prior! and! during! the! study,! available! at!
www.stigmaindex.org!
!
The! questionnaire! was! translated! into! Mauritian! Creole! (see! Annex( 1)! and! covers! the!
perceptions!of!stigma!and!discrimination!of!people!living!with!HIV!in!the!following!10!areas:!
•
•
•
•
•
•
•
Experiences!of!stigma!and!discrimination!and!their!causes!
Access!to!work!and!services!
Internal!stigma!
Rights,!laws!and!policies!
Effecting!change!
HIV!testing!
Disclosure!and!confidentiality!
•
•
•
Treatment!
Having!children!
Problems!and!challenges!
!
Questions! almost! exclusively! refer! to! respondents’! experiences! during! the! previous! twelve!
(
(
Stigma(Index(
months.!However,!some!questions!inquire!into!lifetime!(or!since!diagnosis)!experiences.!In!this!
report,!unless!stated!otherwise,!the!results!relate!to!respondents’!experiences!in!the!previous!
twelve!months.!
!
Data!Collection!!
Data!was!collected!between!8!March!and!10!April!2013,!from!PLHIV!who!fulfilled!the!following!
eligibility!criteria:!
•
•
•
Able!and!willing!to!give!consent!to!participate!in!the!study;!
18!years!of!age!or!older;!and!
Residing!in!the!island!of!Mauritius.!
The!study!protocols!in!Creole!completed!during!faceBtoBface!interviews!included!a!structured!
questionnaire!and!an!informed!consent!form.!Participants!were!informed!both!verbally!and!in!
the! informed! consent! form! about! their! right! to! refuse! to! participate! or! to! interrupt! their!
participation!at!any!stage!of!interview!without!any!consequences.!
!
Participants! were! provided! with! Rs! 100! to! reimburse! their! transportation! costs.! It! was! made!
clear!that!this!sum!was!not!payment!for!their!participation!in!the!study.!!
!
In!order!to!maintain!confidentiality,!the!questionnaire!was!anonymous!and!no!information!was!
collected! which! could! be! used! to! identify! interviewees.! Participants! were! identified! with! a!
unique! nonBidentifying! code! on! each! individual’s! questionnaire! and! data! entry! files.! These!
were!kept!at!the!NAS!in!a!secure!location,!and!no!one!except!the!research!team!was!permitted!
to!access!the!information.!The!completed!questionnaires!were!housed!at!the!NAS!during!study!
completion!then!were!destroyed!at!the!end!of!the!study.!
!
Data!quality!control!
Steps! were! taken! to! ensure! that! data! from! each! questionnaire! was! appropriately! captured,!
including:!
•
Instructions!to!the!interviewers!during!the!training!session!to!make!comments!next!to!
unanswered!questions!in!order!to!explain!if!an!omission!was!purposeful!and,!if!so,!the!
reason.!
•
Once!surveys!were!completed,!interviewers!returned!the!completed!questionnaire!to!
the! field! supervisor! who! reviewed! the! questionnaire! and! checked! for! information!
gaps.!Only!once!they!had!been!checked!and!approved!were!interviewers!given!more!
blank!questionnaires.!!
•
During!data!entry,!data!was!crosschecked!and!cleaned!by!the!data!entry!manager.!
•
During!analysis,!to!the!extent!possible!and!when!necessary,!data!analysts!crosschecked!
data!for!consistency.!
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Data!analysis!
Data! was! entered! into! the! Statistical! Package! for! Social! Science! (SPSS)! software,! version! 18.!
Analysis! was! undertaken! primarily! using! Excel! software! supplemented! by! SPSS! when!
appropriate.!The!results!presented!are!based!on!the!analysis!of!399!valid!questionnaires.!Note!
that! respondents! were! free! not! to! answer! any! question! and! as! a! result! there! are! questions!
where!data!is!missing,!referred!to!as!‘no!response’!in!the!report.!
!
Data!Validation!
A! stakeholders! meeting! was! held! at! the! Goldcrest! Hotel,! Quatre! Bornes,! on! 26! April! 2013! at!
which! the! results! of! the! Stigma! Index! were! presented! and! discussed! with! draft!
recommendations!formed.!The!list!of!represented!organisations!is!included!in!Annex(2.!
!
Study limitations and challenges
Questionnaire:!
Translation!of!the!Stigma!Index!questionnaire!into!Creole!created!a!number!of!specific!issues,!
including:!!
•
Section! 2B,! questions! 8! and! 9! were! collapsed! into! one! question! covering! family!
planning! and! sexual! health,! as! it! is! not! possible! to! distinguish! ‘sexual! health’! from!
‘reproductive!health’!in!Creole.!!
•
Section!3A,!question!2:!interpretation!of!“I!was!forced!to!take!an!HIV!test”!in!the!sense!
of!coercion!and!its!translation!of!‘fine!force’.!
Other!issues!in!relation!to!the!questionnaire!included:!
(
•
Section! 1,! question! 8! in! relation! to! physical! disability.! Many! respondents! not! only!
provided!a!yes/no!response!but!went!on!to!provide!information!about!their!‘disability’.!
These! responses! indicated! minor! ailments! rather! than! physical! disability! as! generally!
understood.!It!is!possible!that!both!interviewers!and!interviewees!misunderstood!the!
intent!of!this!question.!This!question!was!excluded!from!the!analysis.!!
•
Section! 1,! question! 15! in! relation! to! number! of! days! per! month! without! food.! Many!
respondents! gave! qualitative! answers! rather! than! quantitative! answers! (“a! few”,!
“many”,!etc.)!After!discussion,!the!general!consensus!was!to!translate!these!answers!
into!a!quantitative!amount!(i.e.!2!for!“a!few”!and!5!for!“many”).!
•
Section! 2B,! question! 3! in! relation! to! whether! refused! employment! or! a! work!
opportunity! because! of! HIV! status.! The! questionnaire! asks! that! only! those! employed!
answer! this! question;! however,! many! unemployed! people! living! with! HIV! answered!
this! question,! and! in! fact! this! group! encountered! the! highest! level! of! discrimination.!
The!responses!of!unemployed!interviewees!who!responded!to!this!question!have!been!
included!in!the!analysis.!!
•
Section! 2C,! question! 1B3:! a! category! of! ‘none! of! these/no! to! all’! would! assist! in! data!
(
Stigma(Index(
analysis! of! each! question! as! well! as! providing! an! overall! assessment! of! no! internal!
stigma.!!
•
Section! 3B,! question! 3! in! relation! to! disclosure! of! respondent’s! HIV! status! without!
consent! by! a! health! care! professional! to! other! health! care! workers! and! whether!
interviewees! are! cognizant! of! the! concept! of! ‘shared! confidentiality’! among! health!
care! workers! involved! in! a! person! living! with! HIV’s! treatment! and! care! team!
implemented!in!Mauritius.!What!exactly!interviewees!meant!in!answering!‘yes’!is!open!
to! various! potentially! divergent! interpretations! such! as! shared! confidentiality! being!
perceived!as!a!breach!of!confidence!by!a!health!care!professional!by!the!interviewee.!
Furthermore,!this!question!asks!about!‘ever!told’,!which!includes!breaches!at!any!time!
since!diagnosis.!!
•
Section!3C,!question!2b!in!relation!to!access!to!ART.!In!the!original!questionnaire,!this!
question! is! footnoted! to! explain! that! ‘access’! means! free! and/or! available! at! a!
reasonable!cost.!In!the!translated!questionnaire,!the!question!was!translated!with!this!
addressed!in!the!question!itself,!as!“are!you!able!to!get!access!to!free!ART!even!if!you!
are! not! currently! taking! it”.! It! is! possible! that! some! interviewees! answered! this!
question!in!relation!to!their!knowledge!of!whether!treatment!is!free,!rather!than!the!
intended!answer!of!whether!they!know!about!treatment!access!in!general.!!
!
Sampling!
Efforts!were!taken!in!the!survey!design!and!interviewing!phases!to!include!the!broadest!range!
of! PLHIV! possible! within! funding! and! time! constraints.! The! sample! distribution! was! closely!
indicative! of! the! Mauritian! epidemic! in! terms! of! sex! ratio.! However,! in! terms! of! key!
populations,! which! comprised! over! 75%! of! the! sample,! as! there! are! neither! representative!
data!to!describe!the!HIV!prevalence!and!associated!risk!behaviours!among!PWID,!sex!workers,!
MSM! and! other! key! populations! nor! are! there! accurate! data! on! the! size! of! these! key!
populations! in! Mauritius.! The! results! are!indicative!of!the!range!of!experiences!of!PLHIV!and!
key!populations!in!Mauritius,!though!cannot!be!generalized.!The!results!provide!a!baseline!to!
measure!changes!in!stigma!and!discrimination!over!time!as!well!as!guidance!on!targeting!and!
designing!policies,!programmes!and!services!in!the!short!and!long!terms.!
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What is in this report?
This!report!follows!the!content!of!the!questionnaire!and!is!divided!into!six!sections:!
•
•
Section!1:!General!information!about!the!respondent!and!his/her!household.!
Section! 2:! Reported! experiences! of! HIVBrelated! stigma! and! discrimination;! internal!
stigma;!the!protection!of!the!rights!of!PLHIV!through!law,!policy!and/or!practice;!and!
effecting! change! at! household! and! community! levels! in! responding! to! stigma! and!
discrimination.!
•
•
Section!3:!Experience!of!testing,!disclosure,!treatment!and!having!children.!
Section!4:!Respondents’!opinions!on!the!main!problems!and!challenges!in!relation!to!
HIV! testing! and! diagnosis,! disclosure! and! confidentiality,! ART! and! having! children!
through!a!series!of!openBended!qualitative!questions.!
!
Finally,!conclusions!and!recommendations!are!presented.!
!
(
(
Stigma(Index(
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Section(1:(Background(characteristics(and(
household(composition(
This!section!presents!general!background!information!about!people!living!with!HIV!involved!in!
the!study.!
1.1 Gender and Age
A!sample!of!399!respondents!was!interviewed!of!whom!250!(62.7%)!were!male,!131!(32.8%)!
female!and!18!(4.5%)!were!transgender!(Figure(3).!The!gender!distribution!of!the!respondents!
generally!reflects!the!HIV!epidemic!in!Mauritius,!which!was!79.4%!male!and!20.6%!female!in!
34
December! 2012 .! No! official! data! has! yet! been! collected! on! HIV! prevalence! among!
transgender.!
!
250!
131!
95!
85!
52!
41!
2! 3! 0!
15!10! 3!
21!18!
0!
6!
8!
15,19!
20,24!
25,29!
30,39!
40,49!
32!
Male!
Female!
18!
7! 1!
50+!
!
Transgender!
Total!
Age!Group!
Figure!3:!Age!distribution!of!respondents,!disaggregated!by!gender!
!
Respondents’!ages!ranged!from!18B50!years!and!above.!Over!one!third!of!respondents!(38%,!
n=153)! were! aged! 30B39! years! with! over! another! third! (34%,! n=134)! aged! 40–49! years.! Ten!
percent!were!aged!25B29!(n=39)!or!50!years!of!age!or!older!(n=40)!with!seven!percent!(n=28)!
aged!20B24!years!while!only!one!percent!(n=5)!were!aged!18B19!(Figure(3).!
!
The!highest!percentages!of!both!males!(23.8%,!n=99)!and!females!(13%,!n=52)!were!in!the!30–
39! age! group,! followed! by! males! (21.3%,! n=85)! and! females! (10.3%,! n=41)! in! the! 40–49! age!
group.!In!the!50!and!above!age!bracket,!8%!of!respondents!(n=32)!were!male!and!only!about!
2%!female!(n=7).!All!but!four!of!the!18!transgender!respondents!were!aged!between!30!and!49!
years!(Figure(3).!
!
(
(
Stigma(Index(
1.2 Length of time living with HIV35
Nearly!40%!of!respondents!had!been!living!with!HIV!for!1B4!years!(38.8%,!n=153)!or!5B9!years!
(39.3%,!n=155).!Over!10%!of!respondents!had!been!living!with!HIV!between!10!and!14!years!
(12.7%,!n=50)!with!less!than!10%!(6.9%,!n=27)!for!1–4!years,!and!just!over!two!percent!for!15!
years!or!more!years!(2.3%,!n=9)!(Figure(4).!
39%!
39%!
!
13%!
7%!
2%!
<1!year!
1,4!years!
5,9!years!
10,14!years!
>15!years!
Figure!4:!Length!of!time!living!with!HIV!(i.e.!since!diagnosis)!
!
1.3 Relationship status
About! one! third! of! respondents! were! married! or! cohabiting! and! currently! living! with! their!
partners!(31.8%,!n=127):!others!included!21%!of!respondents!(n=82)!being!in!a!relationship!but!
not!living!with!their!partners!(13.3%,!n=53),!or!married!or!cohabiting!but!the!spouse!or!partner!
is!temporarily!away!from!the!household!(6%,!n=24).!Over!40%!of!respondents!(43.4%,!n=173)!
were!single!(unmarried,!divorced!or!widowed)!(Figure(5).!!
Married!or!Cohabiting!
18!
22!
33!
127!
Married!or!Cohabiting!but!
Partner!Temporarily!Away!
In!a!Relationship!but!Not!
Living!Together!
Single!
!
Divorced/Separated!
122!
24!
53!
Widowed!
No!Response!
Figure!5:!Relationship!status!of!the!respondents(
!
Of!the!219!respondents!who!responded!to!the!question!about!the!number!of!years!they!had!
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been!in!relationships,!36!(16.4%)!had!been!with!their!spouse!or!partner!for!less!than!a!year,!80!
(36.5%)!for!1B4!years,!45!(20.5%)!for!5–9!years,!29!(13.2%)!for!10B14!years!and!29!(13.2%)!for!
15!or!more!years!(Figure(6).!!
36.5%!
20.5%!
16.4%!
<1!year!
1,4!years!
5,9!years!
13.2%!
13.2%!
10,14!years!
>15!years!
Length!of!Time!in!a!Relationship!
Figure!6:!Number!of!years!in!relationship!(n=219)
!
1.4 Sexual activity
About! two! thirds! of! the! respondents! (n=271)! reported! being! sexually! active! while! over! one!
quarter!(26.6%,!n=106)!were!not.!TwentyBtwo!respondents!(5.5%)!did!not!answer!(Figure(7).!!
5.5%!
Sexually!Active!
26.6%!
Not!Sexually!Active! !
67.9%!
No!Response!
Figure!7:!Sexual!activity!of!respondents!!
!
When! disaggregated! by! relationship! status,! approximately! 90%! of! married! or! cohabitating!
respondents!(89.0%,!n=121)!and!those!in!a!relationship!but!not!living!together!were!sexually!
active! (92.7%,! n=51);! while! nearly! three! quarters! of! those! married! or! cohabiting! but! the!
partner! was! temporarily! away! (74.1%,! n=20)! were! sexually! active.! Half! of! single! respondents!
(n=63)!were!sexually!active!whereas!less!than!40%!of!divorced!or!separated!(38.2%,!n=13)!and!
only!14.3%!(n=3)!of!widowed!respondents!were!sexually!active!(Figure(8).!
(
(
Stigma(Index(
Widowed!
Divorced/Separated!
Single!
In!a!Relationship!but!Not!Living!
Together!
Sexually!Active!
Not!Sexually!Active!
Married!or!Cohabiting!but!Partner!
Temporarily!Away!
!
No!Response!
Married!or!Cohabiting!
,10!
40!
90!
Number!of!Repondents!
140!
Figure!8:!Whether!respondents!were!sexually!active!or!not,!disaggregated!by!relationship!
status!
!
1.5 Key populations
The!largest!group!of!key!population!respondents!were!PWID!(60.9%,!n=243).!Over!40%!(41.4%,!
n=103)!reported!being!an!exBdetainee,!and!nearly!one!quarter!(23.1%,!n=92)!did!not!identify!
with!any!of!these!groups.!About!16%!of!all!genders!identified!as!a!sex!worker!(15.8%,!n=63).!
Both!males!and!transgenders!identified!as!men!who!have!sex!with!men:!17.6%!of!males!(n=44)!
and!22.2%!of!transgenders!(n=4).!The!percent!of!respondents!identifying!as!belonging!to!other!
key!populations!such!gay!or!lesbian,!migrant!worker!or!transgender!ranged!from!1.8%!to!3.5%.!
Though! these! groups! are! small,! it! is! important! to! consider! them! as! they! may! provide! insight!
into!stigma!faced!by!underrerepresented!groups!of!people!living!with!HIV!(Table(1).!
!
Table!1:!Respondents!disaggregated!by!key!population!and!gender(
(
Key(Population(
Men!who!have!sex!with!men!
Gay!or!lesbian!
Transgender!
Sex!worker!
People!who!inject!drugs!
Migrant!worker!
ExBdetainee!
None!of!these!
TOTAL!
Gender(%((n`value)(
Male(
Female(
Transgender(
17.6%!(44)!
0%!(0)!
22.2%!(4)!
2.4%!(6)!
0.8%!(1)!
0%!(0)!
0%!(0)!
0%!(0)!
77.8%!(14)!
2.8%!(7)!
41.1%!(53)!
22.2%!(4)!
73.6%!(184)!
41.1%!(53)!
27.8%!(5)!
1.2%!(3)!
3.1%!(4)!
0%!(0)!
53.6%!(134)!
20.2%!(26)!
27.8%!(5)!
12%!(30)!
47.3%!(61)!
5.6%!(1)!
63%!(250)! 32.5%!(129)!
4.5%!(18)!
(
Total*(
12%((48)!
1.8%((7)!
3.5%((14**)!
15.8%!(63)!
60.9%!(243)!
1.8%((7)!
41.4%((165)!
23.1%((92)!
!
*Note:!Totals!are!greater!than!100%!as!some!respondents!identified!as!belonging!to!more!than!one!key!population.!
**!Note!that!some!respondents!who!indicated!their!gender!as!transgender!(n=18)!did!not!respond!as!transgender!in!
relation!to!this!question!of!key!population.!
!
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Nearly! three! quarters! of! male! respondents! (73.6%,! n=184),! over! 40%! of! female! respondents!
(41.1%,!n=53)!and!over!a!quarter!of!transgender!respondents!identified!as!PWID.!Further,!over!
40%!of!female!respondents!(41.1%,!n=53)!and!over!20%!of!transgender!(22.2%,!n=4)!identified!
as!a!sex!worker.!Respondents!identifying!as!exBdetainees!were!50%!male!(53.6%,!n=134),!over!
20%!female!(20.2%,!n=26)!and!over!a!quarter!transgender!(27.8%,!n=5).!!
!
1.6 Education
Among!the!392!respondents!who!replied,!the!educational!level!was!generally!low,!with!6.1%!
(n=24)! reporting! no! formal! education! and! 58.7%! (n=230)! reporting! primary! level! education.!
Just! over! one! third! reported! secondary! school! education! (33.9%,! n=133)! with! less! than! 2%!
(1.3%,! n=5)! reporting! completed! tertiary! level! education! (Figure( 9).! When! disaggregated! by!
gender! there! was! no! significant! variation! between! female! and! male! respondents’! education!
level.!!
1.3%!
6.1%!
No!formal!education!
33.9%!
Primary!school!
Secondary!school!
58.7%!
Technical!college!or!
university!
Figure!9:!Respondents’!education!level!(n=392)!
!
1.7 Employment
Some! 224! respondents! (56.1%)! reported! being! unemployed! with! just! over! one! third! of!
respondents! reporting! some! form! of! employment! (35.1%,! n=140)! during! the! last! year.! This!
36
contrasts!sharply!with!an!estimated!national!unemployment!rate!of!7.9% .!!
!
Of!the!140!employed!respondents,!10.5%!(n=42)!were!in!full!time!employment!as!employees!
(9.5%,!n=38)!or!selfBemployed!(1%,!n=4),!while!24.5%!(n=98)!were!in!partBtime!employment,!as!
employee!(13.5%,!n=54)!or!selfBemployed!(11%,!n=44)!(Table(2).!!
!
(
(
Stigma(Index(
Table!2:!Respondents’!employment!status(
(
Employment(Status(
Full!time!work!as!employee!
Part!time!work!as!employee!
Full!time!work,!selfBemployed!
Part!time!work,!selfBemployed!
Unemployed!
No!response!
(
Gender(%((n`value)(
Male(
Female(
Transgender(
8.4%(21)!
9.9%(13)!
22.2%(4)!
12.0%(30)! 15.3%(20)!
22.2%(4)!
0.4%(1)!
1.5%(2)!
5.6%(1)!
14%(35)!
6.9%(9)!
0%!(0)!
54.4%!(136)! 61.1%(80)!
44.4%(8)!
10.8%(27)!
5.3%(7)!
5.6%(1)!
(
Total(
9.5%(38)!
13.5%(54)!
1%(4)!
11%(44)!
56.1%(224)!
8.8%(35)!
(
Figure( 10! shows! when! employment! status! is! disaggregated! by! gender! that! there! is! higher!
unemployment! among! female! (61%,! n=80)! than! male! (54.4%,! n=136)! respondents.! Male!
respondents!were!more!likely!to!be!selfBemployed,!part!time,!than!female!respondents!(14%,!
n=35!compared!to!6.9%,!n=9)!!
61%!
54%!
44%!
22%!
8%!
10%!
!
22%!
15%!
12%!
14%!
6%!
0%! 2%!
Full!Time!
Part!Time!
11%!
7%!
5%! 6%!
0%!
Full!Time!SE! Part!Time!SE! Unemployed!
Male!
Female!
Transgender!
No!response!
Figure!10:!Respondents’!employment!status,!disaggregated!by!gender(
!
Figure( 11! shows! that! when! employment! was! disaggregated! by! key! population,! the! highest!
numbers!of!unemployed!people!are!among!sex!workers!(n=44,!77.2%),!PWID!(n=149,!61.3%)!
and!exBdetainees!(n=96,!58.2%)!with!percentages!expressed!of!the!respective!population.!
(
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149!
96!
44!
5! 6! 0!
13!19!
3! 1! 1! 1! 0!
Men!who!
Gay!or!
have!sex!with! Lesbian!
men!
Full!Time!
2! 6! 0! 5!
3! 4! 1! 0! 5!
30! 26!
10!
2!
6!
0! 2! 1! 1! 3!
25! 19!
1!
!
Transgender! Sex!Workers! Person!who! Migrant! Ex,Prisoners!
Injects!Drugs! Workers!
Part!Time!
Full!Time!SE!
Part!Time!SE!
Unemployed!
Figure!11:!Respondents’!employment!status,!disaggregated!by!key!population(
(
1.8 Income
Of! the! 392! respondents! (98.2%)! who! responded! to! the! question! about! income,! 195! (48.9%)!
had!a!monthly!income!of!MRU!Rs!1!001!–!5!000!(USD!32!–!16037),!a!further!15.3%!(n=61)!report!
a!monthly!income!of!MRU!Rs!5!001!–!10!000!(USD!160!–!390),!2%!(n=8)!report!an!income!of!
MRU!Rs!10!001B15!000!(USD!390!B!480),!and!only!2.3%!(n=9)!report!a!monthly!income!of!over!
MRU!Rs!15!000!(USD!480).!As!over!50%!of!respondents!(56.1%)!were!unemployed,!110!(0.6%,!
n=5)!indicated!that!they!had!no!monthly!income!and!a!further!9!(2.3%)!indicated!an!income!of!
Rs!0!–!1!000!(Figure(12).!
!
As!the!official!median!monthly!income!was!MRU!Rs!14!640!(USD!468)!in!Mauritius!in!200738,!
96.9%! of! respondents! (n=383)! report! a! monthly! income! under! the! median,! highlighting! the!
socioBeconomic!disadvantage!prevalent!among!the!sample.!
Monthly!Income!in!Mauritian!
Rupees!
!
15!000!+!
9!
10!001!,!15!000!
8!
5!001!,!10!000!
61!
1!001!,!5!000!
195!
0!,!1!000!
9!
!
0!
110!
No!Response!
7!
0!
50!
100!
150!
200!
250!
Number!of!Respondents!
Figure!12:!Monthly!income!of!respondents!
!
(
(
Stigma(Index(
1.9 Household size
On! average! there! were! 2.7! persons! living! in! a! respondent’s! household! at! the! time! of! the!
survey.! At! least! 17%! of! respondents! (n=68)! reported! living! alone.! This! figure! may! be! a!
significant! underestimate,! as! there! is! uncertainty! as! to! whether! the! 77! people! reporting! one!
person!living!in!the!household!were!in!fact!referring!to!herself!or!herself,!or!to!another!person.!
If!the!former!were!the!case,!the!percentage!of!people!living!alone!would!increase!to!over!one!
third!(36%,!n=145)!of!respondents.!!
!
In! total! 31! respondents! reported! having! children! and! youths! living! in! their! households! who!
39
were! AIDS! orphans .! Of! these,! 14! listed! one! orphan,! another! 14! reported! two! orphans,! one!
listed!3!orphans,!and!2!listed!4!or!more.!NinetyBtwo!percent!of!respondents!reported!either!no!
AIDS!orphans!in!their!homes!or!did!not!reply!(Table(3).!!
!
Table!3:!Number!of!children!and!youth!in!household!who!are!AIDS!orphans!
Number(of(children(and(youths(who(are(AIDS(orphans(
Number(of(Respondents((%)(
None!/!Did!not!reply!
368!(92%)!
1!
14!(3.5%)!
2!
3!
14!(3.5%)!
1!(0.25%)!
4+!
2!(0.5%)!
!
1.10 Location
The!sample!included!159!respondents!residing!in!rural!areas!and!208!residing!in!a!city!on!the!
island! of! Mauritius.! As! Mauritius! is! a! relatively! small! island! nation,! data! has! not! been!
disaggregated!according!to!respondents’!place!of!residency.!!
1.11 Food Security
SixtyBeight!percent!(n=272)!of!all!respondents!provided!an!answer!to!the!question!related!to!
food! security.! While! 128! respondents! (32%)! indicated! there! was! no! day! in! the! last! month!
during!which!a!household!member!had!gone!without!food!i.e.!no!food!insecurity;!nearly!40%!
of! respondents! (39%,! n=144)! indicated! food! shortages! within! the! household! (Figure( 13).! Of!
these:!
•
22!(6%)!reported!moderate!food!shortages!i.e.!at!least!one!member!of!the!household!
did!not!have!enough!to!eat!1B2!times!during!last!month;!and!
•
122! (31%)! reported! serious! food! shortages! i.e.! 3! or! more! days! during! last! month! in!
which!at!least!one!member!of!the!respondent's!household!did!not!have!enough!to!eat.!
•
127!respondents!(32%)!did!not!provide!a!response.!
!
Mauritius(
32%!
32%!
Food!Secure!(0!days)!
Moderately!Food!Insecure!(1!
to!2!days!without!food)!
!
Seriously!Food!Insecure!(3+!
days!without!food)!
No!Response!
6%!
31%!
Figure!13:!Food!insecurity!levels!in!participants’!household!in!the!past!month!
(
(
Stigma(Index(
Mauritius(
Section(2:(Experience(of(stigma(and(
discrimination(
This!section!comprises!five!subBsections:!experiences!of!HIVBrelated!stigma!and!discrimination;!
discrimination! related! to! accommodation,! work,! education! and! health! services;! internalized!
stigma;!protection!through!the!law,!policies!or!practice;!and!effecting!change.!
!
2.1 Experience of HIV-related stigma and discrimination
Respondents!were!asked!about!their!experiences!of!stigma!and!discrimination!in!the!previous!
12!months.!Over!half!of!respondents!(55%,!n=220)!reported!being!gossiped!about!at!least!once!
in! the! last! 12! months! with! 43%! stating! this! had! happened! often! (n=172).! Significant!
percentages!of!respondents!also!reported!having!been!verbally!insulted/harassed/threatened!
(26%,!n=105);!physically!harassed!and/or!threatened!(22%,!n=85);!and/or!physically!assaulted!
(18%,!n=72)!at!least!once!in!the!last!year.!When!disaggregated!by!gender,!female!respondents!
were!twice!as!likely!to!report!physical!assault!as!male!respondents!(25.4%,!n=33!compared!to!
13.2%,! n=33).! When! disaggregated! by! key! population,! nearly! 40%! of! sex! workers! (n=25)! and!
16%!of!PWID!(n=39)!reported!being!assaulted.!
!
In! addition,! less! than! 10%! of! respondents! reported! exclusion! from! social! gatherings! or!
activities!such!as!weddings,!funerals,!parties!etc.!(9%,!n=38),!family!activities!such!as!cooking!
or!eating!together!(8%,!n=31)!and/or!religious!activities!(4%,!n=13)!(Figure(14).!
Been!physically!assaulted!
Been!physically!harassed!and/or!threatened!
Been!verbally!insulted,!harassed,!and/or!threatened!
Been!gossipped!about!
(
Excluded!from!family!activities!(cooking,!eating!together,!
sleeping!in!the!same!room,!doing!laundry!together)!
Excluded!from!religious!activities!or!places!of!worship!
Excluded!from!social!gatherings!(wedding,!funeral,!party,!
etc.)!
Once!
2,3!Times!
Often!
Never!
0%!
20%!
No!Response!
40%!
60%!
80%!
Figure!14:!Stigmatization!and!discrimination!experienced!in!the!past!12!months(
(
(
100%!
Stigma(Index(
Respondents! were! asked! to! indicate! reasons! for! being! stigmatised! and! discriminated! against!
during! the! last! 12! months.! Of! 220! respondents! who! had! been! gossiped! about,! 71%! (n=156)!
40
indicated!that!it!occurred,!in!whole!or!in!part,!because!of!their!HIVBpositive!status ,!while!21%!
indicated! that! it! was! for! another! reason.! In! addition,! 66%! indicated! being! verbally!
insulted/harassed/threatened! (n=69),! 52%! being! physically! harassed! and/or! threatened!
(n=44),!and!44%!being!physically!assaulted!(n=31),!in!whole!or!in!part,!due!to!their!HIVBpositive!
status!(Figure(15).!
!
Been!physically!assaulted!(n=72)!
Been!physically!harassed!and/or!threatened!
(n=85)!
HIV!status!
wholly!or!
partly!
Other!reasons!
Been!verbally!insulted,!harassed,!and/or!
threatened!(n=105)!
Been!gossipped!about!(n=220)!
Excluded!from!family!activities!(cooking,!eating!
together,!sleeping!in!the!same!room,!doing!
laundry!together)!(n=31)!
Excluded!from!religious!activities!or!places!of!
worship!(n=12)!
Not!sure!why!
!
No!response!
Excluded!from!social!gatherings!(wedding,!
funeral,!party,!etc.)!(n=38)!
0%!
20%!
40%!
60%!
80%!
100%!
Figure!15:!Respondent’s!perceived!reasons!for!being!stigmatized!and!discriminated!against!
in!the!last!12!months!
!
Perpetrators(of(physical(assault(
Of! the! 71! respondents! who! reported! physical! assault,! the! perpetrator! was! known! to! the!
respondent!in!just!over!70%!of!instances!(n=50),!though!unknown!to!the!respondent!in!nearly!
30%!of!the!cases!(29.6%,!n=21).!In!46.5%!of!cases!(n=33)!the!perpetrator!lived!outside!of!the!
household.! Physical! assault! within! the! household! took! place! in! a! quarter! of! cases! (n=17),!
including!nearly!10%!in!which!a!spouse!or!partner!was!the!perpetrator!(9.9%,!n=7)!(Figure(16).!!
Mauritius(
Husband/Wife/Partner!
7!
10!
Another!member!of!the!household!
Person(s)!outside!of!household!known!to!
respondent!
33!
21!
Unknown!Person!
!Figure!16:!Perpetrator!of!physical!assault!(n=71)!
(
Key(population`related(discrimination(
Respondents! were! requested! to! elaborate! upon! the! reasons! for! the! discrimination! they!
experienced! in! instances! in! which! it! was! not! because! of! their! HIV! status.! Of! the! 263!
respondents! who! experienced! stigma! and/or! discrimination! for! reasons! other! than! their! HIV!
41
status ,!137!related!it!to!being!a!person!who!injects!drugs,!70!cited!being!an!exBdetainee,!51!
indicated!their!sexual!orientation,!40!cited!being!a!sex!worker!and!4!a!migrant!worker!(Figure(
17).!!
137!
79!
54!
51!
40!
4!
Sexual!
Orientation!
(MSM,!G/L,!TG)!
Sex!Worker!
Intravenous!Drug! Migrant!Worker!
User!
Prisoner!
None!of!the!
above;!Another!
reason!
Figure!17:!Other!reason!for!experienced!stigma!and!discrimination!(n=263)!
!
Of!the!54!respondents!who!chose!none!of!the!above,!additional!reasons!cited!for!experiencing!
stigma!and!discrimination!included:!because!of!partner’s!status!as!a!PWID!or!HIVBpositive,!thus!
guilt!by!association!(n=5);!being!an!exBperson!who!uses!drugs!and!exBsex!worker,!thus!stigma!
(
(
Stigma(Index(
following! the! person! for! life! (n=3);! race! (n=3);! assumed! to! be! a! sex! worker! (n=2);!
discrimination! by! health! care! worker! (n=3);!physical!disability!(n=2),!marital!status!(i.e.!being!
single)!(n=2);!and!being!unemployed!(n=1).!!
(
Stigma(and(discrimination(in(relationships(
Respondents!were!asked!about!specific!types!and!incidence!of!discrimination!in!relationships!
experienced! because! of! their! HIVBpositive! status! during! the! last! 12! months,! including:! how!
they!were!treated!by!their!spouse!or!partner,!levels!of!sexual!rejection,!discrimination!by!other!
PLHIV,!as!well!as!stigma!and!discrimination!faced!by!the!respondent’s!husband/wife/partner!or!
other!household!member!(Figure(18).!
Husband/Wife/Partner/Household!Member!
Experienced!Discrimination!(n=353)!
Often!
Discriminated!by!Other!PLHIV!(n=376)!
2,3!Times!
Once!
Sexual!Rejection!(n=368)!
Never!
No!Response!
Psychological!Pressure!by!Husband/Wife/
Partner!(n=339)!
0%!
20%!
40%!
60%!
80%! 100%!
Figure!18:!Experience!of!stigma!and!discrimination!in!relationships!as!a!result!of!
respondent’s!HIV\positive!status!during!the!last!12!months
!
In! the! last! twelve! months,! 11.6%! of! all! respondents! (n=46)! stated! that! their!
husband/wife/partner!or!household!member!had!been!stigmatized!and!discriminated!against!
because! of! the! respondent’s! HIV! status,! with! 9.9%! (n=37)! stating! this! occurred! more! than!
once.!Over!three!quarters!of!respondents!stated!that!this!had!not!occurred!(76.9%,!n=307).!
!
About! 15.6%! of! respondents! (n=62)! stated! being! discriminated! by! other! PLHIV! at! least! once.!
Over! 10%! stated! it! had! occurred! more! than! once! (12.1%,! n=48).! Over! three! quarters! of!
respondents!did!not!experience!discrimination!by!other!PLHIV!(78.7%,!n=314).!Three!hundred!
seventyBsix!respondents!answered!this!question.!!
!
About!one!fifth!of!respondents!(20.3%,!n=81)!reported!experiencing!sexual!rejection!because!
of!their!HIV!status!at!least!once!in!the!last!twelve!months,!with!15.3%!of!respondents!(n=61)!
who!stated!that!this!occurred!more!than!once.!Over!70%!of!respondents!stated!that!this!had!
not!occurred!(71.9%,!n=287).!There!was!no!significant!difference!of!sexual!rejection!when!data!
Mauritius(
was!disaggregated!by!gender.!Three!hundred!sixty!eight!respondents!answered!this!question.!!
!
Finally,! 10.3%! of! respondents! (n=41)! reported! being! subjected! to! psychological! pressure! or!
manipulation! by! a! husband/wife/partner! in! which! the! respondent’s! HIVBpositive! status! was!
used!against!the!respondent.!Nearly!three!quarters!of!all!respondents!(74.7%,!n=298)!reported!
no! such! pressure! or! manipulation.! Three! hundred! thirty! nine! respondents! answered! this!
question.!!
!
Reasons(for(stigma(and(discrimination!
Figure( 19! shows! respondents’! reported! reasons! for! experiencing! HIVBrelated! stigma! and/or!
discrimination! in! the! last! 12! months42.! Approximately! 40%! of! respondents! feel! the! reason! is!
due!to:!
• People!being!afraid!of!getting!infected!with!HIV!from!the!respondent!(40.8%,!n=122);!
or!
• People!not!understanding!how!HIV!is!transmitted/afraid!of!getting!infected!by!casual!
contact!(38.5%,!n=115).!
!
In! addition,! over! 30%! of! respondents!identified! the! reason! for! experienced! stigma! to! people!
thinking!HIV!is!shameful!and!they!should!not!be!associated!with!the!respondent!(31.8%,!n=95).!
Another! 22.4%! cited! people! disapproving! of! the! respondent’s! lifestyle! or! behaviour! (n=67).!
Other! reasons! included! looking! sick! with! symptoms! associated! with! HIV! (16.1%,! n=48)! and!
religious! beliefs! or! moral! judgements! (8%,! n=24).! Nearly! one! quarter! were! unsure! of! the!
reason!(24.1%,!n=72).!
!
41%!
People!are!afraid!of!getting!infected!with!HIV!from!me!
People!don't!understand!how!HIV!is!transmitted!and!are!
afraid!I!will!infect!them!with!HIV!through!casual!contact!
38%!
People!think!that!having!HIV!is!shameful!and!they!
should!not!be!associated!with!me!
32%!
24%!
I!don't!know/I!am!not!sure!of!the!reason(s)!
22%!
People!disapprove!of!my!lifestyle!or!behaviour!
16%!
I!look!sick!with!symptoms!associated!with!HIV!
Religious!beliefs!or!'moral'!judgements!
0%!
8%!
10%!
20%!
30%!
Figure!19:!Reasons!respondents!felt!stigmatized!and!discriminated!against
(
(
40%!
50%!
Stigma(Index(
2.2 Access to accommodation, work, education and health services
Accommodation(
Over! three! quarters! (75.4%,! n=301)! of! respondents! had! never! been! forced! to! change! their!
residence!or!been!unable!to!rent!accommodation!during!the!12!months.!However,!94!(23.6%)!
had,!with!27!(6.8%)!indicating!this!had!occurred!once,!39!(9.8%)!a!few!times,!and!28!(7%)!often!
(Figure(20).!
!
1.0%!
7.0%!
9.8%!
Never!
Once!
6.8%!
2,3!Times!
!
Often!
75.4%!
No!Response!
Figure!20:!Forced!to!change!place!of!residence!or!unable!to!rent!accommodation!in!last!12!
months!(n=395)(
(
When!asked!why!this!had!happened,!92!of!the!94!respondents!answered!with!46!(50%)!stating!
that! it! was! because! of! both! their! HIV! status! and! other! reasons! and! another! 11! (12%)! solely!
because!of!HIV!status.!In!fact,!57!respondents!(62%)!cited!HIV!status!as!a!relevant!factor!with!
34! respondents! (37%)! citing! other! reasons.! Only! one! respondent! (1%)! was! not! sure! why! this!
had!occurred!(Table(4).!
!
Table!4:!Reason!for!being!forced!to!change!place!of!residence!or!unable!to!rent!
accommodation!(n=92)
Reason(
Because!of!HIV!status!
For!another!reason!
Both!HIV!status!and!another!reason!
Not!sure!why!
Respondents([%((n)](
12%!(11)!
37%!(34)!
50%!(46)!
1%!(1)!
!
(
(
(
Mauritius(
Work(
Over!half!of!respondents!were!unemployed!(56.1%,!n=224).!Of!the!140!respondents!who!had!
some!form!of!employment!in!the!last!12!months,!18!(19.3%)!had!lost!a!job!or!other!source!of!
income!(selfBemployed!or!as!an!informal/casual!worker),!including!seven!reporting!it!occurred!
once,!nine!reporting!a!few!times,!and!two!often!(Figure(21).!
9!
2!
7!
Never!
Once!
A!few!times!
Often!
122!
Figure! 21:! If! employed,! how! often! lost! a! job! or! other! source! of! income! in! last! 12! months!
(n=140)(
When! asked! why! they! thought! they! lost! their! jobs,! eight! respondents! stated! that! HIV! was! a!
reason,!in!whole!or!in!part,!and!ten!cited!other!reasons.!The!respondents!who!cited!their!HIV!
status!as!a!reason!for!lost!employment!said!it!was!due!to!discrimination!by!their!employer!and!
coBworkers! (n=5),! feeling! obliged! to! stop! working! due! to! poor! health! (n=3),! or! both!
discrimination!and!poor!health!(n=3).!
!
Furthermore,! 33! (16.9%)! of! 195! respondents! reported! having! been! refused! employment!
because! of! their! HIV! status,! while! 162! (83.1%)! reporting! this! was! not! the! case.! Of! the! 33!
respondents! reporting! refusal! of! employment,! 16! were! unemployed! (8.2%)! and! 14! (7.2%)! in!
part!time!employment!(selfBemployed!or!as!employees)!(Figure(22).!
(
(
Stigma(Index(
162!
69!
32!
30!
3!
Employee!
Full!Time!
3!
0!
Self!
Employed!
Full!Time!
8!
Employee!
Part!Time!
28!
6!
33!
16!
Self!
Unemployed!
Employed!
Part!Time!
Yes!
Total!
No!
Figure!22:!In!the!last!12!months,!refused!employment!or!work!opportunity!because!of!HIV!
status!(n=195)!
Respondents!were!asked!whether!their!job!description!or!nature!of!work!had!been!changed,!
or! if! they! had! been! refused! a! promotion! in! the! last! 12! months.! Among! the! 118! respondents!
who!answered,!103!(84.4%)!said!there!had!been!no!change!in!their!job!description!or!nature!of!
work! whereas! 15! respondents! (12.3%)! said! this! had! occurred! at! least! once,! with! two! (1.6%)!
citing!one!instance,!10!(8.6%)!stating!2B3!times!and!three!(n=3,!2.5%)!often!(Figure(23).!
!
22!
3!
Never!
Once!
10!
2,3!times!
2!
Often!
103!
No!Response!
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)!
!
Mauritius(
Among!the!11!respondents!who!provided!information!on!the!reason!for!changes!in!their!job!
description!or!refusal!of!promotion,!six!cited!discrimination!by!their!employer!and!coBworkers,!
two!poor!health,!and!three!a!combination!of!discrimination!and!poor!health.!
Education(
Of! the! 242! respondents! who! provided! information! on! how! often! they! had! been! dismissed,!
suspended!or!prevented!from!attending!an!educational!institution!because!of!their!HIV!status!
in! the! last! 12! months,! 94.2%! (n=228)! stated! that! these! events! had! never! occurred.! Fourteen!
respondents!indicated!that!this!had!occurred!(5.7%)!with!three!(1.2%)!citing!one!instance,!10!
(4.1%)!stating!2B3!times,!and!one!(0.4%)!stating!this!had!occurred!often!(Figure(24).!Note!that!
the! majority! of! respondents! were! not! in! school! in! the! last! 12! months,! explaining! the! high!
number!of!respondents!answering!‘not!applicable’.!
!
117!
Never!
Once!
2,3!Times!
!
Often!
1!
10!
228!
Not!Applicable!
3!
Figure! 24:! In! the! last! 12! months,! dismissed,! suspended! or! prevented! from! attending! an!
educational!institution!because!of!HIV!status!(n=359)!
!
Respondents! were! also! requested! to! indicate! how! often! their! children! had! been! dismissed,!
suspended! or! prevented! from! attending! an! educational! institution! because! of! the!
respondent’s!HIV!status!in!the!last!12!months.!This!had!never!occurred!to!218!(96%)!of!the!227!
respondents!who!provided!an!answer!to!this!question.!Nine!(3.9%)!respondents!indicated!that!
their!child(ren)!had!faced!some!form!of!discrimination!at!least!once,!5!(2.2%)!stated!this!had!
happened!2B3!times,!and!one!(0.4%)! said!this!had!happened!often.! For!139!respondents!this!
question!was!inapplicable,!and!another!33!did!not!respond!(Figure(25).!!
!
(
(
Stigma(Index(
Never!
139!
Once!
2,3!Times!
218!
!
Often!
Not!Applicable!
1!
5!
3!
Figure!25:!In!the!last!12!months,!respondent’s!children!have!been!dismissed,!suspended!or!
prevented! from! attending! an! educational! institution! because! of! respondent’s! HIV! status!
(n=366)!
(
Health(Services(
One!hundred!and!twelve!respondents!(28%)!reported!being!denied!access!to!health!services,!
including!dental!care,!at!least!once!in!the!last!twelve!months!because!of!their!HIV!status.!This!
includes! 52! respondents! (13%)! reporting! denial! of! access! 2B3! times! and! 28! (7%)! reporting!
denial! often.! Nearly! two! thirds! of! respondents! (63.9%,! n=255)! indicated! this! had! never!
happened! to! them.! Note! that! 21! respondents! (5.3%)! stated! that! this! was! inapplicable! and!
another!11!did!not!respond!(2.8%)!(Figure(26).!
!
5.3%!
2.8%!
7.0%!
Never!
Once!
13.0%!
2,3!Times!
Often!
8.0%!
63.9%!
!
Not!Applicable!
No!Response!
Figure!26:!Denial!of!health!services,!including!dental!care,!because!of!HIV!status!in!the!last!
12!months!(n=388)!
Mauritius(
Regarding! access! to! family! planning! and! SRH! services! in! the! last! 12! months,! 20! respondents!
(5%)!said!they!had!been!denied!access!because!of!their!HIV!status!while!229!(57.4%)!said!this!
had!never!happened.!Of!those!denied!access!to!services,!this!occurred!once!to!16!respondents!
(4%),!2B3!times!to!two!respondents!(0.5%)!and!often!to!another!two!respondents!(0.5%).!Note!
that!109!respondents!(27.3%)!stated!that!this!was!inapplicable!and!another!41!did!not!respond!
(10.3%)!(Table(5).!
!
Table! 5:! Denial! of! access! to! family! planning! and! sexual! health! services! because! of! HIV\
positive!status!
Denied(access(to(family(planning(or(SH(services(
Never!
Once!
2B3!times!
Often!
Not!applicable!
No!response!
57.4%!(229)!
4%!(16)!
0.5%!(2)!
0.5%!(2)!
27.3%!(109)!
10.3%!(41)!
!
2.3 Internalized stigma
Feelings(experienced(by(PLHIV(
Respondents! were! requested! to! identify! feelings! they! had! experienced! because! of! their! HIV!
status!in!the!last!12!months.!Approximately!45%!reported!they!had!felt!guilty!(46.1%,!n=!182)!
and/or!had!low!selfBesteem!(44.1%,!n=172).!Nearly!40%!blamed!themselves!(39%,!n=!153)!and!
over!one!third!felt!ashamed!(36.1%,!n=143).!Just!over!20%!felt!they!should!be!punished!and!
slightly!under!20%!blamed!others!(17%,!n=66).!Nearly!30%!of!respondents!(29.6%,!n=117)!had!
felt!suicidal!(Figure(27).!!
46.1%!
44.1%!
39.0%!
36.1%!
29.6%!
21.6%!
17.0%!
I!feel!
ashamed!
(n=396)!
I!feel!guilty!
(n=395)!
I!blame!
myself!
(n=392)!
I!blame!
others!
(n=388)!
!
I!have!low! I!feel!I!should!I!feel!suicidal!
self,esteem! be!punished! (n=395)!
(n=390)!
(n=394)!
Figure!27:!Feelings!experienced!by!PLHIV!because!of!their!HIV!status!
(
(
Stigma(Index(
When!the!data!about!internal!stigma!was!disaggregated!by!gender,!female!respondents!were!
approximately! twice! as! likely! as! male! respondents! to! report! blaming! others! (26.9%,! n=33!
compared!to!9.8%,!n=24)!and!feeling!suicidal!(42.6%,!n=55!compared!to!22.2%,!n=55)!(Figure(
28).!!
!
%!of!respondents!
80%!
60%!
Male!
40%!
Female!
20%!
Transgender!
0%!
I!feel!ashamed!
(n=396)!
I!blame!myself!
(n=392)!
I!have!low!self,
esteem!(n=390)!
I!feel!suicidal!
(n=395)!
Figure!28:!Feelings!experienced!by!PLHIV!because!of!their!HIV!status,!disaggregated!by!
gender(
!
Decisions,(resignations,(avoidance(
Respondents!were!also!asked!to!indicate!the!things!they!had!or!had!not!done!because!of!their!
HIV!status!in!the!previous!12!months!(Figure(29).!The!most!frequent!decision,!made!by!42%!of!
respondents! (n=163),! was! not! to! have! children.! Over! one! quarter! decided! not! to! have! sex!
(27%,!n=106).!Furthermore,!39%!(n=154)!isolated!themselves!from!friends!and!relatives,!32.6%!
(n=151)!chose!not!to!attend!social!gatherings!and!28.7%!(n=129)!opted!not!to!marry.!
!
25.1%!
avoided!going!to!the!hospital!(n=398)!
avoided!going!to!a!local!clinic!(n=397)!
20.4%!
42.0%!
decided!not!to!have!children!(n=388)!
27.0%!
decided!not!to!have!sex!(n=392)!
28.7%!
decided!not!to!get!married!(n=387)!
withdrew/not!take!up!education/training!(n=384)!
decided!not!to!apply!for!a!job/work/promotion!
(n=385)!
decided!to!stop!working!(n=378)!
13.3%!
!
23.1%!
25.4%!
39.0%!
isolated!myself!from!family!and/or!friends!(n=395)!
chosen!not!to!attend!social!gatherings!(n=396)!
32.6%!
0.0%! 10.0%! 20.0%! 30.0%! 40.0%! 50.0%!
Figure!29:!Decisions!made!in!the!last!12!months!because!of!HIV!status!
Mauritius(
Internal! stigma! also! affects! access! to! health! care:! 25.1%! (n=100)! avoided! going! to! a! hospital!
and!20.4%!(n=80)!avoided!going!to!a!local!clinic!when!necessary.!In!relation!to!education!and!
employment:! 23.1%! (n=89)! decided! not! to! apply! for! a! job! or! a! promotion,! 13.3%! (n=51)!
withdrew!from!education!or!training,!and!25.4%!(n=96)!gave!up!their!job.!!
!
When!disaggregated!by!gender,!greater!percentages!of!male!than!female!respondents!chose!
not!to!attend!social!gatherings!(34.4%!compared!to!26.6%),!stopped!working!(29.8%!compared!
to! 13.9%),! not! to! apply! for! a! job/work! or! promotion! (26.1%! compared! to! 15.9%),! withdrew!
from! education/training! or! did! not! take! up! opportunity! for! education/training! (16.3%!
compared! to! 6.3%),! decided! not! to! get! married! (32.4%! compared! to! 22.4%),! decided! not! to!
have! sex! (32.4%! compared! to! 18.8%)! and! decided! not! to! have! children! (43.2%! compared! to!
41.5%).!Conversely,!greater!percentages!of!female!than!male!respondents!isolated!themselves!
from!their!family!and/or!friends!(38.5!%!compared!to!37.1%),!and!avoided!going!to!local!clinic!
(27.9%!compared!to!16%)!or!hospital!when!needed!to!(31.5%!compared!to!20.4%)!(Figure(30).!
!
80%!
60%!
40%!
20%!
Male!
0%!
avoided!going!to!the!hospital!(n=398)!
avoided!going!to!a!local!clinic!(n=397)!
decided!not!to!have!children!(n=388)!
decided!not!to!have!sex!(n=392)!
decided!not!to!get!married!(n=387)!
withdrew/not!take!up!education/training!
(n=384)!
decided!not!to!apply!for!a!job/work/
promotion!(n=385)!
decided!to!stop!working!(n=378)!
isolated!myself!from!family!and/or!friends!
(n=395)!
chosen!not!to!attend!social!gatherings!
(n=396)!
Female!
!
Transgender!
Figure!30:!Things!done!and!decisions!taken!by!respondents!because!of!their!HIV!status,!
!
!
!
(
(
Stigma(Index(
Fears(experienced(by(respondents(
Nearly!half!of!respondents!(48.3%,!n=185)!indicated!that!they!were!fearful!of!being!gossiped!
about,! with! over! 30%! (30.5%,! n=115)! afraid! of! being! verbally! insulted,! harassed! and/or!
threatened,! while! approximately! 25%! were! afraid! of! being! physically! harassed! and/or!
threatened!(24.9%,!n=92)!or!being!physically!assaulted!(23%,!n=84)!(Figure(31).!These!findings!
highlight! the! fact! that! respondents! fear! gossip! most,! followed! by! verbal!
insults/harassment/threats.!Respondents!fear!physical!assault!slightly!less.!!
being!physically!assaulted!(n=366)!
23%!
being!physically!harassed!and/or!
threatened!(n=370!
25%!
being!verbally!insulted,!harassed!
and/or!threatened!(n=380)!
30%!
being!gossiped!about!(n=383)!
48%!
0%! 10%! 20%! 30%! 40%! 50%! 60%!
Figure!31:!Fear!of!gossip,!verbal!insults,!physical!harassment!and!physical!assault
There!were!observable!differences!between!levels!of!fear!when!the!data!was!disaggregated!by!
gender!(Figure(32).!On!the!whole,!females!reported!fearing!being!gossiped!about,!verbally!or!
physically! harassed,! and! physically! assaulted! more! than! males.! The! majority! of! transgender!
respondents!feared!all!of!these!as!well.!!
72%!
56%!
43%!
67%!
61%!
61%!
44%!
38%!
35%!
Female!
21%!
15%!
Male!
14%!
Transgender!
being!gossiped!
being!verbally! being!physically! being!physically!
about!(n=383)! insulted,!harassed! harassed!and/or! assaulted!(n=366)!
and/or!threatened!
threatened!
(n=380)!
(n=370)!
Figure!32:!Fear!of!gossip,!verbal!insults,!physical!harassment!and!physical!assault,!
!
Mauritius(
In!addition,!over!40%!of!respondents!(42%,!n=162)!indicated!they!were!afraid!someone!would!
not! want! to! be! sexually! intimate! with! them! because! of! their! HIVBpositive! status,! with! no!
genderBbased!difference.!
!
Overall,!33!respondents!answered!“no”!to!all!internal!stigma!questions,!representing!8.3%!of!
the!sample!exhibiting!no!form!of!internal!stigma.!
!
2.4 Rights, laws and policies
(
Knowledge(of(the(Declaration(of(Commitment(on(HIV/AIDS(and(HIV(and(AIDS(Act(2006(
This! section! addressed! respondents’! awareness! of! rights,! international! policies! and! national!
laws!related!to!PLHIV.!The!results!indicate!that!of!398!respondents!who!replied,!218!(54.8%)!
had!heard!of!the!United!Declaration!of!Commitment!on!HIV/AIDS43!of!whom!80!(36.7%)!had!
read!or!discussed!it.!With!regards!to!the!Mauritian!HIV!and!AIDS!Act!200644,!395!respondents!
answered;!over!half!(57.5%,!n=227)!had!heard!of!it,!of!which!41%!(n=93)!had!read!or!discussed!
it.!In!summary,!there! were!similar!levels!of!awareness!of!the!Declaration!of!Commitment!on!
HIV/AIDS!and!the!HIV!and!AIDS!Act!2006!and!their!contents.!
!
Violation(of(rights(
During! the! previous! 12! months,! of! the! 397! respondents! replying,! over! 10%! (13.6%,! n=54)!
reported! they! had! been! subjected! to! one! or! more! discriminatory! practices! by! governmental,!
legal,!and/or!medical!institutions;!58.4%!(n=232)!had!not!and!28%!(n=11)!were!unsure.!!
!
Discriminatory(treatment(by(governmental,(legal,(and/or(medical(institutions(
The! most! frequent! violation! reported! by! 25! respondents! was! being! forced! to! submit! to! a!
medical! procedure! (including! HIV! testing)! (6.3%),! followed! by! being! denied! health! or! life!
insurance!(n=20,!5%).!Smaller!numbers!of!respondents!indicated!that!they!had!been!detained,!
quarantined,!isolated,!or!segregated!(n=9,!2.3%)!with!seven!each!reporting!arrest/being!taken!
to! court! on! an! HIVBrelated! charge! or! having! to! disclose! their! HIV! status! in! order! to! enter!
another!country!(1.8%!each)!(Figure(33).!
(
(
Stigma(Index(
I!was!forced!to!submit!to!a!medical!or!health!procedure!
(including!HIV!testing)!
25!
I!was!denied!health!or!life!insurance!because!of!my!HIV!
status!
20!
I!was!arrested!or!taken!to!court!on!a!charge!related!to!my!
HIV!status!
7!
I!had!to!disclose!my!HIV!status!in!order!to!enter!another!
country!
7!
I!had!to!disclose!my!HIV!status!to!apply!for!residence!or!
nationality!
3!
I!was!detained,!quarantined,!isolated!or!segregated!
!
9!
None!of!these!happened!to!me!
340!
0!
50! 100! 150! 200! 250! 300! 350! 400!
Figure!33:!Number!of!respondents!who!had!their!rights!violated!in!the!last!12!months!
!
Seeking(Redress(
When! asked! whether! they! had! tried! to! get! legal! redress,! 53! respondents! replied! with! only! 9!
(17%)!indicating!that!they!had!tried!to!get!legal!redress!and!44!(83%)!reporting!they!had!not.!
Three!said!that!the!legal!redress!process!had!begun!in!the!preceding!12!months.!When!asked!
whether!the!matter!had!been!dealt!with,!one!of!the!eight!who!responded!indicated!the!matter!
had! been! dealt! with;! two! said! the! matter! was! still! in! process! of! being! dealt! with,! while! the!
remaining!5!indicated!that!nothing!happened!and!thus!the!matter!was!not!dealt!with.!!
!
Reasons!for!not!seeking!legal!redress!were!then!explored:!25!responded!with!15!(60%)!saying!
they!felt!the!process!of!addressing!the!problem!was!too!bureaucratic,!four!indicating!they!had!
little!to!no!confidence!in!the!outcome,!two!felt!intimidated!or!scared!to!take!action,!and!one!
was! advised! against! taking! action.! Three! respondents! replied! that! none! of! the! reasons!
suggested!had!led!him!or!her!not!to!seek!legal!redress!(Figure(34).!!
!
Mauritius(
3!
Process!of!addressing!problem!
appeared!too!bureaucratic!
Felt!intimidated!or!scared!to!
take!action!
4!
Was!advised!against!taking!
action!
1!
15!
2!
!
No/little!congidence!outcome!
would!be!successful!
None!of!the!above!
Figure!34:!Reasons!for!not!trying!legal!redress!for!an!abuse!of!rights!(n=25)!
!
When!the!54!respondents!were!asked!whether!they!had!tried!to!get!a!government!employee!
to!take!action!against!an!abuse!of!their!rights!in!the!preceding!12!months,!10!(18.5%)!reported!
doing!so.!When!asked!when!the!process!begun,!eight!reported!in!the!preceding!12!months.!In!
terms! of! outcomes,! one! indicated! the! matter! was! still! in! process! and! six! said! either! nothing!
had!been!done!or!the!matter!had!not!been!dealt!with.!
(
Four!of!the!54!respondents!(7.4%)!reported!trying!to!get!a!local!or!national!politician!to!take!
action! against! an! abuse! of! their! rights! in! the! preceding! 12! months.! All! four! indicated! that!
either!nothing!had!been!done!or!the!matter!was!not!dealt!with.!
!
2.5 Effecting change
This! subBsection! explores! respondents’! reactions! to! incidents! of! stigma! and! discrimination,!
awareness!of!potential!sources!of!assistance!when!confronted!with!stigma!and!discrimination,!
and!participation!in!policy!reform!on!HIVBrelated!stigma!and!discrimination.!
!
Reactions(to(incidents(of(stigma(and(discrimination(
When! asked! whether! they! had! confronted,! challenged! or! educated! someone! who! was!
stigmatizing! and/or! discriminating! against! them! in! the! last! 12! months,! over! three! quarters!
(75.9%,!n=303)!stated!they!had!not,!while!21.6%!(n=86)!said!they!had.!Ten!respondents!did!not!
answer.! When! disaggregated! by! gender,! 19.6%! of! male! (n=49),! 24.4%! of! female! (n=32)! and!
27.8%!of!transgender!(n=5)!respondents!stated!they!had!confronted,!challenged!or!educated!
someone.!
(
(
Stigma(Index(
Awareness(of(potential(sources(of(assistance(
Over!half!of!respondents!(55.9%,!n=223)!knew!of!organizations!or!groups!they!could!go!to!for!
help! if! they! experienced! stigma;! however,! over! 40%! did! not! (42.6%,! n=170).! Six! respondents!
did!not!answer!(1.5%).!When!disaggregated!by!gender,!52%!of!male!(n=130),!61.8%!of!female!
(n=81)! and! 66.7%! of! transgender! (n=12)! respondents! stated! knowing! of! an! organization! or!
group!that!they!could!go!to!for!help!if!they!experienced!stigma.!
!
Nearly! half! of! all! respondents! cited! ‘PLHIV! group’! (48.1%,! n=192)! and! 28%! cited! ‘Network! of!
PLHIV’! (27.6%,! n=110)! as! a! type! of! organization! they! know! of! to! go! to! for! help! related! to!
stigma.!Both!of!these!are!likely!referring!to!the!group!Vivre!Plus.!Nearly!40%!cited!a!national!
NGO!(37.8%,!n=!151),!which!refers!to!PILS.!All!other!categories!were!nominated!by!less!than!
10%! of! respondents,! including! human! rights! organizations! (7.8%,! n=31),! faithBbased!
organisations!(4%,!n=16),!and!legal!practices!(1.5%,!n=6)!(Figure(35).!
48.1%!
37.8%!
1.8%!
0.3%!
Others!
2.8%!
United!Nations!
National!NGO!
7.5%!
International!NGO!
7.8%!
Human!right!
organisation!
1.5%!
Legal!practice!
FBOs!
Network!of!PLHIV!
PLHIV!Group!
4.0%!
National!AIDS!
Secretariat!
27.6%!
!
Figure!35:!Type(s)!of!organization(s)!respondents!know!they!could!go!to!for!help!if!they!
experienced!stigma!
!
Seeking(assistance(from(organizations(
Nearly!10%!of!respondents!(9.3%,!n=37)!indicated!they!had!sought!help!from!any!of!the!types!
of!organizations!outlined!in!Figure(35!to!resolve!an!issue!relating!to!stigma!and!discrimination.!
Over!80%!stated!they!had!not!(83.2%,!n=332),!and!30!respondents!did!not!reply!(7.5%).!
!
Support(to(other(PLHIV(
Almost!half!the!respondents!(48.1%,!n=192)!stated!they!had!provided!support!to!other!PLHIV!
in! the! last! 12! months,! while! 164! (41.1%)! stated! they! had! not.! FortyBthree! (10.8%)! did! not!
respond.!Support!to!other!PLHIV!included!emotional!support!(65.2%,!n=187),!physical!support!
(11.8%,!n=34),!and!referral!to!other!services!(23%,!n=66)!(Table(6).!
!
Mauritius(
Table!6:!Type!of!support!provided!by!respondents!to!other!PLHIV!
Type(of(support(provided(
Emotional!support!(e.g.!counselling,!sharing!personal!stories!
and!experiences)!
Physical!support!(e.g.!providing!money!or!food,!doing!an!
errand!for!them)!
Referral!to!other!services!
Total(
187!(65.2%)!
34!(11.8%)!
66!(23%)!
192!(100%)!
!
Involvement(in(programmes,(legislation,(policies(or(guidelines(
Among! respondents,! 20.6%! (n=82)! reported! being! a! member! of! a! support! group! and/or!
network!of!PLHIV.!In!addition,!7.5%!of!respondents!(n=30)!reported!having!been!involved!as!a!
volunteer!or!employee!in!any!programme!or!project!(either!governmental!or!NGO)!providing!
assistance!to!PLHIV!in!the!previous!12!months.!Finally,!7.5%!of!respondents!(n=30)!indicated!
that!they!had!been!involved!in!efforts!to!develop!HIVBrelated!legislation,!policies!or!guidelines.!!
(
Ability(to(influence(policies,(laws(and(programmes(
Table( 7! focuses! on! respondents’! feelings! of! being! able! to! influence! policies,! laws! and!
programmes.!Nearly!90%!of!respondents!(89.5%,!n=357)!reported!feeling!able!to!influence!in!
at!least!one!of!these!areas!while!10.5%!(n=42)!did!not.!Among!these!respondents,!236!(59.1%)!
felt! they! could! influence! legal/rights! matters! affecting! PLHIV,! 147! respondents! (36.8%)! felt!
they!could!influence!local!projects!intended!to!benefit!PLHIV,!and!101!(25.3%)!felt!they!had!the!
power! to! influence! local! government! policies! affecting! PLHIV.! EightyBeight! (22%)! felt! able! to!
influence! national! policies! affecting! PLHIV,! and! 70! (17.5%)! felt! able! to! influence!
programmes/projects! intended! to! benefit! PLHIV.! Only! 6.5%! (n=26)! felt! able! to! influence!
international!agreements/treaties.!!
!
Table!7:!Areas!which!respondents!felt!they!could!influence!decisions!
Power(to(influence(any(of(the(following?(
Legal/rights!matters!affecting!PLHIV!
59.1%!(236)!
Local!government!policies!affecting!PLHIV!
25.3%!(101)!
Local!projects!intended!to!benefit!PLHIV!
36.8%!(147)!
National!government!policies!affecting!PLHIV!
22.1%!(88)!
National!programmes/projects!intended!to!benefit!PLHIV!!
17.5%!(70)!
International!agreements/treaties!
6.5%!(26)!
None!of!these!
10.5%!(42)!
(
(
(
Stigma(Index(
Most(important(thing(that(organizations(of(PLHIV(should(be(doing(
Figure( 36! outlines! respondents’! recommendations! regarding! the! most! important! things!
organizations!should!do!to!address!stigma!and!discrimination.!Over!one!quarter!recommended!
either! advocating! for! the! rights! of! all! people! living! with! HIV! (28.6%,! n=114)! or! raising! the!
awareness! and! knowledge! of! the! public! about! AIDS! (26.6%,! n=106).! Advocacy! for! the! rights!
and/or! providing! support! to! particularly! marginalized! groups! was! supported! by! 17.8%! of!
respondents! (n=71).! Slightly! less! than! 15%! cited! educating! PLHIV! about! living! with! HIV!
(including! treatment! literacy)! (14%,! n=56),! and! over! 10%! cited! providing! emotional,! physical!
and!referral!support!to!PLHIV!as!a!recommendation!(10.3%,!n=41).!
(
29%!
Advocate!for!the!rights!of!all!PLHIV!
Raise!awareness!and!knowledge!of!the!public!
about!AIDS!
27%!
Advocate!for!the!rights!and/or!provide!
support!to!particularly!marginalised!groups!
18%!
!
Educate!PLHIV!about!living!with!HIV!
(including!treatment!literacy)!
14%!
Provide!support!to!PLHIV!by!providing!
emotionaly,!physical!and!referral!support!
No!Response!
10%!
3%!
Figure!36:!Recommendations!of!respondents!regarding!what!organizations!should!to!do!
address!HIV\related!stigma!and!discrimination!
Mauritius(
Section(3:(Experience(of(testing,(
disclosure,(treatment(and(having(children(
This!section!comprises!four!subBsections:!testing!and!diagnosis;!disclosure!and!confidentiality;!
treatment;!and!experience!of!having!children.!!
!
3.1 Testing and diagnosis
Reason(for(undergoing(HIV(testing(
Respondents! were! asked! to! indicate! why! they! underwent! HIV! testing! (Figure( 37).( Over! 40%!
indicated! they! simply! wanted! to! know! their! HIV! status! (41.3%,! n=237);! nearly! a! quarter! had!
been!offered!a!test!upon!entry!into!prison!(23.5%,!n=92);!12.2%!were!offered!upon!admission!
to! hospital! (n=48);! 9.2%! by! a! methadone! centre! (n=36);! 8.4%! during! pregnancy! (n=33);! 7.1%!
because! of! HIVBrelated! symptoms! (n=28);! 6.1%! because! their! husband/wife/partner/family!
member!was!infected!(n=24);!5.9%!because!of!a!STI!(n=23);!5.4%!by!an!outreach!caravan!(NEP!
or! PILS)! (n=21);! and! under! 3%! for! each! other! reasons! (2.6%,! n=10),! illness! or! death! of!
husband/wife/partner/family!member!(2.3%,!n=9),!to!prepare!for!marriage/sexual!relationship!
(1.5%,!n=6)!or!employment!(1.5%,!n=6).!
!
41%!
Just!wanted!to!know!
23%!
Offered!at!prison!entry!
12%!
Offered!at!hospital!admission!
9%!
Offered!by!methadone!centre!
8%!
Pregnancy!
7%!
Offered!because!of!HIV,related!symptoms!
Husband/wife/partner/family!member!
infected!
Offered!because!of!sexually!transmitted!
infection!
6%!
6%!
5%!
Offered!by!outreach!caravan!(NEP!or!PILS)!
Other!reason!
3%!
Illness!or!death!of!husband/wife/partner/
family!member!
2%!
To!prepare!for!marriage/sexual!relationship!
2%!
Employment!
2%!
Figure!37:!Reason!for!getting!tested!for!HIV!(n=392)!
(
(
!
Stigma(Index(
Whether(HIV(testing(was(voluntary(
Respondents!were!asked!about!their!decision!to!be!tested!for!HIV!and!whether!their!HIV!test!
was! undertaken! voluntarily,! under! pressure! or! coercion,! or! without! their! knowledge! (Figure(
38).! Of! the! 387! respondents! who! answered,! over! 80%! reported! being! tested! voluntarily!
(83.7%,! n=324).! FortyBone! respondents! (10.6%)! reported! being! forced! to! take! a! HIV! test! or!
being!tested!under!pressure!from!others.!The!remaining!22!respondents!(5.7%)!reported!that!
they!were!tested!without!their!knowledge.!!
!
6.2%!
5.7%!
Voluntary!
4.4%!
Voluntary,!but!under!
pressure!from!others!
Coercion!
83.7%!
(
Tested!without!my!
knowledge,!found!out!
after!test!had!been!done!
Figure!38:!Nature!of!decision!for!being!tested!(n=387)!
(
Counselling(
Figure( 39! outlines! respondents’! reported! access! to! counselling! during! HIV! testing.! Both! preB!
and! postBtest! counselling! was! only! provided! to! half! of! the! 388! interviewees! who! responded!
(50.8%,!n=197).!As!such,!half!of!respondents!received!inappropriate!counselling,!including!7%!
of! respondents! who! reported! only! receiving! preBtest! counselling! (n=27),! 25%! receiving! only!
postBtest!counselling!(n=97),!and!17.3%!received!no!counselling!at!all!(n=67).!
!
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17.3%!
Both!pre,!and!post,
test!
Only!pre,test!
50.8%!
25.0%!
Only!post,test!
(
None!
7.0%!
Figure!39:!Types!of!HIV!test!counselling!received!(n=388)!
!
3.2 Disclosure and confidentiality
In! an! attempt! to! assess! issues! related! to! disclosure! and! confidentiality,! respondents! were!
asked! about! how! different! groups! of! people! were! first! told! of! their! HIV! status,! if! at! all.! A!
summary!of!the!findings!is!presented!in!Figures(40,(41(and(42.!
!
Disclosure(
In!Figure(40,!the!highest!percentages!of!respondents!had!disclosed!their!status!to!spouses!or!
partners!(86.7%),!other!adult!family!members!(82.7%),!injecting!drug!partners!(80.1%),!other!
HIVBpositive! people! (79.9%),! health! care! workers! (64.7%),! and! social! workers! and! other!
counsellors!(68.8%).!However,!10%!had!not!disclosed!their!status!to!their!permanent!partner!
(n=21)!and!a!further!18.3%!had!not!disclosed!to!injecting!drug!partners!(n=38).!Of!those!in!sex!
work,!83.3%!had!not!disclosed!to!their!clients!(n=15).!
!
Disclosure! of! a! respondent’s! HIV! status! without! their! consent! was! uncommon.! However,!
several! instances! were! recorded,! namely:! disclosure! without! consent! to! other! adult! family!
members!(6.5%,!n=17),!friends!and!neighbours!(4.5%,!n=16),!other!PLHIV!(2.5%,!n=9),!children!
in!family!(2.2%,!n=6)!and!health!care!workers!(1.1%,!n=4).!!
!
A! large! number! of! respondents! indicated! that! some! categories! were! inapplicable! to! them.!
Even! among! respondents! for! whom! categories! were! applicable,! the! majority! of! respondents!
had! not! disclosed! their! HIV! status! to! these! groups! of! people,! namely:! community! leaders!
(82.4%),! religious! leaders! (85.2%),! media! (84.9%)! and! government! officials! (87.3%).! Of! the!
relatively! few! respondents! in! employment! or! education,! respondents! were! unlikely! to! have!
(
(
Stigma(Index(
disclosed! their! HIV! status:! the! nondisclosure! rate! to! employers! was! 76.9%,! to! coBworkers!
68.5%,!and!to!teachers!95.45%.!
!
Other!PLHIV!(n=378)!
Healthcare!Workers!(n=376)!
Friends/Neighbours!(n=371)!
Social!Workers!(n=376)!
Children!in!Family!(n=376)!
Other!Adult!Family!Members!(n=386)!
Injecting!Drug!Partners!(n=363)!
Husband/Wife/Partner!(n=397)!
Community!Leaders!(n=357)!
Religious!Leaders!(n=363)!
!
Media!(n=356)!
Coworkers!(n=389)!
Government!Ofgicials!(n=367)!
Employer/Boss!(n=384)!
Teachers!(n=367)!
Clients!(n=354)!
0%! 10%! 20%! 30%! 40%! 50%! 60%! 70%! 80%! 90%! 100%!
I!told!them!
Someone!else!told!them,!with!my!consent!
Someone!else!told!them,!without!my!consent! They!don't!know!my!HIV!status!
Not!applicable!
Figure!40:!Whether!and!in!what!manner!HIV!status!of!respondents!disclosed!
!
Pressure(to(disclose(
Figure( 41( shows! that! most! respondents! (89%,! n=359)! reported! that! they! had! not! felt!
pressured!from!other!PLHIV!or!PLHIV!networks/groups!to!disclose!their!HIV!status.!However,!
28! felt! they! had! (7%):! 7! felt! pressured! once! (1.8%),! 11! two! to! three! times! (2.8%)! and! 10!
respondents!often!(2.5%).!Twelve!respondents!(3%)!provided!no!response.!
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3%! 3%!
2%!
3%!
Often!
2,3!Times!
Once!
!
Never!
No!Response!
90%!
Figure!41:!Feel!pressure!from!other!PLHIV!or!PLHIV!networks/groups!to!disclose!status!
!
Figure( 42( shows! that! most! respondents! (88%,! n=351)! reported! that! they! had! not! felt!
pressured!from!other!from!people!not!living!with!HIV!to!disclose!their!HIV!status.!However,!9%!
felt!they!had!(n=35),!including!10!respondents!reporting!feeling!pressured!once!(2.5%),!12!two!
to!three!times!(3%)!and!13!respondents!often!(3.3%).!Thirteen!respondents!(3%)!provided!no!
response.!
3%!
3%! 3%!
3%!
Often!
2,3!Times!
Once!
!
Never!
No!Response!
88%!
Figure!42:!Pressure!from!people!not!living!with!HIV!to!disclose!HIV!status.!
Health(Care(Workers(
When!asked!whether!a!health!care!professional!had!ever!told!anyone!about!the!respondents’!
HIV! status! without! their! consent,! nearly! 40%! of! respondents! said! this! had! never! happened!
(
(
Stigma(Index(
(38.3%,! n=159),! nearly! one! third! were! not! sure! (31.1%,! n=124),! and! over! one! quarter! stated!
that! this! had! happened! (26.8%,! n=107).! Fifteen! respondents! (3.8%)! provided! no! response!
(Figure(43).!
38.3%!
31.1%!
26.8%!
!
3.8%!
Yes!
No!
Not!Sure!
No!Reponse!
Figure!43:!Healthcare!professional!ever!told!other!people!about!HIV!status!without!consent!
!
Over!one!third!of!respondents!(35.1%,!n=140)!were!sure!that!their!medical!records!were!kept!
completely! confidential.! Half! the! respondents! did! not! know! (50.6%,! n=202),! and! 49!
respondents!(12.3%)!said!it!was!clear!to!them!that!their!medical!reports!were!not!being!kept!
confidential.!Eight!respondents!(2%)!provided!no!response!(Figure(44).!
50.6%!
35.1%!
!
12.3%!
2.0%!
I!am!sure!that!they!are! I!don't!know!if!they!are! It!is!clear!they!are!not!
kept!completely!
congidential!
being!kept!congidential!
congidential!
No!response!
Figure!44:!Participants’!knowledge!of!confidentiality!of!medical!records!
!
Respondents!were!asked!about!the!reactions!of!different!people!when!they!first!knew!about!
their! HIV! status.! Figure( 45! shows! perceived! reactions,! with! categories! ranging! from! very!
discriminatory!to!very!supportive.!!
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Coworkers!(n=369)!
!
Employer/Boss!(n=367)!
Media!(n=365)!
Government!Ofgicials!(n=367)!
Religious!Leaders!(n=362)!
Community!Leaders!(n=355)!
Teachers!(n=359)!
Clients!(n=342)!
0%! 10%! 20%! 30%! 40%! 50%! 60%! 70%! 80%! 90%! 100%!
Very!discriminatory!
Discriminatory!
Normal!
Supportive!
Very!supportive!
Not!Applicable!
Figure!45:!Perceived!reactions!to!disclosure
It!is!important!to!note!that!some!of!the!categories!represent!people,!or!groups!of!people,!with!
whom!respondents!can!disclose!their!status!at!their!own!discretion!(for!example,!children!or!
employers).! For! other! categories! of! people! such! as! health! care! workers,! spouses! or! partners!
(sexual! or! drug! using),! reasons! for! disclosure! may! be! more! pressing.! The! more! discretion!
respondents! feel! that! they! can! exercise! in! deciding! who! should! know! their! HIV! status,! the!
more!support!one!would!expect!to!find.!This!may!be!because!respondents!have!more!ability!to!
decide!to!keep!their!HIV!status!private!from!people!they!expect!will!mistreat!them.!
!
The! following! analysis! combines! the! responses! ‘discriminatory’! and! ‘very! discriminatory’,! as!
well!as!‘supportive’!and!‘very!supportive’!and!includes!only!categories!of!people!identified!as!
important! in! the! majority! of! the! respondents’! lives! (Figure( 46).! Of! the! respondents! who!
(
(
Stigma(Index(
disclosed! their! status! to! spouses! and! partners,! 12.3%! experienced! discriminatory/very!
discriminatory! reactions,! while58.2%! experienced! supportive/very! supportive! reactions.! The!
remaining! 29.4%! reported! neutral! reactions.! In! 10.3%! of! cases,! respondents! who! disclosed!
their!status!to!other!adult!family!members!reported!discriminatory!reactions,!59.1%!reported!
supportive!reactions,!and!10.3%!reported!neutral!responses.!!
!
Health! care! workers! clearly! had! the! highest! levels! of! discriminatory! reactions,! with! 40.5%! of!
respondents!reporting!discriminatory/very!discriminatory!reactions.!In!14.3%!of!cases,!health!
care!workers’!attitude!was!supportive/very!supportive,!and!in!the!remaining!45%,!health!care!
workers!had!neutral!reactions.!!
Clients!(n=342)!
0%! 10%! 20%! 30%! 40%! 50%! 60%! 70%! 80%! 90%!
Discriminatory!
Normal!
Supportive!
Figure!46:!Aggregated!responses!of!select!groups’!reaction!to!respondent’s!HIV!status!
!
Nearly!half!of!respondents!found!disclosing!their!HIV!status!to!be!an!empowering!experience!
(48.9%,! n=195)! while! over! one! third! did! not! (35.8%! n=143).! The! remaining! respondents! had!
either!not!disclosed!their!status!(8.3%,!n=33)!or!did!not!provide!a!response!(7%,!n=28)!(Figure(
47).!
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!
7%!
8%!
Empowering!
Not!Empowering!
49%!
HIV!Status!Not!Disclosed!
!
No!Response!
36%!
Figure!47:!HIV!disclosure!as!an!empowering!experience!
!
3.3 Treatment
Self`description(of(health(
Figure(48!shows!that!16%!(n=44)!described!their!health!as!'excellent’!or!‘very!good’,!while!over!
one!quarter!(25.8%,!n=103)!described!their!health!as!‘good’.!Over!half!the!respondents!(57.1%,!
n=228)!indicated!that!their!current!health!was!‘fair’!or!‘poor’.!Four!(1%)!did!not!reply.!!
!
30.3%!
26.8%!
25.8%!
11.0%!
5.0%!
1.0%!
Excellent!
Very!Good!
Good!
Fair!
Poor!
No!Response!
Figure!48:!Respondent’s!self\description!of!health!
!
When! disaggregated! by! gender,! male! respondents! were! more! likely! to! describe! their! health!
status!as!fair’!or!‘poor’!(60.8%,!n=152)!than!female!respondents!(50.4%,!n=66)!(Figure(49).!
(
(
Stigma(Index(
Transgender!(n=18)!
28%!
6%! 11%!
33%!
22%!
Excellent!
Very!Good!
Female!(n=131)!
6%!
15%!
28%!
34%!
Good!
17%!
Fair!
Poor!
Male!(n=250)! 3%!10%!
0%!
26%!
20%!
28%!
40%!
No!Response!
32%!
60%!
80%!
100%!
Figure!49:!Respondents’!health!status,!disaggregated!by!gender!
!
Antiretroviral(treatment(
Over!half!of!respondents!(54.4%,!n=217)!were!currently!taking!ART!and!nearly!75%!said!that!
they!could!access!ART!(i.e.!they!know!where!to!get!it!and!it!is!free!of!charge)!should!they!need!
it!(71.7%,!n=286).!Nearly!10%!of!respondents!said!that!they!could!not!access!ART!(8.3%,!n=18)!
and!18%!(n=72)!indicated!that!they!did!not!know!whether!they!could!access!ART!or!not.!!
!
Opportunistic(infections(
Over!20%!of!respondents!(20.1%,!n=80)!indicated!that!they!were!taking!medication!to!prevent!
or! to! treat! opportunistic! infections,! and! over! half! (53.6%,! n=214)! reported! having! access! to!
these!medications!even!if!they!were!not!currently!taking!it.!However,!just!under!one!third!of!
respondents!(32.1%, n=128)!did!not!know!whether!they!had!access!or!not,!and!9.8%!(n=39)!
reported!not!having!access!to!such!medication,!if!needed.!!
!
Discussions(with(health(care(workers(
Of! the! 376! respondents! who! responded,! half! (n=188)! reported! having! had! a! constructive!
discussion!with!a!health!care!professional!on!HIVBrelated!treatment!options!during!the!last!12!
months,!and!half!did!not!(n=188).!TwentyBthree!did!not!reply!(6%!of!total).!In!addition,!of!the!
371!reporting,!nearly!60%!(58.2%,!n=216)!reported!having!had!a!constructive!discussion!with!a!
health!care!professional!on!SRH,!sexual!relationships,!emotional!well!being,!or!drug!use!in!the!
last!12!months,!while!just!over!40%!had!not!(41.8%,!n=155).!TwentyBeight!(7%!of!total)!did!not!
reply.!
!
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3.4 Having children
This! subBsection! focuses! on! respondents’! experiences! regarding! reproductive! options! and!
sexual! and! reproductive! health! services! (SRH).! Female! respondents! were! asked! additional!
questions!relating!to!pregnancy!and!infant!feeding!practices.!
!
Number(of(children(
Over! half! of! respondents! (54.9%,! n=216)! have! children,! 155! do! not! (38.8%)! and! 28!
respondents!did!not!provide!information!(7%).!Of!those!with!children,!20!had!at!least!one!HIVB
positive!child!(9.3%).!
!
Reproductive(Health(Counselling(
Since! HIV! diagnosis,! over! one! third! of! respondents! (35.6%,! n=142)! had! been! counselled! on!
reproductive! health! and! childbearing,! while! just! over! 20%! had! not! (20.6%,! n=83).! Over! one!
third!stated!the!question!was!inapplicable!to!them!(n=140)!and!8.8%!failed!to!respond!(n=35).!
When! disaggregated! by! gender,! female! respondents! were! more! likely! to! have! received! such!
counselling!(63.4%,!n=83)!than!males!(23.2%,!n=58)!(Figure(50).!
!
63%!
56%!
46%!
39%!
35%!
36%!
Male!
Female!
23%!
23%!
18%!
Transgender!
21%!
Total!
14%!
8%!
6%!
!
9%!
5%!
0%!
Yes!
No!
Not!Applicable!
No!Response!
Figure!50:!Ever!received!counselling!about!reproductive!options!since!diagnosis,!
!
Nearly!half!of!respondents!(47.1%,!n=173)!indicated!they!had!never!been!advised!not!to!have!
more!children,!though!4.3%!(n=36)!had.!Of!these,!24!were!female!and!12!male!(Figure(51).!
!
(
(
Stigma(Index(
60%!
56%!
50%!
43%!
39%!38%!
38%!
Male!
Female!
Transgender!
18%!
16%!
9%!
5%!
Total!
8%!
6%!
!
6%!
10%!
0%!
Yes!
No!
Not!Applicable!
No!Response!
Figure! 51:! Health! care! professional! ever! advised! a! respondent! not! to! have! a! child! since!
diagnosis,!disaggregated!by!gender!
!
Nearly! half! of! respondents! (47.1%,! n=188)! reported! never! being! coerced! by! a! health! care!
professional! to! undergo! sterilization! since! HIV! diagnosis.! However,! 4.3%! (n=17)! stated! they!
had,!including!12!female!and!5!male!respondents!(Figure(52).!
69%!
56%!
52%!
47%!
Male!
39%!40%!
39%!
Female!
Transgender!
Total!
18%!
9%!
2%!
4%!
8%!
6%!
!
9%!
5%!
0%!
Yes!
No!
Not!Applicable!
No!Response!
Figure!52:!Health!care!professional!coerced!respondent!into!being!sterilized!since!diagnosis,!
!
When! asked! about! their! ability! to! obtain! ART! on! condition! that! they! use! certain! forms! of!
contraception,!nearly!40%!of!respondents!(38.1%,!n=152)!said!this!is!not/has!never!been!the!
case,! though! 3.5%! of! respondents! indicated! that! this! is/has! been! the! case! (n=14),! including!
three!female!and!11!male!respondents!(Figure(53).!!
!
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64%!
56%!
51%!
39%!
38%!
Male!
Female!
28%!
26%!
Transgender!
Total!
17%!
11%!
11%!
9%!
8%!
6%!
4%!
2%! 4%!
0%!
Yes!
No!
Not!Applicable!
Don't!Know!
10%!
6%!
11%!
No!Response!
Figure!53:!Ability!to!obtain!ART!conditional!on!the!use!of!certain!forms!of!contraception,!
!
Most! of! the! female! respondents! who! had! been! pregnant! in! last! 12! months! experienced! no!
coercion! by! health! care! professionals! regarding! anteB! and! postBnatal! care.! However,! two!
(1.9%)!of!108!respondents!reported!being!coerced!into!terminating!a!pregnancy.!Furthermore,!
10!(8.3%)!of!120!women!reported!coercion!regarding!the!method!of!giving!birth!and!12!(10%)!
of!120!respondents!coercion!in!relation!to!infant!feeding!practices!in!the!last!12!months.!
!
Prevention(of(mother`to`child(transmission(of(HIV(
Women! who! had! been! pregnant! since! diagnosis! were! asked! about! their! access! to! PMTCT!
services.! Of! 114! female! respondents,! over! 40%! (42.1%,! n=48)! had! received! ART! for! PMTCT,!
7.9%! (n=9)! indicated! they! did! not! know! such! prophylaxis! existed,! 2.6%! (n=3)! did! not! have!
access,!and!47.4%!(n=54)!were!not!HIVBpositive!at!the!time!of!pregnancy!(Figure(54).!!
Yes!,!I!received!treatment!
42.1%!
47.4%!
No!,!I!did!not!know!treatment!
existed!
No!,!I!was!refused!treatment!
No!,!I!did!not!have!access!to!
treatment!
7.9%!
No!,!I!was!not!HIV+!when!
pregnant!
2.6%!
0.0%!
Figure!54:!ART!during!pregnancy!for!PMTCT!
(
(
Stigma(Index(
When! asked! whether! they! had! been! given! information! about! healthy! pregnancy! and!
motherhood! as! part! of! PMTCT,! 45! women! responded! of! whom! 43! reported! receiving!
information!(95.5%)!and!2!reported!not!having!been!provided!such!information!(4.4%).!
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Section(4:(Qualitative(questions(
Through! a! series! of! qualitative! questions,! respondents! were! asked! what! they! believed! to! be!
the! main! problems! and! challenges! in! relation! to! HIV! testing! and! diagnosis,! disclosure! and!
confidentiality,! treatment! and! having! children.! The! most! common! responses! and! notable!
responses!are!listed!below!within!subBcategories.!!
!
4.1 Testing and Diagnosis
Testing(and(diagnosis!
134!people!listed!some!issue!with!testing!and!diagnosis:(
(
Counselling(
• Often!people!lack!confidence!to!take!the!test!as!there!isn’t!enough!counselling!before!
hand!
• Lack!of!counselling!
!
Lack(of(consent(
• I!didn’t!know!they!were!doing!a!test,!I!was!unconscious,!someone!else!gave!consent!
•
•
I!didn’t!know!that!they!were!doing!a!HIV!test!
Test!should!always!be!voluntary!
!
Confidentiality(
• There!is!no!confidentiality!on!the!test!tube!as!name!is!written!
!
Health(care(workers(
• The!way!the!nurse!did!the!test!was!very!stigmatizing!especially!when!I!told!her!I!was!a!
•
•
•
drug!addict!
The!person!doing!the!test!didn’t!know!enough!about!the!subject!
Need!more!information!on!how!the!sickness!will!develop!
I!have!problems!with!how!they!look!at!me!
!
Services(
• I! have! problems! coming! in! the! morning,! the! National! Day! Care! Centre! for! the!
•
•
•
•
(
Immunosuppressed!(NDCCI)!is!only!open!half!a!day!
Lost!results!
Test!takes!too!much!time!to!get!results!
I!had!problems!to!get!my!results!
Test!is!not!100%!reliable!
(
Stigma(Index(
•
The!test!went!well!but!it!was!too!bad!it!wasn’t!done!before!I!was!pregnant!
•
They!should!undertake!in!another!area!separate!from!HIV!treatment!
(
Prison(
• A!bit!brutal!(i.e.!taking!blood)!in!prison!
!
Drawing(blood(
• Not!enough!qualified!and!competent!people!to!draw!blood!
•
To!draw!blood!from!an!PWID!is!hard!
!
4.2 Disclosure and confidentiality
114!people!listed!some!issue!with!disclosure!and!confidentiality:!
(
Disclosure(and(confidentiality(
• Disclosure!was!very!confidential!
• It!was!done!in!a!place!where!only!people!with!AIDS!go!
•
•
•
•
•
•
At!PILS!there!is!confidentiality!but!in!the!hospital!there!is!not!
The!result!was!given!in!front!of!many!people!
There!wasn’t!any!confidentiality;!I!was!referred!to!NDCCI!in!front!of!other!people!
Often!there!are!many!doctors!in!the!consult!room!when!they!give!you!the!result!
There!was!lack!of!confidentiality!even!with!my!friend!
Lack!of!confidentiality:!they!called!my!husband!in!when!giving!me!the!results!
!
Prison(
• In!prison!everyone!hears!when!they!call!you!for!the!result!
• In!prison!lack!of!confidentiality!when!it!is!announced!
!
Information(
• When!I!was!told!the!result!I!had!no!information!about!HIV!
• Disclosure!went!poorly!even!though!it!was!confidential.!They!told!me!I!would!only!live!
•
for!eight!years!
It!is!a!bad!thing!to!announce!someone!that!they!are!HIV+!when!they!are!going!to!be!in!
a!jail!cell!in!a!few!hours!
!
Attitudes(
• The!manner!in!which!they!say!your!name!to!give!the!result!is!not!correct!
!
!
!
!
!
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4.3 Treatment
57!people!listed!some!issue!with!ARV!treatment:(
(
Information(
• They!don’t!do!enough!therapeutic!education!
• Don’t!explain!enough!
• Poorly!explained!
!
When(to(start(
•
•
The!need!to!wait!until!you!get!to!a!350!CD4!count!doesn’t!make!sense!
It!should!be!up!to!the!infected!person!to!decide!when!to!start!taking!ARVs!
!
Effects(of(
• I’m!not!yet!adjusted!to!it.!I!often!forget!to!take!my!medicine!
• I!feel!sick!when!I!take!it.!It!was!hard!at!first,!now!I!feel!okay!
• I’ve!stopped!taking!it!because!of!the!side!effects!
•
•
I!have!problems!when!I!have!to!change!the!quantity!or!type!of!ARV!
My!friend!was!once!given!an!expired!medication!
!
Fear(of(stigma(
• I!just!started!treatment.!In!prison!I!didn’t!go!to!the!doctor!because!I!didn’t!want!other!
people!to!see!me!
• Today!was!the!third!time!that!I!restarted!treatment.!I!had!to!stop!treatment!twice!
when!I!started!work!on!a!boat!
!
CD4(and(viral(load(testing(
• It!is!too!complicated!to!get!the!result!from!a!viral!load!test!
• I’ve!had!difficulties!to!do!the!CD4!and!viral!load!test;!1!year!has!passed!since!I!did!a!
viral!load!CD4!test,!when!it!should!be!done!2B3!times!a!year!
• If!you!have!to!go!get!your!CD4!count!done,!you!have!to!go!very!early!in!the!morning;!
•
otherwise!they!won’t!draw!your!blood.!Because!of!that,!a!lot!of!people!are!not!able!to!
go!for!their!CD4!appointments.!It!doesn’t!make!sense!since!don’t!even!need!to!be!
fasting!when!you!go!
Need!to!do!more!tests,!especially!viral!load!
!
!
!
!
!
!
!
(
(
Stigma(Index(
4.4. Having children
34!people!listed!some!issue!with!having!children:(
(
Fear(and(misinformation(
• It!is!a!problem!for!me!as!my!health!is!not!good,!so!I!don’t!think!about!having!kids!
• Personally!I!don’t!think!it!is!worth!it!even!though!it!hurts!me!to!say!it.!How!are!we!to!
ensure!our!children’s!future!when!we!can’t!ensure!our!own?!
• I’m!scared!of!infecting!my!partner.!That’s!why!I!haven’t!had!children!yet!
• I’m!scared!of!having!children!
•
•
•
•
•
It’s!okay!but!there!is!a!lot!of!risk!
I!don’t!want!to!have!HIVBpositive!children!
Not!able!to!breast!feed!
I!haven’t!yet!decided!
I!don’t!know.!I!haven’t!asked!
!
Information(
•
In!the!hospital!they!don’t!explain!to!people!well!enough!
!
Health(care(workers(
• I!think!all!health!care!personnel!should!have!training!
• Doctor!was!scared!to!do!caesarean!section!
!
Mauritius(
Conclusions(
The!conclusions!from!the!study!are!presented!in!line!with!the!discussions!that!occurred!at!the!
stakeholders!meeting!at!the!Goldcrest!Hotel,!Quatre!Bornes,!on!26!April!2013,!specifically:!
!
• GIPA,!social!and!economic!empowerment;!
• Health!services,!including!in!prisons;!and!
• Legal!and!human!rights.!
!
Overall,! the! study! shows! that! HIVBrelated! stigma! and! discrimination,! including! high! levels! of!
internal!stigma,!is!ongoing!and!acts!as!a!barrier!for!PLHIV!to!access!HIV!prevention,!treatment!
and! care! services! in! Mauritius.! With! a! concentrated! HIV! epidemic,! many! PLHIV! face! layered!
stigma!related!to!their!perceived,!previous!or!actual!belonging!to!one!or!more!key!population!
groups,!in!addition!to!being!a!PLHIV.!
!
Respondents!in!general!had!low!education!levels!(64.8%,!n=254),!high!rates!of!unemployment!
(55%,!n=224),!and!nearly!40%!reported!food!insecurity!(39%,!n=144).!On!average!there!were!
2.7! persons! living! in! a! respondent’s! household! at! the! time! of! the! survey! and! at! least! 17%! of!
respondents! (n=68)! reported! living! alone.! A! little! over! half! the! respondents! have! children!
(54.1%,!n=216),!20!of!whom!have!at!least!one!HIVBpositive!child,!and!31!of!whom!reported!at!
least! one! AIDS! orphan! in! their! household.! Underlining! the! socioBeconomic! disadvantage!
evident!among!the!sample,!96.9%!of!respondents!(n=383)!report!a!monthly!income!under!the!
median!of!MRU!Rs!14!640!(USD!468)45.!
!
GIPA,(social(and(economic(empowerment(
!
Internal!stigma!
In! addition! to! low! socioBeconomic! status,! respondents! exhibited! significant! psychosocial!
effects,! for! example,! high! levels! of! internalized! stigma46! and! fear! about! the! ways! they! were!
perceived! and! treated! in! the! community47! and! in! relationships48.! Some! 30%! of! respondents!
reported! feeling! suicidal! in! the! last! 12! months49.! Internal! stigma! also! results! in! decisions! to!
isolate! socially50! and! impede! access! to! health! care,! education! and! employment51.! Only! 33!
respondents!reported!no!internal!stigma,!representing!8.3%!of!the!sample.!
!
Disclosure!and!confidentiality!
Nearly!half!of!respondents!described!disclosing!their!HIV!status!as!an!empowering!experience!
(48.9%,! n=195).! High! levels! of! disclosure! included! to:! spouse! or! partner! (86.7%),! other! adult!
family! members! (82.2%),! other! people! living! with! HIV! (85.2%),! health! care! workers! (89.4%),!
children! in! the! family! (72.7%),! clients! (68.2%),! social! workers! and! counsellors! (66.3%),! and!
(
(
Stigma(Index(
friends!and!neighbours!(45.9%).!However,!10%!of!respondents!had!not!disclosed!their!status!
to! their! permanent! partner! (n=21)! and! a! further! 18.3%! had! not! disclosed! to! injecting! drug!
partners!(n=38).!
!
Approximately!90%!of!respondents!reported!that!they!had!not!felt!pressured!to!disclose!their!
HIV!status!by!others.!However,!7%!of!respondents!(n=28)!reported!having!felt!pressure!from!
other! PLHIV! to! disclose! their! HIV! status! and! 9%! (n=35)! reported! having! felt! pressure! from!
people!other!than!PLHIV!to!disclose!their!HIV!status.!The!reaction!of!different!groups!of!people!
when!first!told!about!the!respondent’s!HIV!status!varied,!though!most!were!supportive,!very!
supportive! or! indifferent.! Just! over! 10%! respondents! (12.3%)! said! the! reaction! of! different!
groups!of!people!was!discriminatory!or!very!discriminatory.!!
!
Experiences!of!stigma!
The!most!common!experience!of!stigma!in!the!previous!12!months,!being!gossiped!about,!was!
reported! by! over! half! the! respondents52.! Less! than! 10%! reported! HIVBrelated! exclusion! from!
social! gatherings! (9%,! n=38),! family! activities! (8%,! n=31)! or! religious! activities! (4%,! n=13).!
Violence! and! abuse! are! prevalent.! Approximately! one! in! five! respondents! reported! having!
been! verbally! insulted/harassed/threatened! (26%,! n=105),! physically! harassed! and/or!
threatened!(22%,!n=85),!and/or!physically!assaulted!(18%,!n=72)!at!least!once!in!the!last!year.!
Of!these,!66%!(n=69),!52%!(n=44),!and!43%!(n=31),!respectively,!reported!that!this!was!due!to!
their!HIVBpositive!status,!in!whole!or!in!part.!Female!respondents!were!twice!as!likely!to!have!
experienced!physical!assault!as!male!respondents!(25.4%,!n=33!compared!to!13.2%,!n=33).!In!
addition,!nearly!40%!of!sex!workers!(n=25)!and!16%!of!PWID!(n=39)!reported!being!physically!
assaulted.!The!perpetrator!of!physical!assault!was!known!to!the!respondent!in!just!over!70%!of!
instances!(n=50),!lived!within!the!household!in!a!quarter!of!cases!(n=17),!and!was!the!spouse!
or!partner!in!9.9%!of!assaults!(n=7).!
!
In! relation! to! HIV! statusBrelated! discrimination! experienced! in! relationships:! 20.3%! of!
respondents! had! experienced! sexual! rejection! (n=81),! 10.3%! reported! psychological! pressure!
or! manipulation! by! a! spouse! or! partner! (n=41),! and! 15.6%! reported! being! discriminated!
against!by!other!PLHIV!(n=62).!Discrimination!against!a!spouse!or!partner!or!other!member!of!
the!household!because!of!the!respondent’s!HIV!status!was!reported!by!11.6%!of!respondents!
(n=46).!
!
Approximately!40%!of!respondents!feel!that!HIVBrelated!stigma!and/or!discrimination!is!due!to!
people!being!afraid!of!being!infected!by!them!(40.8%,!n=122).!Another!38.5%!believed!it!was!
because! people! were! not! aware! of! how! HIV! was! transmitted! (n=115).! Reasons! for!
discrimination! other! than! HIV! status! included! being! a! PWID! (n=! 137),! an! exBdetainee! (n=70),!
sexual!orientation!(n=51)!or!being!a!sex!worker!(n=40).!
!
!
Mauritius(
Effecting!change!
During! the! last! 12! months,! over! 20%! of! respondents! (21.6%,! n=86)! reported! having!
confronted,! challenged! or! educated! someone! who! was! stigmatizing! and/or! discriminating!
against! them.! There! is! modest! involvement! of! PLHIV! in! personal! support53,! with! one! in! five!
participants!being!involved!in!a!PLHIV!support!group!or!network54,!and!less!than!10%!involved!
in!programmes!or!projects!assisting!PLHIV55.!Over!half!of!the!respondents!(55.9%,!n=223)!knew!
of!organizations!or!groups!they!could!go!to!for!help!if!they!experienced!stigma,!while!over!40%!
did! not! (42.6%,! n=170).! Nearly! 10%! of! respondents! (9.3%,! n=37)! indicated! they! had! sought!
help! from! an! organisation.! The! most! widely! known! sources! of! support! were! Vivre! Plus! and!
PILS56.!!
!
Over!one!quarter!recommended!either!advocating!for!the!rights!of!all!PLHIV!(28.6%,!n=114)!or!
raising! the! awareness! and! knowledge! of! the! public! about! AIDS! (26.6%,! n=106)! as! the! most!
important!thing!organisations!should!do!to!address!stigma!and!discrimination.!
!
Health(services,(including(in(prisons(
!
Health!status!
Respondents! selfBassessed! health! status! is! relatively! poor,! with! over! half! (57.1%! n=228)!
indicating! that! their! current! health! was! ‘fair’! or! ‘poor’,! over! one! quarter! (25.8%,! n=103)!
describing!their!health!as!‘good’,!and!only!one!in!five!respondents!(16%!n=44)!describing!their!
health!as!'excellent’!or!‘very!good’.!!
!
HIV!testing!and!counseling!
Over!40%!of!respondents!(41.3%,!n=237)!reported!taking!a!HIV!test!just!to!know!their!status,!
while! over! a! third! (35.2%,! n=138)! were! offered! testing! when! accessing! health! services,!
including!upon!hospital!admission,!at!a!methadone!centre,!during!pregnancy!or!by!an!outreach!
caravan! (NEP! or! PILS).! One! quarter! took! an! HIV! test! upon! entry! into! prison! (23.5%,! n=92).!
Under!10%!(7.1%!n=28)!were!referred!for!HIV!testing!when!already!symptomatic.!
!
Access!to!health!services!
The! results! underscore! a! consistent! pattern! of! denial! of! the! rights! of! PLHIV! in! health! care!
settings,!including!SRH!rights.!For!example:!
•
•
•
(
30.1%!of!all!respondents!(n=122)!report!being!denied!health!services!at!least!once!in!
the!last!12!months!
5%!of!all!respondents!(n=20)!were!forced!to!submit!to!a!medical!procedure!(including!
HIV!testing)!
In!terms!of!HIV!testing:!!
(
Stigma(Index(
o
•
10.3%!of!all!respondents!(n=41)!reported!that!they!were!forced!to!take!a!HIV!
test!or!were!tested!under!pressure!from!others,!and!5.5%!(n=22)!were!tested!
without!their!knowledge.!
o 7%!of!all!respondents!received!only!preBtest!counselling!(n=27),!another!24%!
received!only!postBtest!counselling!(n=97);!and!16.8%!received!no!counselling!
at!all!(n=67).!
Over!one!quarter!of!respondents!(26.8%,!n=107)!stated!that!a!health!care!professional!
had!told!other!people!about!their!HIV!status!without!their!consent.!
!
There!are!also!gaps!in!providing!quality!SRH!services,!for!example:!
• 5%! of! respondents! (n=20)! have! been! refused! family! planning! and! sexual! health!
services!during!the!last!12!months.!
• 20.8%! of! respondents! (n=83)! respondents! indicated! that! they! had! never! received!
counselling! on! their! reproductive! options! since! their! HIV! diagnosis.! Female!
respondents! were! more! likely! to! have! been! received! such! counselling! (63.4%,! n=83)!
•
•
•
than!males!(23.2%,!n=58).!
9%of! respondents! (n=36)! indicated! they! had! ever! been! advised! not! to! have! more!
children,!of!whom!24!were!female!and!12!male.!
4.3%!of!respondents!(n=17)!had!been!coerced!by!a!health!care!professional!to!undergo!
sterilization!since!HIV!diagnosis!including!12!female!and!5!male!respondents.!
3.5%! of! respondents! (n=14)! reported! that! their! ability! to! obtain! ART! was! conditional!
on!using!certain!forms!of!contraception.!
!
However,! PMTCT! services! provide! generally! appropriate! services,! with! small! exceptions,! for!
example:!
• Most!of!the!108!respondents!who!had!been!pregnant!in!last!12!months!and!responded!
experienced! no! coercion! by! health! care! professionals! in! anteB! and! postBnatal! care;!
however,!two!(1.7%)!reported!being!coerced!into!terminating!a!pregnancy.!
• Of! 114! female! respondents,! over! 40%! (42.1%,! n=48)! had! received! ART! for! PMTCT,!
•
7.9%! (n=9)! indicated! they! did! not! know! such! prophylaxis! existed! and! 2.6%! (n=3)! did!
not!have!access.!The!remaining!women!were!not!HIVBpositive!at!time!of!pregnancy.!
Of!45!female!respondents,!43!reported!receiving!information!about!healthy!pregnancy!
and!motherhood!as!part!of!PMTCT,!while!two!reported!not!having!been!provided!such!
information.!
!
Internal! stigma! among! respondents! markedly! affects! access! to! health! care.! A! quarter! of! all!
respondents! (25.1%,! n=100)! had! avoided! going! to! a! hospital! and! 20.4%! (n=80)! had! avoided!
going!to!a!local!clinic!when!needing!care.!
!
!
!
Mauritius(
Legal(and(human(rights(
!
Violations!
The! highest! levels! of! discrimination! were! reported! in! access! to! health! care! (see! above)! and!
access!to!accommodation.!Nearly!a!quarter!of!respondents!(23.6%,!n=94)!had!been!forced!to!
change! residency/refused! accommodation! in! the! last! year,! of! which! 61%! (n=57)! thought! the!
reason!was!HIV!statusBrelated.!
!
While! unemployment! among! respondents! was! high,! of! the! 140! respondents! who! had! some!
form!of!employment,!18!(19.3%)!had!lost!a!job!or!other!source!of!income!(selfBemployed!or!as!
an!informal/casual!worker)!at!least!once!in!the!previous!12!months,!eight!of!whom!stated!HIV!
as!a!reason,!in!whole!or!in!part.!Access!to!education!is!not!a!priority!issue!for!respondents!as!
the! majority! were! not! attending! an! educational! institution! in! the! last! 12! months.! Fourteen!
respondents! (5.7%)! reported! being! dismissed,! suspended! or! prevented! from! attending! an!
educational! institution! because! of! their! HIV! status;! nine! (3.9%)! reported! that! their! children!
have! been! dismissed,! suspended! or! prevented! from! attending! one! because! of! the!
respondent’s!HIV!status!during!the!last!12!months.!Internal!stigma!also!affects!education!and!
employment! opportunities:! 23.1%! of! respondents! (n=89)! decided! not! to! apply! for! a! job! or! a!
promotion,!13.3%!(n=51)!withdrew!from!education!or!training,!and!25.4%!(n=96)!gave!up!their!
job!in!the!last!12!months.!
!
During!the!previous!12!months,!over!10%!of!respondents!(13.5%,!n=54)!reported!having!been!
subjected! to! one! or! more! discriminatory! practices! by! governmental,! legal,! and/or! medical!
institutions.! The! most! frequent! violation! was! denial! of! health! or! life! insurance! reported! by!
6.3%!of!respondents!(n=25).!Disclosure!of!a!respondent’s!HIV!status!without!their!consent!was!
uncommon.! However,! several! instances! were! recorded,! including:! disclosure! to! other! adult!
family! members! (n=17,! 6.5%),! friends! and! neighbours! (n=16,! 4.5%),! other! PLHIV! (n=9,! 2.5%),!
children!in!family!(n=6,!2.2%)!and!health!care!workers!(n=4,!1.1%).!
!
Redress!
Seeking!redress!for!rights!violations!appears!to!not!be!a!viable!option!for!most!respondents.!Of!
53! respondents! experiencing! rights! violations! in! governmental,! legal,! and/or! medical!
institutions,!83%!(n=44)!had!not!tried!to!get!legal!redress!and!only!17%!(n=9)!had.!Further,!of!
the! 25! respondents! who! had! not! sought! legal! redress,! 15!had! not! done! so! because! they! felt!
the!process!was!too!bureaucratic!and!4!had!little!to!no!confidence!in!the!outcome.!!
!
Policy!
At! the! policy! level,! over! 40%! of! respondents! (40.9%,! n=163)! had! been! involved! in! efforts! to!
develop!HIVBrelated!legislation,!policies!or!guidelines,!and!nearly!90%!(89.5%,!n=357)!felt!able!
to!influence!policies,!laws!and!programmes!at!either!national!or!local!levels.!This!engagement!
(
(
Stigma(Index(
is!reflected!in!over!half!of!respondents!(57.5%,!n=227)!knowing!of!the!Mauritian!HIV!and!AIDS!
Act!2006,!of!whom!41%!(n=93)!had!read!or!discussed!it.!
!
Mauritius(
Recommendations(
A! stakeholders! meeting! was! held! at! the! Goldcrest! Hotel,! Quatre! Bornes,! on! 26! April! 2013! at!
which! the! results! of! the! Stigma! Index! were! presented! and! discussed! with! recommendations!
made!on!the!basis!of!the!above!conclusions!in!the!following!areas:!
•
GIPA,!social!and!economic!empowerment;!
•
•
Health!services,!including!in!prisons;!and!
Legal!and!human!rights.!
!
In!addition,!in!response!to!the!limitations!of!and!from!the!results!of!the!studies,!a!number!of!
follow!up!small!scale!studies!are!recommended,!including:!
•
•
•
•
•
A!study!to!explore!the!specific!needs!and!issues!of!the!transgender!population,!as!the!
sample!size!was!small.!
A!complementary!study!to!include!PLHIV!currently!in!detention!to!explore!the!specific!
issues! and! needs! of! PLHIV! in! prisons,! as! only! exBdetainees! and! no! current! detainees!
were!interviewed.!
A! study! to! clarify! experiences! of! breaches! of! confidentiality! by! PLHIV! and! their!
understanding! of! ‘shared! confidentiality’! among! health! care! workers,! in! order! to!
assess!the!level!of!confidentiality!breaches!in!health!care!settings!with!a!commitment!
to!remedying!systemic!issues,!if!and!when!identified.!
A! local! study! to! identify! the! specific! issues! and! needs! of! PLHIV! living! on! Rodrigues!
Island,!as!this!population!was!not!included!in!this!study.!
Further! research! into! the! underlying! facilitators! of! HIV! status! disclosure,! including!
disclosureBrelated!feelings!of!empowerment!and!stigma,!to!address!the!needs!of!key!
populations!living!with!HIV.!
!
!
1.(GIPA(Social(and(Economic(Empowerment((
!
Policy!
• Disseminate! the! findings! of! this! study! to! government,! civil! society,! UN! agencies! and!
donors.!
•
•
•
(
Advocate!with!the!Ministry!of!Home!Affairs,!Ministry!of!Social!Security,!and! National!
Empowerment!Foundation!to!cater!for!the!specific!needs!of!the!most!vulnerable.!!
Support!the!ongoing!active!participation!of!PLHIV!in!the!development!of!laws,!policies!
and!guidelines,!and!in!providing!communityBbased!services!and!support57.!
Integrate! Positive! Health,! Dignity! and! Prevention! programs58! at! all! levels! (i.e.! policy!
through! Behaviour! Change! Communication! Committee,! and! systems! and! service!
delivery!through!NGOs).(
(
Stigma(Index(
•
Advocate! for! the! implementation! of! the! People! Living! with! HIV! Stigma! Index!
recommendations!and!for!the!Stigma!Index!study!to!be!repeated!in!2B3!years.!
!
Systems!
• Strengthen! PLHIV! networks! and! peer! networks! such! as! the! Positive! Ambassadors!
program!to!reach!out!to!hidden!and!hard!to!reach!populations.!
• Build! the! capacity! of! NGOs,! sociocultural! organisations! and! faithBbased! organisations!
working! with! PLHIV! to! provide! empowerment! e.g.! skills! building,! income! generation!
•
activities!etc.!
Encourage! and! build! the! capacity! of! PLHIV! to! advocate! for! their! rights;! be! actively!
involved! (either! as! a! volunteer! or! as! an! employee)! in! developing! and! implementing!
stigma!and!discrimination!reduction!projects!and!programmes;!and!to!provide!support!
and! assistance! to! PLHIV! individually! and! through! support! groups! and! other! local!
organisations.!
!
Service!Delivery!
• Scale! up! Positive! Ambassadors,! peer! education! programme,! as! well! as! peer! support!
programmes!
• Establish!an!ambassador!for!“The!Stigma!Project”!to!disseminate!findings!of!the!Stigma!
Index,!and!lead!activities!and!media!campaigns.!
• Reinforce! public! awareness! of! HIV! through! updated! education! and! mass! media! (TV,!
radio,! SMS)! campaigns,! and! through! implementation! of! the! Behaviour! Change!
•
•
Communicationstrategy,! using! the! message:! le! sida! c’est! une! infection! comme! les!
autres!
Produce!and!disseminate!a!video!with!a!focus!not!solely!on!HIV!but!discussing!prisons,!
genderBbased! violence,! the! National! Empowerment! Foundation,! and! public! health!
system.!
Empower!HIVBpositive!people!to!know!and!assert!their!rights.!
(
(
2.(Health(Services(
(
Policy!
• Develop!an!action!plan!to!adapt!services!to!the!needs!of!people!who!use!drugs,!
including!in!prisons.!
• Advocate!for!youth!friendly!harm!reduction!services!for!young!people!who!use!drugs!
such!as!youthBfriendly!access!to!methadone!induction!and!rehabilitation,!including!for!
rehabilitation!youth!centres!and!correctional!youth!centres.!
!
!
!
Mauritius(
Systems!
Health!Care!Personnel!
• Address!human!resource!constraints!through!increased!health!personnel!in!the!NDCCI!
to! improve! service! quality,! develop! a! policy! for! prevention! of! burnout! among! health!
care!workers,!including!task!shifting!and!task!sharing,!and!strengthen!communication!
(i.e.!referral)!between!doctors!in!the!NDDCI!and!public!hospitals.!
• In!terms!of!human!resource!capacity!building:!
• Reinforce!preB!and!inBservice!training,!not!only!of!health!care!professional!but!
also!for!all!health!personnel.!
Invite!hospital!superintendants!more!often!to!training!and!update!sessions.!
Rotate! medical! practitioners! in! HIVBrelated! units! and! divisions! as! a! means! of!
updating!on!HIV!prevention,!treatment,!care!and!support.!
Revise! training! tools! to! incorporate! stigma! and! discrimination! modules!
including! HIVB! and! drugBrelated! stigma! and! discrimination;! and! legal!
requirements,!enforcement!mechanisms!and!penalties!under!the!HIV!and!AIDS!
•
•
•
•
•
Act!(2006)!and!the!Equal!Opportunities!Act!(2008),!as!well!as!identified!issues!
including! logistics! supply! management,! specifically! commodities! storage!
procedures,!and!adherence!counselling.!
In!order!to!address!gaps!in!healthBrelated!information!among!respondents!and!to!
improve!the!quality!of!the!NDCCI!services:!
• Disseminate!information!to!PLHIV!on!services!at!NDCCIs!and!HIV!testing!
points.!
• Station!a!government!social!worker!based!at!NDCCI.!
Develop! and! support! stigma! and! discrimination! monitoring! systems! for! health! care!
settings.!Suggestions!include:!
• Encouraging! PLHIV! to! report! any! ill! treatment! as! soon! as! possible,! with! name! of!
health!professional!to!a!legal!aid!or!social!worker.!
• Formal! policies! and! procedures! instituted,! for! example,! write! to! the! Regional!
Health!Director,!who!sends!the!matter!to!the!Ministry!of!Health!and!Quality!of!Life!
via! a! specified! committee,! which! has! the! authority! to! take! appropriate! action(s)!
with!respect!to!the!individual!case,!and!to!address!system!issues.!
!
Dental!Services!!
• Increase! communication,! awareness! and! sensitisation! on! HIV! prevention,! treatment,!
care!and!support!and!other!blood!borne!viruses!for!dentists!and!related!staff.!
!
Prisons!
•
(
In!order!to!address!breaches!of!confidentiality!when!conveying!HIV!testing!results!and!
providing! care! in! prison,! institute! a! system! of! prison! patient! appointment! cards! in!
conjunction! with! improved! logistics! (i.e.! appropriate! space! and! size! for! facilities! such!
as!private,!confidential!consultation!rooms).!
(
Stigma(Index(
•
•
Train! and! educate! all! prison! staff! on! HIV! and! other! STIs! and! blood! borne! infections,!
along! with! the! provisions! of! the! Mauritian! HIV! and! AIDS! Act! 2006! and! Equal!
Opportunities!Act!2008,!specifically!on!how!these!Acts!pertain!to!prisons.!
Provide! access! and! support! to! prison! staff! and! detainees! seeking! redress! for! rights!
breaches!prescribed!under!these!Acts.!
(
(
3.(Legal(and(Human(Rights(
(
Policy!
• Advocate!with!the!Ministry!of!Home!Affairs!to!take!steps!to!align!policing!with!public!
health!efforts!targeting!vulnerable!groups.!
!
Law!reform!–!drug!use!related!
• Review! drug! useBrelated! laws,! including! the! Dangerous! Drugs! Act! 2000,! and!
•
•
regulations.!Specific!issues!to!address!include!paraphernalia!laws,!clarification!of!laws!
relating! to! drug! consumer! and! dealer,! laws! which! criminalize! PWID,! prison! diversion!
programmes,! a! framework! for! employees! to! access! medical! services,! including!
methadone!services!provided!by!onsite!doctors,!and!revision/removal!of!the!Morality!
Certificate59.!
Review!and!reform!laws!and!protocols!in!line!with!UN!guidance!relating!to!drug!use!in!
prisons60,!including!access!to!health!services!such!as!clean!syringes!and!condoms,!and!
access!to!methadone!for!detainees!not!in!possession!of!an!identity!card.!
Advocate! for! a! cost! effective! drug! control! framework! e.g.! existing! policies! are!
counterproductive! in! public! health! terms! and! are! expensive! with! little! appreciable!
benefit.!
!
Other!legal!reforms!include:!
• Review!and!enactment!of!the!Sexual!Offence!Bill.!
•
•
•
•
Review!laws!and!regulation!on!sex!work!and!other!laws!that!discriminate!against!key!
populations.!
Recognition!of!transgender!identity.!
Reinforce!laws!to!protect!people!who!bring!stigma!and!discrimination!court!cases!(e.g.!
video!record!hearings.)!
Laws!and!policies!requiring!the!media!and!journalists!to!protect!PLHIV,!especially!with!
regard!to!confidentiality.!
!
Systems!level!
• Train! police,! particularly! the! hierarchy,! on! public! health! efforts! targeting! vulnerable!
groups! and! the! role! of! law! enforcement! in! enabling! these! interventions,! including!
through!establishing!communityBpolice!collaboration.!
Mauritius(
!
Service!delivery!
• Establish!broadBbased!legal!aid!services!to!meet!the!needs!of!PLHIV,!women!and!youth!
as! well! as! key! populations,! including! MSM,! migrant! workers,! PWID,! detainees,! sex!
workers!and!transgender.!
• In!relation!to!rights!awareness:!
• Support! efforts! to! popularize! (make! available! and! accessible)! the! content! of!
laws!e.g.!sketch!and!videos.!
Strengthen! PLHIV! networks!and!peer! networks!such!as!Positive!Ambassadors!
to!reach!out!to!hidden!and!hardBtoBreach!populations.!!
Scale! up! HIV! prevention! session! and! schools! and! train! teachers! to! explain!
human!rights!to!students.!
•
•
(
The! National! Strategic! Framework! 2013B2016! details! the! plan! to! address! issues! relating! to!
stigma! and! discrimination.! In! light! of! the! results! of! the! Stigma! Index! study! in! Mauritius,! the!
specific! recommendations! listed! above! will! be! undertaken! as! part! of! Impact! 3! of! the! NSF,!
61
which!aims!to!eliminate!HIVBrelated!stigma!and!discrimination. !
(
(
Stigma(Index(
Mauritius(
Annex(1:(People(Living(with(HIV(Stigma(
Index:(Kreol(morisien(
Section 1: Ou information
1. Ki ou sex?
Masculin  1
Féminin  2
Transgenre  3
2. Ki laz ou éna?
15-19 ans  1
20-24 ans  2
25-29 ans  3
30-39 ans  4
40-49 ans  5
plis ki 50 ans  6
3. Depi comié lane ou pé viv avec VIH?
Moins ki 1 an  1
1-4 ans  2
5-9 ans  3
10-14 ans  4
4. Dan ki kalité rélation ou été?
Marié, ou pé viv ek kiken, et tou lé dé rest dan mem lacaz
1
Marié, ou vive k kiken mais ou partenaire pa pe viv dans
mem lacaz ek ou pour le momen`t  2
Dan ène rélation mais ou pas vive ek ou partenaire  3
Pa éna personne dans ou lavi  4
Divorcé ou séparé  5
Veuf/Veuve  6
5. Si ou éna ène partenaire, dépi comié tan
zot ensam?
Moins ki 1 an  1
1-4 ans  2
5-9 ans  3
10-14 ans  4
6. Eski ou pé gagne relation sexuel?
Oui  1
Non  2
7. Eski ou tom dans sa bane categories ki
mo pou dire ou la? Ou eski dans le passé ou
ti la dans?
Zom ki gagne relation ek zom  1
Gay ou Lesbienne  2
Transgenre  3
Travailleur du sex  4
Toxicomane  5
Travailler étranzer  6
Prisonier  7
Pas dans oken sa bane catégorie la  8
8. Eski ou éna kit handicap physique (pas
bane probleme la santé ki lié ek VIH)?
Oui  1
Non  2
Si oui, dire ki handicap physique:
(
(
Stigma(Index(
9. Ziska ki class ou fine al lekol?
10. Eski ou:
Zamé ine al lekol  1
Lekol primaire  2
Lekol secondaire  3
College teknik ou l’université  4
Éna ene travail full time  1
Éna ene travail part time  2
Travail full time pou ou meme  3
Travail part time pou ou meme ou kan gagne  4
Pas travail ditou  5
11. Ou capav dire moi :
• comié zenfant ki éna moins ki 14
ans rest dans ou lacaz?
• comié zeness ent 15-19 ans ki rest
dan ou lacaz?
• comié adult entre 20-24 ans ki
rest dan ou lacaz?
• …
12. Comié zenfant ou zeness dans ou lacaz
ki ine perdi so mama ou papa acoz SIDA?
Zenfant 0-14 ans: ___________________________
Zeness 15-19 ans: ___________________________
Adult 20-24 ans: ____________________________
Adult 25-29 ans: ____________________________
Adult 30-39 ans: ____________________________
Adult 40-49 ans: ____________________________
Adult plis ki 50 ans: _________________________
Kantité orphelin : ___________________________
13. Eski ou rest dans:
14. Dan 12 derrnier mois, a pé pré comié
cass fine rent dan ou menaz par mois?
15. Dan moi dernier, comié zour eski kit
membre ou lafami ine mank manzé?
Villaz  1
La ville  2
Kantité cass par mois dan 12 dernier mois : _________
(For data capturers only:
Annual income in Rs: _________
Current exchange rate from Rs to USD: _________
Annual income in USD: _____________________)
Kantité zour : ___________________
Section 2A: stigmatisation ek discrimination ki lezot dimoune ine fer avek ou
1a. Dan sa 12 dernier mois la, comié fois
eski lézot ine empess ou participe dans bann
évènements couma mariaz, lenterremen,
fête, dans clib tou sa?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
Si réponse ‘zamé’, al lor kestion 2a
1b. Ki fer?
Parski ou seropositif  1
Pou lezot raisons  2
Parski ou seropositif ek pou lezot raisons aussi  3
Ou pas cone kifer  4
2a. Pendant 12 dernier mois, comié fois ine
empess ou participe dans bann la prière ou
dan bann place fer la prière?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
Mauritius(
2b. Ki fer?
3a. Dans 12 dernier mois, comié fois ine
empess ou participe dans bane activités
familial couma cuit manzé, manz ensam,
dormi dans meme lassam, lav linze ensam?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
3b. Ki fer?
4a. Dans 12 dernier mois, comié fois ou fine
aprane ki dimoune pé coz ou coser?
4b. Ki fer?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
5a. Dans 12 dernier mois, comié fois eski
dimoune ine insilté ou, ine harcel ou ine
menace ou verbalement?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
5b. Ki fer?
6a. Dans 12 dernier mois, comié fois
dimoune ine harcel ou, ou menace pou
aggress ou physiquement?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
6b. Ki fer?
7a. Pendant 12 dernier mois, comié fois
dimoune ine aggress ou physiquement?
Si réponse ‘zamé’, al lor kestion 8
(
(
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
Stigma(Index(
7b. Ki fer?
7c. Ki sane la ki fine aggress ou?
8. Si dan ban kestion ki mone fek poz ou, ou
fine deza fer face stigmatization ek
discrimination, mais pa parski ou seropositif,
eski ti acoz ou:
Ou mari/fam/partner  1
En dimoune ki rest dans ou lacaz  2
En dimoun ki pas rest dans ou lacaz mais ki ou coné  3
En dimoune ki ou pas coné  4
Ene zom ki gagne relation ek zom; gay; lesbienne;
transgenre  1
Travailleur du sex  2
Toxicomane  3
Travailler étranzer  4
Prisonier  5
Oken sa bane repons la, ti acoz enn lot raison  6
Si “oken sa bane reponse la, acoz enn lot
raison”, dire kifer ou pensé ou ti fer face kit
stigmatization ek discrimination.
9. Dan sa 12 dernier mois la, comié fois eski
ou mari/fam/partner ine servi VIH kont ou
pou fer ou sibir ban pression psycologik ou
bann manipulation?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
10. Dan sa 12 dernier mois la, comié fois
eski dimoune ine répousse ou sexuellement a
coz ou seropositif?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
eski bane lezot dimoune ki p viv ek VIH fine
fer ou sibir bane discrimination?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
eski ou mari/fam/partner, ou ene lot dimoune
ki rest da ou lacaz fine subir discimination
parski ou seropositif?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
13. Si ou fine fer face kit stigmatization ou
discrimination a coz VIH dans 12 dernier
mois, ki raison ou pensé ena derriere sa?
Dimoune per zot pou gagne VIH ar moi  1
Dimoune pa coné couma VIH transmet ek zot per mo pou
infecte zot si zot gagne simple contact ar moi  2
Dimoune pensé VIH ene la honte et fodé pa zot frékent
moi  3
Croyance religieux ou zizmen  4
Dimoune pa dakor ek maniere mo amene mo lavi, ou
comportement  5
Mo paret malad avek bann symptom VIH  6
Mo pa coné  7
Mauritius(
Section 2B: Ou l’accès ar travy, service la santé ek service lédikation
1a. Dan sa 12 dernier mois la, comié fois ou
fine oblizé sanz lendroit kot ou resté, ou bien
ou pane capav louer ene lacaz?
1b. Ki fer?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
Ou pas coné kifer  4
(Si client la pane éna oken revenu pendant
sa 12 dernier mois la, al lor kestion 5)
2a. Dans 12 dernier mois, comié fois eski ou
fine perdi travay (si ou employé) ou bien ou
revenu (si ou travay pou ou mem)?
2b. Pou ki rézon?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
2c. Si impé ou totalement acoz VIH, eski ou
fine perdu ou travay akoz:
discrimination ou employer ou bane collègue ine fer ar
ou  1
ou fine oblizé arret travay acoz ou la santé pa ti bon  2
discrimination ek la santé pas bon ensam 3
Akoz ene lot rézon  4
3. Dan sa 12 dernier mois la, eski fine réfiz
ou ene travay, ou réfiz fer ou gagne ene
travay acoz VIH?
Oui  1
Non  2
4a. Dan sa 12 dernier mois la, comié fois
fine sanz travay ou fer, ou refiz ou ene
promotion parski ou seropositif?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
4b. Si oui, eski ti acoz:
Discrimination ou employer ou, ou bane collègue fer ek
ou 1
Ou la sante ti p empess ou fer enn bann travay  2
Discrimination ek rézon la santé ensam  3
Akoz ene lot rézon  4
5. Dan sa 12 dernier mois la, comié fois ine
renvoye ou, sispann ou, ou empess ou suiv
ene cours parski ou seropositif?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
Pa applikab  5
6. Dan sa 12 dernier mois la, comié fois eski
fine met ou dehors, sispann ou empess ou
zenfan suiv ene cour parski ou seropositif?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
Pa applikab  5
(
(
Stigma(Index(
7. Dan sa 12 dernier mois la, comié fois fine
refiz ou bann service la santé y compris soin
kot dentist, parski ou seropositif?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
Pa applikab  5
8. Dan sa 12 dernier mois la, eski fine refiz
ou bann service family planning parski ou
seropositif?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
Pa applikab  5
9. Dan sa 12 dernier mois la, eski fine refiz
ou bann service la santé sexuel ek
reproductive
parski
ou
seropositif
(information lor STI, VIH, etc.) ?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
Pa applikab  5
Section 2C: Seki ou penser lor ou meme
1. Dan sa 12 dernier mois la, eski, a coz ou
seropositif, ou finn :
gagne honté: Oui  1 Non  2
senti ou coupab: Oui  1 Non  2
blame ou mem: Oui  1 Non  2
blame lezot: Oui  1 Non  2
perdi lestim pou ou mem: Oui  1 Non  2
senti ou mérite ene pinition: Oui  1 Non  2
envi suicidé:Oui 1Non  2
2. Dan sa 12 dernier mois la, eski, parski ou
seropositif :
Ou fine prefer pas participe dan ene program social:
Oui  1 Non  2
Ou fine ferme ou mem ek ou fami ek kamarad:
Oui  1 Non  2
Ou fine pren decision arret travay:
Oui  1 Non  2
Ou fine decide pa apply pou ene travay ou ene promotion:
Oui  1 Non  2
Ou fine arret ene cours ou ene training ou bien laisse ene
opportunite training passé:
Oui  1 Non  2
Ou fine decide pas marié:
Oui  1 Non  2
Ou fine decide pas gagne relation sexuel:
Oui  1 Non  2
Ou fine decide pas gagne zenfan:
Oui  1 Non  2
Ou fine evite al dans ene dispensaire/clinic kan ou ti bisin
alé:
Oui  1 Non  2
Ou fine evite al hopital kan ou ti bisin alé:
Oui 1Non  2
Mauritius(
3. Dan sa 12 dernier mois la, mem si ca pane
arrive, eski ou fine per :
Cozé dimoune: Oui  1 Non  2
Ki dimoune insulté ou harcel ou, ou menace ou
verbalement: Oui  1 Non  2
Ki dimoune harcel ou, ou menace pou aggress ou
physikmen: Oui  1 Non  2
Ki dimoune aggress ou physikmen:
Oui  1Non  2
4. Dan sa 12 dernier mois la, eski ou fine per
ki kiken refiz rent dan ene relation sexuel
intime ek ou parski ou seropositif?
Oui  1
Non  2
Section 2D: Droits ek la loi
1a. Eski ou fine tane coze “Déclaration d’engagement
lor VIH/sida” ki protez droit bane dimoune ki viv avec
VIH dans le monde?
Oui  1
Non  2
1b. Si oui, eski ou fine deza lire li ou gagne ene
discussion lor seki ena ladan?
Oui  1
Non  2
2a. Eski ou fine tane coze HIV & AIDS Act ki protez
droit bane dimoune ki viv avec VIH dans Maurice?
Oui  1
Non  2
2b. Si oui, eski ou fine deza lire li ou gagne ene
discussion lor seki ena ladan?
Oui  1
Non  2
3. Dan sa 12 dernier mois la, parski ou seropositif,
eski ou :
Fine force ou fer ene test medical, incluant
test VIH  1
Fine refiz ou ene l’assurance maladie ou ene
lassurance lavi a coz ou seropositif  2
Fine arret ou, ou amene ou la court pou ene
raison ki lier ek le fait ki ou seropositif  3
Fine bizin dire ki ou seropositif pou rente
dans ene lot pays  4
Fine bizin dire ki ou seropositif pou apply pou
permis residence/nationalité  5
Fine ferme ou, isole ou, separe ou, ou met ou
en quarantaine  6
Aucun sa bane zafer la pane ariv moi  7
4a. Dan sa 12 dernier mois la, eski ou bane droit en tant
ki ene dimoune ki viv avec VIH fine abisé?
Oui  1
Non  2
Pa koné  3
Si répons la non, al lor prochain section (2E)
4b. Si oui, eski ou fine essaye pren bane action legal ?
Si répons la non, ou pas koné, al lot kestion 4e.
Oui  1
Non  2
Pa koné  3
4c. Eski ou fine comens kit demars legal dans 12 dernier
mois?
4d. Ki fine arrivé lerla?
Oui  1
Non  2
Case la ine fini  1
Case la encore p roulé  2
Pane ariv nanye/pa fine ena case  3
Aster al lot kestion 5a.
(
(
Stigma(Index(
4e. Si réponse pou kestion 4b ti ‘non’ ou ‘pas koné’, ki
fer ou pane essaye pren action legal?
Pena assez cass pou fer demars  1
Demars pou fer ene case paret tro compliqué
2
Per/mank couraz pou prend action  3
Dimoune ine conseil pa al de lavan  4
Pa ti pou gagné sa case la  5
Aucun sa bane raisons la  6
5a. Eski ou fine essaye tap laporte ene dimoune ki travay
dan gouvernement pou pren action kont violation ou
droit en tant ki ene dimoune ki p vivre ar VIH?
Oui  1
Non  2
Si réponse ‘non’, al lor kestion 6a.
5b. Eski sa fine arrivé dans 12 dernier mois?
5c. Ki fine arrivé lerla?
Oui  1
Non  2
6a. Eski ou fin essaye tap la porte ene politicien pou pren
action kont violation ou droit en tant ki ene dimoune ki p
vivre ar VIH?
Oui  1
Non  2
Si réponse ‘non’, al section 2E.
6b. Eski sa fine arrivé dan 12 dernier mois?
6c. Ki fine arrivé lerla?
Oui  1
Non  2
Section 2E: Ammen bann changement
1. Dan sa 12 dernier mois la, eski ou fine confronte,
eduque ou rapel a l’ordre enn dimoune ki ti p fer
stigmatisation ek discrimination kont ou?
Oui  1
Non  2
2a. Eski ou kone kit organisation ou group ek ki ou
capav demande l’aide si ou subir stigma ek
discrimination?
Oui 1
Non  2
Si ‘non’, al lor kestion 3.
2b. Si oui, ki kalité organisation ou group eski ou coné?
Group de soutien pou PVVIH 1
Rezo dimoune ki vive ek VIH  2
Organisation religieux  3
Cabinet legal  4
Ene organisation droits de l’homme  5
ONG national  6
National AIDS Secretariat 7
ONG international  8
Organisation Nations Unies  9
Lezot  10
Mauritius(
2c. Si ou finn reponn « lezot », eski ou capav decrire
l’organisation ou group la?
3. Eski ou fine demane l’aide kot sa bane organisation ou
group la pou resoud ene problem stigmatisation ou
discrimination?
Oui  1
Non  2
4. Si ou fine essay resoud ene problem stigmatisation ou
discrimination par ou meme, ou avec l’aide lezot, eski ou
capav decrire kin arrive?
Ki sane la fine aide ou?
Comment ou, ou bien lezot, fine resoud situation la?
5a. Dan sa 12 dernier mois la, eski ou fine aide lezot
dimoune ki vive avec VIH?
5b. Si oui, dan ki facon ou fine aider?
Oui  1
Non  2
Support moral (conseil, partaz ou prop
l’experience)  1
Support en terms l’arzent, manzé ou bane
demars  2
Ou fine refer zot a bane services  3
6. Eski ou membre ene group de support pou bane
dimoune ki vive ek VIH ?
Oui 1
Non  2
7. Dan sa 12 dernier mois la, eski ou fine implik ou
couma ene volontaire ou travailler dan ene projet ou ene
service (gouvernmental ou non-gouvernmental) ki done
l’aide a bane dimoune ki viv ek VIH?
Oui  1
Non  2
8. Dan sa 12 dernier mois la, eski ou fine impliké dan
ene projet pou develop bane la loi ou bane decisions ki
concerne VIH?
Oui  1
Non  2
9. Eski ou senti ki ou ena capacité influence bane
decision ki concerne:
Bane droit bane dimoune ki viv ek VIH  1
Bane decision au niveau ou la ville ou village
ki concerne PVVIH  2
Bane projet ki concerne bien-etre bane
PVVIH  3
Bane decision au niveau national ki concerne
PVVIH  4
Bane projet national dan l’interet bane
PVVIH  5
Bane la loi international/accord international
6
Ene lot zafer ki pane mentioné ici  7
10. Ena ene bane organisation bane PVVIH ki p travay
kont stigmatisation et discrimination.
Si ene ladans dimane ou: ki kiksoz pli important ki nou
bizin fer en tant ki ene organisation pou lit kont
stigmatisation ek discrimination, ki ou ti pou
récomandé?
La guerre pou droit bane PVVIH  1
Done support moral, physique ou refer ou a
enn service a bane PVVIH  2
La guerre pou droit et done sipor bane group
couma bane homosexuel, toxicomane ek
prostitué  3
Fer ledikasyon bane PVVIH lor couma viv ek
VIH ek traitement  4
Sensibilise ek fer ledikasyon public lor
VIH/sida
5
(
(
Stigma(Index(
Section 3A: Testing/Diagnosis
1. Ki fer ou ti fer test VIH?
Pou ene travail  1
Grossesse  2
Parski ou ti p al marié ou al gagne relation sexuel  3
Ene clinic/hopital ti refer ou acoz infection sexuellement
transmisible  4
Ti refer ou parski ou ti ena bane symptomes VIH  5
Mari/fam/ene membre lafami ti positif  6
Maladie ou deces mari/fam/ene membre lafami 7
Ou ti envi coné  8
Lot raison  9
Si ene lot raison, donn raison la:
2. Eski fine laisse ou pren decision si ou pou
fer test la?
Oui, mone pren decision la mo meme  1
Mone pren decision la mo meme mai lezot ine met
pression lor moi  2
Fine force moi fer test la  3
Mo pa ti mem coné ine fer test ar moi – kan ine fini fer
test ki mone coné  4
3. Eski ti fer counselling ar ou kan ti fer test?
Mone gagne conseil avant et apres test la  1
Mone gagne conseil zis avant fer test  2
Mone gagne conseil zis apres fer test  3
Mone pane gagne aucun conseil kan ine fer test 4
Section 3B: Annonce ek confidentialité
1. Pou tout sa bane dimoune ou group dimoune mo pou dir ou la, expliké couma fine dir zot ki ou positif, si fine
dir zot:
Mo mem mone
dir
Ene dimoune
ine dire avek
mo lakor
Ene dimoune
ine dire zot san
mo lakor
Zot pa coné mo
positif
Pas applicab
Ou
mari/fam/partner
1
2
3
4
5
Bane memb ou
fami ki adult
1
2
3
4
5
Zenfan da mo
fami
1
2
3
4
5
Kamarad/voisins
1
2
3
4
5
Lezot dimoun
PVVIH
1
2
3
4
5
Bane dimoune
ek ki ou travail
1
2
3
4
5
Ou
employeur/sef
1
2
3
4
5
Ou bane clients
1
2
3
4
5
Ou bane
kamarad
toxicomane
1
2
3
4
5
Mauritius(
Prete/Sef
religieux
1
2
3
4
5
Force vive
1
2
3
4
5
Dimoune travail
dan
lopital/dispensair
e
1
2
3
4
5
Travayer Social
1
2
3
4
5
Professeur lekol
1
2
3
4
5
Travayer
gouvernment
1
2
3
4
5
Zournalist
1
2
3
4
5
2a. Comié fois eski ou fine gagne pression depi
lezot PVVIH ou depi bane organisation PVVIH
pou rend piblik ki ou viv ek VIH?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
2b. Comié fois eski ou fine gagne pression depi
lezot dimoune ki pa viv ek VIH (couma bane
fami, bane travayer social, ONG) pou rend piblik
ki ou viv ek VIH?
Zamé  1
1 fois  2
2-3 fois  3
Souvent  4
3. Eski ene dimoune ki travay dan la santé couma
ene dokter, nurse ou ene dimoune ki travay dan
lopital fine deza dir lezot dimoune ki ou viv ek
VIH sans ou donn ou lakor?
Oui  1
Non  2
Pas koné  3
4. Eski ou pensé ki ou dossier medical lor VIH
confidentiel?
Mo sir mo dossier garder avek confidentialité
1
Mo pas coné si mo dossier garder avek confidentialité  2
Li clair pou moi ki mo dossier pa gardé avec confidentialité
3
5. Couma ou ti pou decrire reaction bane dimoune
kan zot fine coné pou premier fois ki ou viv ek
VIH?
6. Eski ou fine trouve l’annonce ki ou PVVIH ene
lexperience ki rane ou pli fort?
(‘Pas applikab’ si ou pa fine annonce ki ou
seropositif)
(
(
Oui  1
Non  2
Pas applicab  3
Stigma(Index(
Section 3C: Traitement
1. En zénéral, couma ou ti pou décrir l’état ou la santé pou le
moment?
2a. Eski ou p pren antirétroviral (traitement sida) en ce moment?
Excellent  1
Bien bon  2
Bon  3
Pas mal  4
Pas bon  5
Oui  1
Non  2
2b. Eski ou capav gagne antiretroviral gratuit mem si ou pa p
pren li?
Oui  1
Non  2
Pa koné  3
3a. Eski ou p pren kit medicament pou empess ou gagne, ou pou
soigne bane infection opportunist aster?
Oui  1
Non  2
Pas koné  3
3b. Eski ou capav gagne medicament pou infection opportunist
gratis mem si aster la ou pa prend li?
Oui  1
Non  2
Pas koné 3
4. Dan sa 12 dernier mois la, eski ou fine gagne ene bon
conversation ek ene dimoune ki travay dan la santé lor bane
different possibilité traitement ki capav ena pou ou?
Oui  1
Non  2
5. Dan sa 12 dernier mois la, eski ou fine gagne ene bon
conversation ek ene dimoune ki travay dan la santé lor ou
sexualité, possibilité gagne zenfan, contraception, bien-etre moral
ou consommation la drogue?
Oui  1
Non  2
Section 3D: Ena zenfan
1a. Eski ou ena zenfan?
Oui  1
Non  2
1b. Si oui, eski ena ki p viv ek VIH?
Oui  1
Non  2
2. Depi ki ou fine coné ki ou viv ek VIH, eski ou fine recevoir
conseil lor bane option possib pou gagne zenfan?
Oui 1
Non 2
Pas applicab  3
3. Eski ene dimoune ki travay dan la santé fine deza conseil ou pa
gagne zenfan parski ou fine testé positif?
Oui  1
Non  2
Pas applicab  3
4. Eski ene dimoune ki travay dan la santé fine deza force ou pou
fer kiksoz pou ki ou nepli gagne zenfan parski ou seropositif?
Oui  1
Non  2
Pas applicab  3
5. Eski donn ou anti-retroviral a condition ki ou servi kit moyen
contraception?
Oui  1
Non  2
Pas applicab  3
Pas koné  4
(Kestion 6 et 7 pou bane candidat madam selman)
Mauritius(
6. Dan sa 12 dernier mois la, eski ene dimoune ki travay dan la
santé fine force ou, parski ou positif:
Fer lavortement  1
Accouche ene facon  2
Nourri ou baba ene facon  3
7a. Eski fine deza donn ou traitement anti-retroviral pou empess
transmission VIH pendant grossesse?
Oui, mone recevoir traitement  1
Non, mo pas ti coné ena sa traitement
la  2
Non, mone refiz sa traitement la  3
Non, mo pane gagne sa traitement la
4
Non, mo pas ti positif kan mo ti
enceinte  5
7b. Si « oui », eski ou fine recevoir information lor ene bon
grossesse et responsabilité couma enn maman pou empess
transmission VIH a baba?
Oui  1
Non  2
Section 3E: Problems ek difikiltés
Ki bane problem ek difikiltés ki ou trouvé ena ek:
1. Test VIH:
2. L’annonce ek confidentialité kan ou positif:
3. Traitement anti-retroviral:
4. Gagne zenfan kan ou positif:
(
(
Stigma(Index(
Annex(2:(Stigma(Index(Results(Validation(
Meeting(List(of(Participants(
The!People!Living!with!HIV!Stigma!Index!Study!in!Mauritius!workshop!on!preliminary!findings!
was!held!at!Gold!Crest!Hotel!in!Quatre!Bornes!on!26!April!2013.!The!participants!included!
representatives!from!the!following!organisations:!
•
National!AIDS!Secretariat!
•
Ministry!of!Health!and!Quality!of!Life!
•
Mauritius!Prison!Services!
•
Prévention!Information!Lutte!contre!le!SIDA!(PILS)!
•
Vivre!Plus!
•
VizaG!
•
Chrysalide!
•
Kinouete!
•
Groupe!A!de!Cassis!
•
Centre!Idrice!Goomany!
•
Collectif!ArcBenBCiel!
•
Sangram!Sewa!Sadan!
•
AILES!
Mauritius(
Annex(3:(Chronological(Key(Steps(in(the(
Local(Implementation(Process(
1. Read!the!People!Living!with!HIV!Stigma!Index!User(Guide!from!www.stigmaindex.org!to!get!
acquainted!with!the!study,!objectives,!methodology,!etc.!!
2. Seek(guidance!from!the!People!Living!with!HIV!Stigma!Index!coordinator!at!the!
International!Planned!Parenthood!Federation/GNP+!
Request!the!original!People!Living!with!HIV!Stigma!Index!questionnaire!from!the!
coordinator!!
3. Write!the!Concept(Paper!for!the!Stigma!Index,!with!an!introduction,!justification,!objective,!
outline!of!the!study!methodology,!and!costing.!!
•
4. Introduce!the!People!Living!with!HIV!Stigma!Index!research!study!to!key(stakeholders(and!
partners!(the!people!living!with!HIV!networks!and!organizations)!and!present!the!concept!
paper!
•
Discuss!how!the!research!results!from!the!People!Living!with!HIV!Stigma!Index!can!
support!local!advocacy!and!other!activities.!!
•
Clarify!the!role!that!the!key!stakeholders!and!partners!can!play!in!the!research!
process.!!
Discuss!what!resources!are!available!for!the!research!and!how!any!necessary!
additional!resources!can!be!mobilized!(for!example,!help!with!sampling,!recruitment,!
•
•
etc.)!
Discuss!a!possible!dissemination!strategy!for!the!results,!including!sharing!results!with!
the!study!participants!and!the!wider!community.!!
Agree!to!timelines!and!a!mechanism!whereby!key!stakeholders!and!partners!can!be!
kept!informed!about!the!progress!of!the!research.!!
5. Secure!financial(support!for!the!study!–!make!a!detailed!costing!analysis,!taking!into!
•
account!salaries!of!interviewers,!compensation!for!interviewees,!transportation!costs,!
printing!costs,!workshop!costs,!etc.!!
6. Decide!on!the!sampling(frame(and(sample(size.!Consult!with!a!statistician!to!determine!
what!type!of!sampling!to!use!(in!this!study,!snowball!and!purposive)!based!on!the!
population!you!want!to!reach!and!the!feasibility!of!each!sampling!method!in!reaching!
potential!participants.!Generate!a!sample!size!for!each!of!several!key!groups!(in!this!study!
for!example,!a!3:1!male!to!female!ratio!was!needed,!and!at!least!10%!of!participants!
belonging!to!the!IDU,!sex!worker,!exBdetainee!and!MSM!key!population!groups).!!!
7. Secure!approval!from!the!Ethics(Committee(to!conduct!the!research:!prepare!a!research!
protocol!that!includes!information!on!the!study,!ethical!issues!and!considerations!and!how!
you!prepare!to!deal!with!them.!!
(
(
Stigma(Index(
8. Arrange!that!the!questionnaire,!information!sheet!and!consent!forms!are!translated(into!
the!local!language!(Mauritian!Creole).!Have!the!translated!documents!checked!for!quality!
by!having!another!translator!review!and!backBtranslate!them.!!
9. With!the!stakeholders,!go!over!the!questionnaire:!verify!if!translations!are!clear!and!
transmit!the!same!information!and!connotations!as!the!original,!and!also!decide!whether!
additional(country`specific(questions!should!be!added!(for!this!study,!no!questions!were!
added,!but!certain!question!answers!were!modified!to!reflect!the!Mauritian!context.)!
10. Decide!how(many(interviewers!will!be!necessary,!based!on!the!sampling!frame!of!
participants,!funds!available,!and!time!available!for!the!study!(in!this!study,!10B12!
interviewers!were!needed.)!
11. Recruitment!of!interviewers:!
•
Send!out!a!call!for!interviewers!to!local!NGOs,!networks!and!organizations,!explaining!
what!the!SI!is,!and!what!qualifications!are!necessary:!HIV+,!able!to!read!and!write!in!
the!questionnaire!language,!preferably!has!previous!experience!in!interviewing/social!
work,!etc.!!
•
Set!up!an!interview!time!for!all!applicants!interested!in!the!position:!in!the!interview,!
conduct!a!mock!interview!session!to!test!their!ability!to!properly!conduct!an!interview.!
Select!the!interviewers,!ensuring!sufficient!numbers!of!both!women!and!men.!
•
12. Select!a!field(supervisor!whose!role!will!be!to!oversee!the!distribution!of!questionnaire,!
the!rollout!of!the!survey!itself,!the!organization!of!the!interviewers,!checking!completed!
questionnaires,!etc.!(In!this!study,!we!selected!our!field!supervisor!from!the!interviewers,!
she!thus!had!two!roles.)!
13. Have!each!team!member!and!service!provider!sign!a!confidentiality(agreement(
(Appendices!5–9!in!User!Guide).!!
14. Establish!an!appropriate!system!to!manage!the!financial(and(administrative(aspects(of!the!
research!process.!!
15. In!consultation!with!members!of!the!local!people!living!with!HIV!network/advisory!group!
members,!decide!which!national(law,(policy(or(set(of(guidelines(that!upholds!the!rights!of!
people!living!with!HIV!would!be!the!most!appropriate!to!include!in!Section!2D!of!the!
questionnaire!(HIV!and!AIDS!Act!2006!for!Mauritius)!
16. In!consultation!with!members!of!the!local!people!living!with!HIV!network/advisory!group!
members,!develop!a!list(of(local(organizations(that!interviewees!can!be!referred!to!should!
they!require!further!support!(for!Mauritius,!we!provided!the!contact!information!for!all!
NDCCI’s,!as!well!as!NGOs!that!help!various!causes,!such!as!women!in!difficulty,!exB
detainees,!drug!users,!etc.)!
17. Determine!if!and!how!the!participants!will!be!compensated:!if!monetary!compensation,!
determine!how!much,!and!have!a!discussion!with!the!field!supervisor!for!the!best!way!to!
keep!the!money!safe!during!the!process.!Include!a!“Payment!Receipt”!form!to!be!included!
in!the!interview!packet!for!the!participant!to!sign!saying!they!received!their!payment.!(In!
this!study,!we!decided!that!we!would!provide!Rs!100!for!transport,!but!no!compensation!
for!participation!itself.)!
Mauritius(
18. Create!a!“checklist”!to!be!at!the!top!of!the!interview!packet,!explaining!in!brief!all!the!
steps!the!interviewer!must!do!before,!during!and!after!each!survey.!!
19. In!consultation!with!the!stakeholders,!decide!where!the!interviews!will!take!place:!arrange!
a!suitable(venue(in!which!the!interviews!can!be!conducted.!!
20. Determine!what!type!of!Unique(Non`Identifying(Code!will!be!used!for!each!participant.!!
21. Recruit!a!data(entry(team!that!will!be!entering!the!completed!surveys!into!an!electronic!
database.!(In!this!case,!the!data!entry!team!was!from!the!Ministry!of!Health!and!Quality!of!
Life.)!
22. Recruit!an!international(consultant!to!help!with!the!future!steps!in!the!process,!mainly!
write!up!of!the!report.!Organise!when!inBcountry!dates!will!be!necessary;!consult!about!
any!special!needs!in!the!training!session,!etc.!!
23. Establish!a!safe(place(for(the(data!and!the!interviewee!contact!and!code!list!to!be!stored!
(in!this!case,!at!the!NAS.)!
24. Print!out!the!interview!packets!that!include:!checklist,!information!sheet,!consent!form,!
receipt!of!compensation!form,!list!of!local!organizations!for!support,!questionnaire,!follow!
up!sheet.!(Printing!for!the!Mauritian!study!was!made!possible!by!help!from!the!Ministry!of!
Health!and!Quality!of!Life.)!
25. Train(the(interviewers!in!a!2B3!day!training!session:!
• Present!objectives!of!the!training!session!and!stigma!index!
•
•
Ensure!thorough!understanding!of!concepts!(stigma!vs.!discrimination)!
Include!interactive!activities,!such!as!discussions!about!personal!experiences,!
•
observed!experiences,!etc!
Discuss!with!interviewers!their!own!personal!strategies!for!combating!
stigma/discrimination,!how!to!deal!with!it!personally,!etc.!
•
Get!the!conversation!going!on!the!topic!so!the!interviewers!feel!empowered!by!each!
others’!experiences!to!help!the!future!participants!in!the!study!
•
•
Explain!the!logistics!of!the!study!
Go!through!the!questionnaire,!question!by!question!–!stop!if!there!is!any!
misunderstanding!or!questions!
•
•
Discuss!problems!that!might!be!encountered!(logistical,!emotional,!etc.)!
Conduct!mock(interviews:!ensure!that!every!person!has!the!role!of!the!interviewer!
AND!the!interviewee!
•
Clearly!explain!consent(and(confidentiality!
• Explain!the!importance!of!their!participation!in!this!study!!
26. Set!up!regular!supervision(meetings!between!the!team!leader!and/or!supervisors!and!
interviewers.!!
27. Recruit(participants:!introduce!the!People!Living!with!HIV!Stigma!Index!to!potential!
interviewees,!based!on!the!sampling!methodology,!and!set!up!the!interviews.!!
28. Conduct(the(interviews.!!
29. Have!the!field!supervisor!give!each!interviewer!approximately!5!questionnaires!to!begin!
with!–!once!they!are!completed,!have!the!field!supervisor!check!the!survey!very!carefully.!
(
(
Stigma(Index(
If!there!are!any!problems!or!issues,!go!through!them!with!the!interviewer,!correct!the!
mistakes,!and!ensure!the!mistakes!are!not!repeated!in!the!next!round!of!interviews.!!
30. If!deemed!necessary,!allocate!a!portion!of!the!interviewers’!salary!to!be!paid!after!each!
completed!survey!(to!cover!transportation!costs).!!
31. As!the!surveys!are!being!completed,!document!the!UIC,!sex,!age,!key!population!group,!
and!any!other!important!information,!to!keep(track(of(the(sample.!After!half!to!three!
quarters!of!all!surveys!are!completed,!determine!that!the!characteristics!of!the!sampling!
frame!are!being!met!(sex!ratio,!key!population!groups,!etc.)!If!any!category!is!
underrepresented,!seek!out!participants!that!will!help!balance!out!the!sample,!if!
necessary.!!
32. Send!the!completed!surveys!to!the!data!entry!team!to!be!entered(into(Epi`Info!/!SPSS!/!
Excel.!!
33. If!time!and!resources!permit,!set!up!and!conduct!case(study(interviews!with!chosen!
interviewees.!!
34. Analyse(the!results:!for!the!report!itself,!only!descriptive!analysis!is!necessary,!but!for!
additional!information,!further,!more!in!depth!statistical!analysis!is!encouraged.!!
35. Arrange!a!workshop!with!stakeholders,!interviewers,!and!other!involved!organizations!and!
individuals!to!discuss!the!results!from!the!Index,!get!their!comments!and!feedback,!and!
discuss!what!recommendations!should!be!drafted!in!order!to!tackle!the!issues!raised!by!
the!data.!!
36. Write(the(Stigma(Index(report,!with!help!from!the!international!consultant,!and!include!
the!recommendations!from!the!training!session.!!
37. Agree!on!how!to!operationalize!the!dissemination!strategy!for!the!data/SI!report!and!the!
different!ways!of!taking!action!following!the!study!results,!based!on!the!drafted!
recommendations.!!
Mauritius(
Disclaimer(
The!People!Living!with!HIV!Stigma!Index!is!designed!as!a!research!tool!by!which!people!living!
with! HIV! capture! data! on! their! experiences! and! perceptions! regarding! stigma! and!
discrimination.!
!
In!this!regard,!the!results!can!be!said!to!comprise!a!snapshot!of!the!level!of!HIVBrelated!stigma!
and! discrimination! in! a! certain! place! and! time.! Through! its! implementation,! the! tool! also!
serves!to!educate!and!empower!people!living!with!HIV!on!human!rights!related!to!HIV.!
!
Survey!questions!therefore!focus!on!experiences!and!perceptions!and!do!not!represent!factual!
investigations,!with!follow!up!questions,!into!particular!allegations,!incidents!or!events!nor!are!
the! answers! to! the! questions! subject! to! independent! verification.! As! research! participants,!
interviewees!have!a!right!to!anonymity!and!to!confidentiality!regarding!their!responses.!
!
In!addition!to!the!empowerment!function,!appropriate!uses!of!the!data!are!for!advocacy!and!
in! order! to! inform! stigma/discrimination! reduction! programming! and! policy! responses! in! the!
national!response!to!HIV.!
!
The!data!is!not!available!as!a!source!of!allegations!of!individual!instances!of!wrongdoing.!
(
(
Stigma(Index(
Endnotes(
1
!A!steering!committee,!including!representative!from!NAS,!Prévention!Information!Lutte!contre!le!Sida!
(PILS),!Ministry!of!Health!and!Quality!of!Life,!Vivre!Plus,!Lacaz!A!and!Chrysalide,!guided!the!process.!
2
!Statistics!Mauritius,!Ministry!of!Finance!&!Economic!Development!Mauritius!in!Figures!2011.!
3
!During!the!last!12!months,!approximately!45%!of!respondents!reported,!because!of!their!HIV!status,!
feeling!guilty!(46.1%,!n=!182)!or!low!selfBesteem!(44.1%,!n=172),!39%!blamed!themselves!(n=!153)!and!
36.1%!had!felt!ashamed!(n=143).!
4
!Overall,!48.3%!of!respondents!(n=185)!feared!being!gossiped!about;!significantly!higher!levels!of!fear!
than! of! being! verbally! insulted,! harassed! and/or! threatened! (30.5%,! n=115).! Approximately! 25%! were!
afraid!of!being!physically!harassed!and/or!threatened!(24.9%,!n=92)!or!being!physically!assaulted!(23%,!
n=84).!
5
! Over! 40%! of! respondents! (42%,! n=162)! indicated! they! were! afraid! someone! would! not! want! to! be!
sexually!intimate!with!them!because!of!their!HIVBpositive!status,!with!no!genderBbased!difference.!
6
!29.6%!of!respondents!(n=117)!reported!feeling!suicidal!with!female!respondents!approximately!twice!
as!likely!as!male!respondents!to!report!feeling!suicidal!(42.6%,!n=55!compared!to!22.2%,!n=55).!
7
!The!most!frequent!decisions!made!because!of!HIV!status!in!the!previous!12!months!were!not!to!have!
more! children! (42%,! n=163),! to! isolate! themselves! from! friends! and! relatives! (39%! n=154)! and! not! to!
attend!social!gatherings!(32.6%!n=151).!
8
!Internal!stigma!affects:!
• access! to! health! care:! 25.1%! (n=100)! avoided! going! to! a! hospital! and! 20.4%! (n=80)! avoided!
going!to!a!local!clinic!when!they!needed!care.!
• education!and!employment:!23.1%!(n=89)!decided!not!to!apply!for!a!job!or!a!promotion,!13.3%!
(n=51)!withdrew!from!education!or!training,!and!25.4%!(n=96)!gave!up!their!job.!!
9
!Being!gossiped!about!had!occurred!to!55%!of!respondents!(n=220)!with!71%!(n=156)!indicating!that!it!
occurred,!in!whole!or!in!part,!because!of!their!HIVBpositive!status!
10
!Almost!half!of!respondents!(48.1%,!n=192)!stated!that!they!had!provided!support!to!other!PLHIV!in!
the!last!12!months,!with!emotional!support!(65.2%,!n=187)!being!the!most!common!type!of!assistance!
rendered.!
11
!One!in!five!respondents!(20.6%!n=82)!reported!being!a!member!of!a!support!group!and/or!network!of!
people!living!with!HIV.!
12
! Under! 10%! of! respondents! (7.5%! n=30)! had! been! involved! as! a! volunteer! or! employee! in! any!
programme!or!project!providing!assistance!to!PLHIV!in!the!previous!12!months.!!
13
!Nearly!half!of!all!respondents!cited!PLHIV!group!(48.1%,!n=192)!and!28%!cited!PLHIV!network!(27.6%,!
n=110)! (i.e.! Vivre! Plus)! and! nearly! 40%! cited! a! national! NGO! (37.8%,! n=! 151)! (i.e.! PILS)! as! a! type! of!
organization!they!know!of!to!go!to!for!help!related!to!stigma.!
14
!For!example:!
• 28%! respondents! (n=122)! report! being! denied! health! services! at! least! once! in! the! last! 12!
months.!
• 5%!of!respondents!(n=20)!were!forced!to!submit!to!a!medical!procedure!(including!HIV!testing).!
• In!terms!of!HIV!testing:!!
o 10.6%!of!respondents!(n=41)!reported!that!they!were!forced!to!take!a!HIV!test!or!were!
tested! under! pressure! from! others,! and! 5.7%! (n=22)! were! tested! without! their!
knowledge.!
o 7%! of! respondents! received! only! preBtest! counselling! (n=27),! another! 25%! received!
only!postBtest!counselling!(n=97);!and!17.3%!received!no!counselling!at!all!(n=67).!
• Over!one!quarter!of!respondents!(26.8%,!n=107)!stated!that!a!health!care!professional!had!told!
other!people!about!their!HIV!status!without!their!consent.!
15
!There!are!also!gaps!in!protection!of!sexual!and!reproductive!health,!for!example:!
Mauritius(
5%!of!respondents!(n=20)!have!been!refused!family!planning!and!sexual!health!services!during!
the!last!12!months.!
• 20.6%! of! respondents! (n=83)! respondents! indicated! that! they! had! never! received! counselling!
on!their!reproductive!options!since!their!HIV!diagnosis.!Female!respondents!were!more!likely!
to!have!been!received!such!counselling!(63.4%,!n=83)!than!males!(23.2%,!n=58).!
• 4.3%!respondents!(n=36)!indicated!they!had!ever!been!advised!not!to!have!more!children,!of!
whom!24!were!female!and!12!male.!
• 4.3%! of! respondents! (n=17)! had! been! coerced! by! a! health! care! professional! to! undergo!
sterilization!since!HIV!diagnosis!including!12!female!and!five!male!respondents.!
• 3.5%!of!respondents!(n=14)!reported!that!their!ability!to!obtain!ART!was!conditional!on!using!
certain!forms!of!contraception.!
16
!For!example:!
• Most! of! the! 108! respondents! who! had! been! pregnant! in! last! 12! months! and! responded! had!
experienced! no! coercion! by! health! care! professionals! in! anteB! and! postBnatal! care;! however,!
two!(1.7%)!reported!being!coerced!into!terminating!a!pregnancy.!
• Of!114!female!respondents,!over!40%!(42.1%,!n=48)!had!received!ART!for!PMTCT,!7.9%!(n=9)!
indicated!they!did!not!know!such!prophylaxis!existed!and!2.6%!(n=3)!did!not!have!access,!the!
remaining!women!were!not!HIVBpositive!at!time!of!pregnancy.!
• Of! 45! female! respondents,! 43! reported! receiving! information! about! healthy! pregnancy! and!
motherhood!as!part!of!PMTCT!and!two!reported!not!having!been!provided!such!information.!
17
! For! example,! strengthen! PLHIV! networks! and! peer! networks! such! as! Positive! Ambassadors! to! reach!
out!to!hidden!and!hard!to!reach!populations.!
18
!Positive,!Health,!Dignity!and!Prevention!takes!a!holistic!approach!to!HIV!prevention!for!people!living!
with! HIV! recognizing! the! health! and! dignity! of! the! person.! UNAIDS,! GNP+,! Positive! health,! dignity! and!
prevention!policy!framework;!2011.!
www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20110701_PHDP
.pdf!
19
!Specific!issues!to!address!include!paraphernalia!laws,!clarification!of!laws!relating!to!drug!consumer!
and!dealer,!laws!which!criminalize!PWID,!prison!diversion!programmes,!a!framework!for!employees!to!
access!medical!services,!including!methadone!services!provided!by!onsite!doctors,!and!revision/removal!
of!the!Morality!Certificate!http://www.gov.mu/portal/sites/dpp/morality.htm.!
20
!See!http://www.who.int/hiv/topics/prisons/en/index.html!
UNODC,! ILO! and! UNDP.! HIV! prevention,! treatment! and! care! in! prisons! and! other! closed! settings:! a!
comprehensive!package!of!interventions.!Policy!Brief.!
http://www.ilo.org/wcmsp5/groups/public/BBBed_protect/BBBprotrav/BBB
ilo_aids/documents/publication/wcms_187290.pdf!
21
National!Strategic!Framework!2012B2016,!National!AIDS!Secretariat,!2012.
22
!www.stigmaindex.org!
23
!National!Strategic!Framework!2012B2016,!National!AIDS!Secretariat,!2012.!
24
! Note! that! there! are! neither! representative! data! to! describe! the! HIV! prevalence! and! associated! risk!
behaviors! among! PWID,! nor! are! there! any! accurate! data! on! the! size! of! the! PWID! population! in!
Mauritius.! It! is! estimated! that! female! PWID! population! constitue! 10%! of! the! entire! PWID! population!
Integrated! Integrated! Behavioral! and! Biological! Surveillance! Survey! among! People! who! Inject! Drugs,!
2011.!
25
! Note! that! there! are! neither! representative! data! to! describe! the! HIV! prevalence! and! associated! risk!
behaviors!among!sex!workers,!nor!are!there!any!accurate!data!on!the!size!of!the!sex!workers!population!
in! Mauritius.Integrated! Integrated! Behavioral! and! Biological! Surveillance! Survey! among! Female! Sex!
Workers,!2010.!
26
! This! high! prevalence! is! due! in! large! part! to! the! fact! that! many! inmates! were! incarcerated! for! drugB
related! offences.! Mauritius! National! HIV! Strategic! Framework! 2012B2016.! National! AIDS! Secretariat!
(unpublished).!
27
!Integrated!Behavioral!and!Biological!Surveillance!Survey!among!Men!who!have!Sex!with!Men,!2010.!
Note!that!there!is!not!accurate!data!on!the!size!of!the!MSM!population!in!Mauritius.!!
•
(
(
Stigma(Index(
28
!Integrated!Behavioral!and!Biological!Surveillance!Survey!among!People!who!Inject!Drugs,!2011.!
!Integrated!Behavioral!and!Biological!Surveillance!Survey!among!People!who!Inject!Drugs,!2011.!
30
!Integrated!Behavioral!and!Biological!Surveillance!Survey!among!People!who!Inject!Drugs,!2011.!!
31
!Integrated!Behavioral!and!Biological!Surveillance!Survey!among!Female!Sex!Workers,!2010.!
32
!Integrated!Behavioral!and!Biological!Surveillance!Survey!among!Men!who!have!Sex!with!Men,!2010.!
33
!Mauritius!National!HIV!Strategic!Framework!2012B2016.!National!AIDS!Secretariat!(unpublished).!
34
!Ministry!of!Health!and!Quality!of!Life,!Health!Statistics!2012.!
http://health.gov.mu/English/Statistics/Pages/default.aspx!
35
!I.e.!since!diagnosis.!
36
!Ministry!of!Finance!and!Economic!Development!(2011).!Mauritius!in!Figures!2011.!Statistics!Mauritius.!
http://statsmauritius.gov.mu/English/Publications/Pages/MauritiusBinBFiguresB2011.aspx!
37
!Exchange!rate!of!MRU!Rs.!1!=!USD!0.03!http://www.xe.com/!
38
39
!Defined!as!having!lost!at!least!one!parent!due!to!AIDSBrelated!causes.!
40
!In!order!to!determine!whether!mistreatment!was!HIV!statusBrelated,!the!responses!'because!of!HIVB
positive!status'!and!'HIVBpositive!status!and!other!reasons!as!well'!were!combined.!
41
!While!the!question!asked!respondents!to!provide!only!one!reason!for!stigma!and!discrimination,!187!
provided!one!reason,!44!two!reasons,!31!three!reasons!and!one!provided!four!reasons.!As!such!it!was!
not!possible!to!calculate!percentages!for!this!question.!
42
!Note!that!multiple!responses!to!this!question!were!permissible.!Therefore!percentages!do!not!add!up!
to!100%.!
43
!
http://www.unaids.org/en/aboutunaids/unitednationsdeclarationsandgoals/2001declarationofcommit
mentonhivaids/!
44
! The! Mauritian! HIV! and! AIDS! Act! 2006! provides! measures! for! the! control! and! prevention! of! HIV! by:!
making!registered!HIV!testing!facilities!available;!testing!donated!blood;!providing!counselling!for!people!
affected!by!HV;!and!providing!specific!details!about!harm!reduction!and!needle!exchange.!Key!elements!
of!the!act!include!an!emphasis!on!confidentiality!and!human!rights,!guaranteeing!that!people!living!with!
HIV!have!equal!rights!to!employment!and!health!care.!It!also!makes!it!illegal!to!impose!HIV!testing!as!a!
preBcondition! for! employment! or! continued! employment,! and! it! includes! penalties! for! HIV!
discrimination.!
Mauritian!HIV!and!AIDS!Act!2006!can!be!accessed!at:!
http://attorneygeneral.gov.mu/English/Documents/ABZ%20Acts/H/Page%201/HIVAIDS1.pdf!
45
46
!During!the!last!12!months,!approximately!45%!of!respondents!reported,!because!of!their!HIV!status,!
feeling!guilty!(46.1%,!n=!182)!or!low!selfBesteem!(44.1%,!n=172),!39%!blamed!themselves!(n=!153)!and!
36.1%!had!felt!ashamed!(n=143).!
47
!Overall,!48.3%!of!respondents!(n=185)!feared!being!gossiped!about;!significantly!higher!levels!of!fear!
than! of! being! verbally! insulted,! harassed! and/or! threatened! (30.5%,! n=115).! Approximately! 25%! were!
afraid!of!being!physically!harassed!and/or!threatened!(24.9%,!n=92)!or!being!physically!assaulted!(23%,!
n=84).!
48
! Over! 40%! of! respondents! (42%,! n=162)! indicated! they! were! afraid! someone! would! not! want! to! be!
sexually!intimate!with!them!because!of!their!HIVBpositive!status,!with!no!genderBbased!difference.!
49
!29.6%!of!respondents!(n=117)!reported!feeling!suicidal!with!female!respondents!approximately!twice!
as!likely!as!male!respondents!to!report!feeling!suicidal!(42.6%,!n=55!compared!to!22.2%,!n=55).!
50
!The!most!frequent!decisions!made!because!of!HIV!status!in!the!previous!12!months!were!not!to!have!
more! children! (42%,! n=163),! to! isolate! themselves! from! friends! and! relatives! (39%! n=154)! and! not! to!
attend!social!gatherings!(32.6%!n=151).!
51
!Internal!stigma!affects:!
• access! to! health! care:! 25.1%! (n=100)! avoided! going! to! a! hospital! and! 20.4%! (n=80)! avoided!
going!to!a!local!clinic!when!they!needed!care.!
• education!and!employment:!23.1%!(n=89)!decided!not!to!apply!for!a!job!or!a!promotion,!13.3%!
(n=51)!withdrew!from!education!or!training,!and!25.4%!(n=96)!gave!up!their!job.!!
29
Mauritius(
52
!Being!gossiped!about!had!occurred!to!55%!of!respondents!(n=220)!with!71%!(n=156)!indicating!that!it!
occurred,!in!whole!or!in!part,!because!of!their!HIVBpositive!status!
53
!Almost!half!of!respondents!(48.1%,!n=192)!stated!that!they!had!provided!support!to!other!PLHIV!in!
the!last!12!months,!with!emotional!support!(65.2%,!n=187)!being!the!most!common!type!of!assistance!
rendered.!
54
!One!in!five!respondents!(20.6%!n=82)!reported!being!a!member!of!a!support!group!and/or!network!of!
people!living!with!HIV.!
55
! Under! 10%! of! respondents! (7.5%! n=30)! had! been! involved! as! a! volunteer! or! employee! in! any!
programme!or!project!providing!assistance!to!PLHIV!in!the!previous!12!months.!!
56
!Nearly!half!of!all!respondents!cited!PLHIV!group!(48.1%,!n=192)!and!28%!cited!PLHIV!network!(27.6%,!
n=110)! (i.e.! Vivre! Plus)! and! nearly! 40%! cited! a! national! NGO! (37.8%,! n=! 151)! (i.e.! PILS)! as! a! type! of!
organization!they!know!of!to!go!to!for!help!related!to!stigma.!
57
! For! example,! strengthen! PLHIV! networks! and! peer! networks! such! as! Positive! Ambassadors! to! reach!
out!to!hidden!and!hard!to!reach!populations.!
58
!Positive,!Health,!Dignity!and!Prevention!takes!a!holistic!approach!to!HIV!prevention!for!people!living!
with! HIV! recognizing! the! health! and! dignity! of! the! person.! UNAIDS,! GNP+,! Positive! health,! dignity! and!
prevention!policy!framework;!2011.!
www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20110701_PHDP
.pdf!
59
!http://www.gov.mu/portal/sites/dpp/morality.htm!
60
!See!http://www.who.int/hiv/topics/prisons/en/index.html!
UNODC,! ILO! and! UNDP.! HIV! prevention,! treatment! and! care! in! prisons! and! other! closed! settings:! a!
comprehensive!package!of!interventions.!Policy!Brief.!
http://www.ilo.org/wcmsp5/groups/public/BBBed_protect/BBBprotrav/BBB
ilo_aids/documents/publication/wcms_187290.pdf!
61
National!Strategic!Framework!2012B2016,!National!AIDS!Secretariat,!2012.
(
(

Mauritius - People Living with HIV Stigma Index

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