by Jordan Waiti and Alison Green
Reducing stigma and discrimination for Māori living with or affected by HIV/AIDS is the theme for a symposium to be held at the University of Waikato in 2015. The symposium is for Māori HIV and sexual and reproductive health promotion practitioners, Māori community development advocates, Māori sexuality education teachers, and Māori researchers and social policy experts. The aim of the symposium is to equip Māori with strengths-based approaches for reducing HIV/AIDS-related stigma and discrimination in the work they do among Māori communities. The symposium will be planned and implemented by a collaboration of Māori and mainstream organisations, bringing together a wealth of national and international experience in kaupapa Māori HIV/AIDS, sexual and reproductive health, sexuality education, research, policy, and Māori community development.
Māori living with HIV/AIDS
Diagnosis data since 1985 show that at the end of 2013 an estimated 3952 people had been diagnosed with HIV/ AIDS. Since 1996 when information on ethnicity was collected, approximately seven percent of those diagnosed with HIV/AIDS were Māori. Of those diagnosed with HIV/AIDS since 1996, the percentage of Māori males has decreased slightly while the percentage of Māori females has slightly increased (AIDS Epidemiology Group, 2014).
What is stigma and discrimination?
Personal accounts from Māori living with HIV indicate they and their whānau face enormous challenges and barriers to well-being as a consequence of HIV/AIDS-related stigma and discrimination (Hutchings & Aspin, 2007). Stigma is commonly defined as an attribute ascribed to an individual that discredits them in the eyes of society (Goffman, 1963). People living with HIV/AIDS report they are treated as if they were profoundly different, and labelled in ways that emphasize notions of ‘us’ and ‘them’ (Link & Phelan, 2001; Ware, 2011). Māori report physical abuse, verbal abuse, social distancing and exclusion as a consequence of their HIV/AIDS status. Not only Māori living with HIV are affected; their whānau and friends are also subjected to stigma which disrupts whānau and undermines Māori values and principles (Rua’ine, 2007). However, Parker (2003) argues for an understanding of stigma that also focuses on addressing the structural conditions that allow some people to exclude others. Although definitions that focus on individuals seem logical in individualised Western societies, we assert that such understandings are counter-productive for Māori and Indigenous communities where the health and well-being of the collective is also valued.
Discrimination is often defined as unfair treatment (Marshall, 1998). More recent definitions, however, emphasise the structural underpinnings of discrimination which, in relation to HIV/AIDS, explain how people living with HIV /AIDS and their families and friends are excluded, and the political conditions that create and maintain exclusion. Parker argues that there is an urgent need to broaden the focus from the stigmatizing and discriminatory treatment by some individuals of others, to an examination of the political, social and economic determinants and consequences of HIV/AIDS related stigma and discrimination.
Consequences of HIV/AIDS related stigma and discrimination
Stigmatising and discriminating against people living with or affected by HIV/AIDS is illegal in the provision of goods and services under the Human Rights Act 1993, and it is a breach of human rights. New Zealand is a signatory to international agreements that support the elimination of HIV/AIDS and associated stigma and discrimination (Ministry of Health, 2003), and these are codified in a raft of New Zealand legislation. For Māori living with and affected by HIV/AIDS, stigma and discrimination is associated with less favourable treatment at medical centres, less favourable treatment regarding their employment, and confidentiality problems (Grierson et al., 2004). Others have described the effects of internalising stigma about HIV/AIDS as resulting in a loss of hope (Pala, 2013), and a reluctance to test for HIV (Miller, 2010). However, what is missing is an analysis of the determinants of HIV /AIDS related stigma and discrimination as these affect Māori, and the development of evidence-based interventions. The report by Miller (2010) to the Ministry of Health recommended a national conversation and response to reducing stigma and discrimination for all New Zealanders and their families living with and affected by HIV/AIDS. The upcoming symposium is an excellent opportunity for Māori to progress the conversation about reducing HIV/AIDS related stigma and discrimination among Māori communities.
Māori strengths-based approaches
Strengths-based approaches are described as community empowerment; bottom-up as opposed to top-down development, and returning political power, agency and ‘voice’ to individuals, families and communities (Kana’iaupuni, 2005; Tuhiwai Smith, 1999; Shea et al, 2011). Recent Whānau Ora policy is described as a Māori strengths-based approach. The goal of Whānau Ora is for Māori families and communities to take control or tino rangatiratanga for their well-being (MP Tariana Turia, 2012). However, little has been written about Māori strength-based approaches for reducing HIV/AIDS-associated stigma and discrimination. Ware (2011) notes that health promotion campaigns in the 1990s that targeted young gay Māori men and depicted them as warriors, proud of their sexuality, were well received by other Māori. The New Zealand AIDS Foundation uses personal testimonies as a successful strengths-based approach to reducing stigma and discrimination (Rua’ine, 2007). The approach is popular among Māori, possibly because it resonates with traditional pūrākau approaches. Pūrākau can be described as the process of telling stories of significance in order to better understand one’s own life experiences (Lee, 2009). Another strengths-based approach that is well supported by Māori are marae-based HIV awareness wānanga which INA HIV/AIDS describes as actively working to help Māori overcome stigma and discrimination (Miller, 2010; Pala, 2013).
Stepping up the use of Māori strengths-based approaches that address the HIV/AIDS-related stigma and discrimination experienced by individuals and groups AND the social, political and economic determinants that foster and maintain stigma and discrimination is an imperative. Stigma and discrimination are significant barriers to health and well-being for Māori and whānau living with HIV/AIDS. The forthcoming symposium on Māori strengths-based approaches is an opportunity to promote what works, and explore new approaches. We’ll keep you posted as we count down to Symposium 2015. Watch this space.
We gratefully acknowledge Dr Peter Saxton, Ms Jane Bruning and Ms Marama Pala who kindly agreed to peer review this article.
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 Te Puāwai Tapu, INA HIV/AIDS, New Zealand AIDS Foundation, Body Positive, and Positive Women