The People Living With HIV Stigma Index: Belize

Persons Living with HIV Stigma Index: Belize INDEX 2013
2013
PEOPLE LIVING WITH HIV STIGMA INDEX:

BELIZE
The Global Status Report of 2012 for Belize indicates that although there has been an increase in the visibility and
involvement of people with HIV and other marginalized populations, fear of stigma and discrimination continues to limit its
significant involvement at the national level.
ALLIANCE
UNDP:
Ms. Mariana Mansur
UNAIDS:
Ms. Melissa Sobers
USAID/PASMO:
Ms. Guadalupe Huitron
Belize Red Cross:
Dr. Deisy Mndez Garca
Hand in Hand Ministries:
Ms. Nadia Armstrong
UNIBAM:
Mr. Kendale Trapp
Liaison Organization:
Collaborative Network of persons Living

with HIV in Belize (C-NET+)
In coordination with REDCA+ Regional Program
Technical group/ M&E:
Mr. Evelio Cocom, Data Entry

Mr. Santiago Campos, Project Coordinator
Mr. Eric Jovanni Castellanos, Executive Director C-NET+
Consultant: Reynaldo DAubuisson Arrieta
ACRONYMS
IPPF
International Planned Parenthood Federation
C-NET+
Collaborative Network of Persons Living with HIV of

Belize
GNP+
Global Network of People Living with HIV
ICW+
International Community of Women Living with
HIV/AIDS
Human Immunodeficiency Virus
USAID
United States Agency for International Development
PASCA
Action AIDS Project of Central America
PASMO
Pan American Social Marketing Organization
UNAIDS
Joint United Nations Programme on HIV/AIDS
UNIBAM
United Belize Advocacy Movement
MSM
Men who have Sex with Men
CONTENTS
ACKNOWLEDGEMENTS
EXECUTIVE SUMMARY
INTRODUCTION
BACKGROUND
JUSTIFICATION
OBJECTIVES
METHODOLOGY
ANALYSIS OF RESULTS
CONCLUSIONS
RECOMMENDATIONS
BIBLIOGRAPHY
ANNEX
ACKNOWLEDGEMENTS
In 2011, Michel Sidibe, UNAIDS executive director stated, Thirty years into the HIV
epidemic we still have major discrimination and stigma related to HIV, as well as laws
and law enforcement that drive people away from HIV services. Such situations are
undermining the HIV response across the world. This will only change if we make major
investments in programmes to reduce such stigma and increase access to justice for
those affected by HIV.
In September 2012 the REDCA+ Regional Program launched the call for proposals for
countries in Central America to submit their proposals for the implementation of the
Stigma Index in each of the seven countries of the Region. In Belize C-NET+, under the
leadership of Eric Castellanos summoned a group of organizations and individuals to
consolidate a country steering committee for the implementation of the Stigma Index in
Belize.
The first to respond to this call were PASMO, UNAIDS, UNDP, Belize Red Cross, Hand
in Hand Ministries, UniBAM, and the NAC Secretariat and were later joined by the
director of National AIDS Program, Dr. Marvin Manzanero who together along with the
liaison organization C-NET+ agreed on submitting a proposal to implement the Stigma
Index in Belize.
We are grateful to UNDP, UNAIDS and USAID/Central America Capacity Project for
their financial and technical contributions for the implementation of the Index. We would
also like to mention our gratitude to the Central American Network of Persons with HIV
who through its Regional Program financed by the Global Fund has established a
regional committee for the monitoring of this process, among them, Rodrigo Pascal
(Human Rights and Gender adviser, UNAIDS Guatemala), Alejandra Trossero (UNDP
Regional) and Sergio Montealegre (Director, REDCA+ Regional Program).
We acknowledge and are grateful for the effort made by the interviewers to reach as
much persons with HIV in the process. Mr Evelio Cocom who was instrumental in the
data entry of data using epi info. To all the persons who have contributed with their
comments to improve the final report and finally we acknowledge and are grateful to the
more than 400 persons with HIV around the country that accepted us in their
homes and made the implementation of the stigma index possible.
EXECUTIVE SUMMARY
A study was conducted in Belize to measure the Stigma index and Discrimination in
People Living with HIV, which will serve as a baseline for future comparisons; this study
was conducted in coordination with the countrys coalition with key actors and agencies
working in the field.
The tool with which the information was collected was provided UNAIDS according to
the user guide: Persons living with HIV Stigma Index which was worked by GNP+,
ICW+ in coordination with UNAIDS and IPPF, and was applied in order to know the
situation of stigma and discrimination associated with HIV in Belize.
Many people are in a position of vulnerability, because of their sexual orientation or
sexual practices, gender or activities that put them in a position of risk; this is why these
findings are important because it reflects these features of stigma and discrimination
internal or external; where by on the basis of evidence, allowing to make timely and
accurate decisions to design strategies and interventions to reduce stigma and
discrimination by a first point to epidemic response; this will also help to guarantee
quality health services according to the needs of people with HIV and motivate to
productive socio-economic participation of persons living with HIV.
Interviews were conducted in the 6 districts of Belize including the Islands, 430 surveys
were processed and completed after the data was processed.
49.5% of total participants were women, follow by 48.83% men and 1.63% Trans. More
than half report being sexually active, 56.27% were interviewed in the major towns and
cities, 22% of the people reported being unemployed, most people do not feel
discriminated against in social, religious or family activities, but those who expressed
being discriminated state that it was because of their HIV status and other reasons;
because of their diagnosis 38% have had to change their place of residence, 63.71% of
the persons who said lost their job said it was because of their HIV status and other
reasons.
Many people are embarrassed by their diagnosis and even guilty, they fear being the
target of gossip. People are aware of organizations that work with persons living with
HIV but are not affiliated with them, they even support their peers but on a personal
level and not as part of a program of an institutional support; they know that there are
laws that should protect them, but in the case of Belize they are none existent; although
there is a draft that was created 7 years ago on the Declaration of human rights but the
final product has not been finalized. Of this has not prohibited people from reporting any
abuse to their rights, and those that did not follow through with reporting such cases,
was for the lack of financial support. More than half of the people interviewed report
having received pre and post counseling when they were diagnosed; they also reported
that they were the ones who revealed their positive diagnosis to their partner, family,
children, friends and neighbors, as well as health workers and social workers. Most
people report that the reaction of others when sharing their diagnosis was supportive.
When people with HIV do not feel identified by their HIV status, there is a process of
self-amending, allowing people to assimilate their diagnosis, and face it and overcome
it. When persons with HIV have reached such state they are able to make sound
decisions, have a life plan, be adherent to medication and enjoy a healthy life style both
physically and mentally, allowing them to be productive individuals in society.
INTRODUCTION
Stigma is recognized as one of the main obstacles to address prevention and effective
response to the epidemic, thus limiting universal access to prevention, treatment,
comprehensive care and support for people living with HIV. Discrimination prevents
these people to have real access to decent employment, social security, to integrated
services and sometimes to education, which contributes greatly to the reduction of
quality of life and to the opportunity to improve socioeconomic conditions.
Stigma and discrimination associated with HIV is manifested in almost every level of
society: community, individual, family, legal, political and programmatic. Although
discrimination is a violation of human rights and is expressly prohibited by international
laws and by most national constitutions, discriminatory practices can actually be
institutionalized in laws, policies and practices that have a negative distinction for
persons living with HIV and other marginalized groups for their real or perceived
association with HIV. Discrimination by default, on the other hand, exists when the type,
size and nature of the responses to the epidemic are not in accordance with the level of
the epidemic among certain populations. (USAID/PASCA, 2011).
Evidence indicates that the underlying causes of stigma and discrimination associated
with HIV are consistent across different contexts and epidemics. Among the most
important are the lack of knowledge and scientific information about HIV transmission,
lack of awareness of stigma and discrimination and its grave consequences for
individuals and societies, and social judgments that relate seropositive status to
questionable, improper or immoral behaviors (USAID/PASCA, 2011).
One of the most important characteristics of a population study on stigma and
discrimination at the national level is that it provides information from the perspective of
a statistically representative sample of the population. The results provide valuable input
to the information provide valuable input for making policy and program decisions
favoring national planning and prevention and HIV care in optimal conditions for
populations at highest risk for HIV (MARPs). They also constitute key processes to be
used in advocacy, policy dialogue and citizen monitoring information. (Public Opinion
Survey, Belize 2013; PASCA USAID).
BACKGROUND
Status of the epidemic
The factors that lead to the persistence of HIV in Belize are: inconsistent condom use
with multiple partners, the onset of sexual life at an early age and gender based
violence. The root of failure to get protected during sexual activity is caused by a
complex psychological problem that causes a gap between behavior and knowledge of
HIV transmission.
In 2012, data from the Ministry of Health indicate that 249 new cases of HIV were
reported. Unlike women, men are still the majority in the positive rapid test results
conducted (ratio 1:47 to 1) however men do less testing than women. The most affected
age group is in the cohort of 15-55 year olds who represent the active economic sector,
with an increment in the ages of 45-49 years.
Regional, international and local data from the Ministry of Health of Belize show a
marked concentration of the epidemic among MSM. The range of men and women in
relation to new cases is expanding, reflecting an increase in men and a decrease in
women. 88 HIV-related deaths were reported in 2012; of these 57 were men and 31
women. (Progress Report 2014, UNAIDS).
Stigma is an "attribute that discredits socially, those who supports it, which is subjected
to adverse reactions, hostility and rejection, which favor social isolation and loneliness"
(Goffman, 1963). In addition, self-stigmatization may occur when people with HIV
internalize or anticipate social attitudes that are experienced in the society. This can
cause shame or self-loathing, guilt and inferiority, which becomes part of their identity
favoring conditions of self-exclusion in many areas of life.
In 2001, UNAIDS indicated that the stigma associated with HIV infection may be the
biggest obstacle to which individuals and communities as well as political and religious
leaders, that work in the response to the HIV epidemic are faced with. A major effort to
respond to stigma will not only improve the quality of life of people living with HIV and
those who are most vulnerable to infection, it also implicates a great condition a large
scale reaction to the epidemic.
Discrimination occurs "when stigma is installed" (UNAIDS, 2005). This is considered as
arbitrary discrimination when it is related to HIV, any measure taken entailing any
arbitrary distinction between individuals based on their health status or their HIV
seropositive status confirmed or suspected; arbitrary discrimination may be the result of
an action or omission.
It is interesting to recall the words of Dr. Jonathan Mann, founder and first director of the
program of the World Health Organization on AIDS which was later replaced by the
Joint United Nations Program on HIV/AIDS (UNAIDS); warning that in all countries it
was possible to identify three different epidemics. The first: the epidemic of HIV infection
that quietly developed in communities, often unnoticed for years without being
perceived or understood.
The second explodes after a few years, which is known as HIV/AIDS with the
consequent appearance of infectious and immunologic diseases generated by the virus;
and finally, Mann described the third epidemic as the most explosive and potentially
dangerous, the epidemic caused by stigma and discrimination: the largest gap for the
full exercise of human rights, with consequences in the family, social, cultural, and
economic policies.
Since then and despite the significant progress made in containing and combating
global impact of HIV, stigma and discrimination continue promoting the spread of the
epidemic. Both people with HIV and those most vulnerable to the same, continue to be
victims of this virus, because of their fear of stigma and discrimination and lack of
knowledge of human rights.
Recent discoveries reported from the Stigma Community based on response Ratings on
the Baseline of 2012, conducted by the Regional Stigma and Discrimination Unit of the
Pan-Caribbean Partnership on HIV (PANCAP); indicate that Belize ranks as one of the
countries with higher levels of stigma and discrimination in the Caribbean. Additionally,
recent studies in Central America led by USAID / PASCA (Action AIDS Project of
Central America) and USAID / PASMO (Pan American Social Marketing Organization),
also report that Belize has one of the highest rates of stigma in Latin America.
The Global Status Report of 2012 for Belize indicates that although there has been an
increase in the visibility and involvement of people with HIV and other marginalized
populations, fear of stigma and discrimination continues to limit its significant
involvement at the national level.
Driven by the existing evidence and the dire need to control stigma and discrimination in
Belize, a number of organized communities, are working to raise awareness of the
potential social, economic and legal factor that people with HIV and other marginalized
populations contribute to the country. To make sure that their achievements are well
coordinated, effectively managed and strategically conveyed, it is urgent to measure the
level of stigma and discrimination experienced by people with HIV in Belize, and to
include a description of their perceptions and experiences.
This is included in the 2012-2016 Strategic Plan for HIV, the analysis of the problem of
stigma and discrimination, where the response to the epidemic needs to intensify efforts
towards the negative influence of stigma and discrimination in the level of professional
services and changing the attitudes of people from vulnerable groups among the
general population, and other marginalized groups affected by HIV. Empowering people
is an important element in creating agents of change within the communities; this allows
the growth of new partnerships that address stigma and discrimination, poor socioeconomic conditions and lack of opportunities for survival. (Belize HIV Strategic Plan,
page 66).
Measuring Stigma Index in persons with HIV is a global initiative developed since 2005
by the International Planned Parenthood (IPPF), the Joint United Nations Program on
HIV (UNAIDS), Global Network of People Living with HIV / AIDS (GNP +) and the
International Community of Women Living with HIV / AIDS (ICW)
The study in Belize was led by the Central American Network of People Living with HIV
(REDCA +) through the REDCA+ Regional Program and co-sponsored by UNAIDS and
UNDP and executed by C-NET+ in coordination with the Alliance formed by key
stakeholders and partners of Belize.
Therefore, the Collaborative Network of Persons Living with HIV of Belize (C-NET +)
joins the initiative of the REDCA + Regional Program, following guidelines to form a
national alliance that includes key stakeholders and partners for the collection of
information to determine the Stigma Index in Belize.
The present study had the benefit of being conducted by an alliance of key stakeholders
such as the National AIDS Commission, UNDP, UNAIDS, USAID / PASMO, Belize Red
Cross, UNIBAM and Hand and Hand Ministries. The Collaborative Network of Persons
living with HIV in Belize conducted joint effort to work in the collection of this information
and managed the process with the support of the REDCA + Regional Program.
The intent of C-NET +, the National Alliance and the REDCA + Regional Program is to
obtain information and make it available, so it can be used as a national tool for
evidence-based data that contribute to the reduction of stigma and discrimination and
that promote the rights of people with HIV; allowing open spaces where people with HIV
can develop and excel in an environment without stigma and discrimination.
JUSTIFICATION
The importance of this report is that it reflects the situations of stigma and discrimination
to which people with HIV are exposed to in Belize, for which it is important to have
evidence to make an impact in the areas necessary to contribute to its reduction mainly
on vulnerable populations.
Considering that in Latin America, the HIV epidemic is concentrated in gay men and
men who have sex with men; homophobia, stigma and discrimination contribute to men
who have sex with men to be at a high risk of contracting HIV. The Trans population
also has higher prevalence of HIV and is discriminated by government agents, including
health care providers, because some countries do not accept the change of gender on
legal documents, both MSM and Trans, report these acts of violence. The gradual
increase in the prevalence rates of HIV-AIDS infection in the world (which on average
reaches 1% today) and expansion into generalized epidemics in at least two sub
regions of the world (sub-Saharan Africa and the Caribbean), becomes to this epidemic
in a serious and perhaps the leading public health problem facing the human race
today.
This information is intended to design a tool that will allow for the development of
advocacy programs and thereby improve the development of spaces for people with
HIV, free from stigma and discrimination.
GENERAL OBJECTIVE
Generate information for national advocacy to improve the rights of people with HIV,
containing the main reasons why people with HIV in Belize are discriminated against
and stigmatized.
SPECIFIC OBJECTIVES
Familiarize the society with the ways in which people with HIV are stigmatized
within the community, and to stimulate the start of policy interventions that favor
its reduction.
Provide information to people with HIV in Belize to conduct advocacy, and for this
to serve as guarantees of quality care in health services and a significant
participation in socio-economy to contribute to their own development and that of
the country.
METHODOLOGY
Before the implementation of the Index the committee reviewed and approved the
methodology; the team of interviewers received three day training and had to take an
online course on Ethics from the NHI. The form was developed in English and Spanish,
and was facilitated by UNAIDS, special attention was given to people that cannot read
or write. The participants were invited to sign or mark with an "X" in the case of those
who could not write, to indicate that they agreed to participate in the study, as they had
the option to refuse to participate. Confidentiality was one of the main specifications and
clarifications that were taken into account in the research.
Particularly, a horizontal approach was used to select the interviewers and interviewees;
the reason for this was to create a relationship between peers, which created an
atmosphere of trust. As good practice an informed consent was included in the survey,
this was obtained from all the interviewees, by the person conducting the survey this
was collected before the survey was implemented. This involved providing information
about the purpose and benefits of the study and what was expected from the valuable
participation of the people in it.
Universe: It consists of all people with HIV in each of the selected areas of the country.
Definition of the sample

The sampling strategy was not an intentional probabilistic type. People over 18 were
sought with a known diagnosis of HIV, with full use of mental and physical faculties to
give informed and legitimate consent, which were available at the time of the collision,
different gender, sexual orientation, educational level, socioeconomic status, were
selected from different parts of the country.
TRAINING PROCESS
12 interviewers were trained, which had coverage of the different parts of the country;
these were the methods details of how they were trained:
Number of
Interviewers
Areas of the
Country
Number of
Respondents
Belize District
235
Corozal
25
Orange Walk
75
Cayo
50
Stann Creek
75
Toledo
15
Islands
25
12
TOTAL
500
Even though the interviews were conducted in the different districts some of the persons do not access health services in the district that
they were interviewed.
From this intervention at total of 500 interviews were programmed, from these 430 were
revised, interpreted, processed, analyzed and completed.
In order to collect the information a clear definition was made as to the required skills of
the interviewer, as well as field supervisors, it was established that the staff was
required to have a suitable profile for the type of work to be done. The design of the
questionnaire is not complicated, however it requires that those who intend to apply this,
need to have a certain level of understanding and mastery of the conceptual issues
involved in each of the questions that compose it.
The required attributes were two: First, the educational level of candidates selected as
interviewers and supervisors were to have at least secondary education, preferably with
a higher education degree. And second, that they were unemployed at the time of the
survey. The reason for this was: first, to provide a means of income for people living
with HIV, who often are unemployed because of stigma and discrimination, and on the
other, to make sure that these people were able to dedicate to the work of data
collection a full time effort.
The tools of the data

To obtain information, a survey is carried out in which the target population is people
living with HIV, through which information is obtained and allows:
a) Document the different experiences of people with HIV, within a particular
country or community in relation to stigma and discrimination associated with
HIV;
b) Measure changes over a period of time, so that the information can reassess the
developments with regard to stigma, discrimination and rights of people living
with HIV in a community;
c) To provide an evidence base research, for policy change and program
interventions.
The tool consists of 3 sections:
1. General overview of interviewees
2. Information focused on stigma and discrimination from other people, access to
work, health and education, self-stigma, rights, laws and policies, management
changes.
3. Information relating to testing / diagnosis, HIV status and confidentiality,
treatment, having children, problems and challenges.
Definition of variables
In the study the following variables were investigated:
SECTION 1
Sociodemographic
Description and other
Sex, age, year of HIV diagnosis, marital status, group

membership, sexual orientation, educational level,
employment status and family income.
SECTION 2
Experience of stigma and
discrimination from others
Experienced discrimination in the last 12 months in

the social, religious, family, education, health
services, etc. .; types and frequency of
discrimination.
Access to work, health and

education
Ways in which discrimination occurred in different

social environments.
Self-stigma and fears
Ways which Stigma to HIV is lived or perceived;

and associated with HIV stigma.
Rights, laws and policies
Knowledge of current legislation and policies in the

country that protect against discrimination for
people with HIV.
Management Change
Ways of reacting to the authorities in cases of

discrimination experienced and the support
received from organizations associated with the
topic.
SECTION 3
Testing and diagnosis
Experiences related to the circumstances of HIV

diagnostic test.
Sharing of HIV status and

confidentiality
Notification of HIV status and handling

confidentially the information within family, work
and society.
Treatment
Use of anti-retroviral drugs.
Family life and having

children
The desire to have children and the support given

by the medical personnel
Data Processing
The information was processed on a database called Epi Info software, performing
crosstabs and getting the results presented below. Also charts and graphs were
generated to illustrate the above-mentioned findings.
ANALYSIS OF RESULTS
SOCIODEMOGRAPHIC
Gender of respondents
Population approached 49.53% are women, 48.84% men and 1.63% Trans women.
This population being between the ages ranges of 30 to 39 years is 28.6%.
Figure 1: Gender of respondents.
GENDER
Female
Male
Trans
Figure 2: Age of respondents
AGES OF RESPONDENTS
Adult aged 50 + years
Female
Adult agaed 40-49 years
Male
Adult aged 30-39 years
Trans

Youth aged 15-19 years
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00%
Years of knowing HIV diagnosis

In relation to the time of knowing their HIV status, 41.86 % of respondents refer being
diagnosed between 1-4 years.
Figure 3: Years of knowing HIV diagnosis
YEARS OF KNOWING HIV DIAGNOSIS

42%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
0-1 year
1-4 years
5-9 years
Current status of the relationship
10-14
years
15 + years
37.21% of the population interviewed reported being single, of which 43.13% were
female and 53.75% male; 21.40% of the sample reported having a relationship but were
not living together, of whom 49% were women and 51% men.
Figure 4: current relationship status
Widow/widower
Single
Female
Cohabiting but partner is
Male
Cohabiting and partner is
Trans
In a relation ship but not living

Divorced/separated
0
20
40
Sexual Activity
Referring to current sexual activity, 61.4% of all respondents, reported being sexually
active at the moment of the interview; by making the analysis by population (gender),
61.03% of women said they were sexually active, in the case of men 61.9% were
sexually active, and in the case of the trans population 57.14% were sexually active.
Figure 5: Sexual Activity
SEXUAL ACTIVITY
70.00%
60.00%
50.00%
YES
40.00%
NO
ND
30.00%
20.00%
10.00%
0.00%
Female
Male
Trans
total
*ND = No Data
Men who have sex with men

Of all the men interviewed, 26.20% report having sex with men.
Figure 6: Men who have sex with men.
MEN WHO HAVE SEX WITH MEN

80.00%
60.00%
40.00%
Men who have sex with

men Percent
20.00%
0.00%
Yes
No
Sex Work
Of all the people interviewed that reported doing sex work, 17.84% are women and
0.95% men. None of the Trans women reported doing sex work.
Figure 7: Sex Work
REPORTING DOING SEX WORK

120.00%
100.00%
80.00%
60.00%
40.00%
20.00%
17.84%
0.95%
0.00%
Female
Male
Sex worker
Transgender
Not Sexworker
Sexual Orientation
Of the total number of women reached 15% claimed to be lesbians and 8.57% of men
claimed to be gay; clarifying that here in Belize is considered gay is one who assumes
his homosexuality and, MSMs are men who have sex with other men but do not
consider themselves as homosexual.
Figure 8: Sexual Orientation
SEXUAL ORIENTATION LESBIAN OR GAY
100.00%
90.00%
80.00%
70.00%
60.00%
Female
50.00%
Male
40.00%
30.00%
20.00%
10.00%
0.00%
YES
NO
Level of Education
Of all the women approached, 47.9% had primary school education, 38.97% secondary,
5.63% Technical College and 7.5% non-formal education. Of all the men approached;
30.48% had primary school education, 48.5% high school level, 14.76% Technical
College level and 6.20% non-formal education.
Figure 9: Level of Education
HIGHEST LEVEL OF EDUCATION COMPLETED

90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
FEMALE
MALE
TRANS
No formal
education
Primary school
Secondary school
Technical
college/University
Employment
Of all those persons reached 26.6% reported having a full-time job as an employee;
14.4% part-time, 6.3% have their own business full time and 15.4% part-time business
owner; and 22.7% reported being unemployed at the time of interview.
Figure 10: Employment
EMPLOYMENT STATUS AT MOMENT

Part-time work (self-employed)
Full-time employment (self-employed)
Unemployed and not working
Part-time employment (as an employee)
Full-time employment (as an employee)
0.00%
10.00%
20.00%
30.00%
Monthly income
23.72% of the respondents reported having monthly incomes between BZ $ 601-900.
Figure 11: Average monthly income
AVERAGE INCOME PER MONTH

$2001 - $7000
$1601 - $ 2000
$1201 - $1600
$901 - $1200
$601 - $900
$ 301 - $600
$1 - $300
10
15
20
25
Orphaned children with HIV at home

The response rate to this indicator was low, with 17.7% [N=76] giving an answer to the
question. Of those responding to the question, 78.9% indicated no AIDS orphans in the
home, while 13.2% indicated 1 child or youth who is an AIDS orphan living at home, and
5.3% indicated 2 children or youth AIDS orphans living in the home.
Figure 12: AIDS Orphans at Home
HOW MANY CHILDREN AND YOUTH IN YOUR

HOUSEHOLD ARE AIDS ORPHANS
6
0
1
2
2
3
0
0.00%
20.00%
40.00%
60.00%
80.00%
Location
Of the respondents 56.27% were interviewed in large cities, 10.23% in the rural area,
22.80% in the small towns and villages and 10.27% did not provide this data.
Figure 13: Location
WHERE IS YOUR HOUSEHOLD IN

TOTAL
ND
Small town or village
TRANS
Rural area
Large town or city
MALE
FEMALE
0.00%
20.00%
40.00%
60.00%
EXPERIENCE OF STIGMA AND DISCRIMINATION FROM OTHERS

Exclusion of routine activities
Of those reached 33.1% were excluded sometime in their life from social gatherings, of
this total 15.6% reported that they were excluded a few times, 14.7% reported they
were excluded at least once and 2.8% reported that they were excluded often, 66.27%
reported never being excluded from a social gathering or activity, 15.8% were excluded
sometime in their life from religious activities or place of worship, of this total 8.4%
reported that they were excluded a few times, 6.5% reported that they were excluded at
least once and 1% reported that they were excluded often, of those respondents 70%
said they were excluded because of their HIV status and some other reasons. 83.3%
said that they were never excluded from religious activities or places of worship. 34%
were excluded from family activities (cooking, eat together, sleep in the same room) of
them 22.8% were excluded a few times, 3.3% were excluded often and once 8%; from
those reported were discriminated 60% reported that they were discriminated against
because of their HIV status and other reasons; which denotes the frontline of
discrimination comes from the family,. 65.11% reported never being discriminated
against in this area,
Figure 14: Exclusion of routine activities
EXCLUDED FROM ACIVITIES

ND
Excluded from
family activities
Often
A few times
Once
never
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Excluded from
religious
activities
Excluded from
social
gatherings
Discrimination by other factors independent to HIV status

From all of respondents 71.63% reported being the subject of gossip, 30.48% of men
have not experienced this situation. 50.9% of people have been verbally abused, of
them 78.08% said that they were discriminated because of their HIV status and other
reasons; 37.90% have been physically harassed on occasion, 66.87% of them said it
was because of their HIV status and other reasons; 38.6% have been physically
assaulted; 44% of these people have been assaulted by a family member, 13% of those
by the wife, husband or partner, which can be considered a type of domestic violence.
From the people those that mentioned that they were discriminated for other reason
independent of their HIV status,23% was because of their sexual orientation (men who
have sex with men, gays, lesbians); 8% reported they were discriminated for being drug
users; 6.4% were discriminated for being in prisoned. 42.33% of persons reported that
it was not due to any of the reasons listed.
Figure 15: Discrimination by other independent causes to HIV status
S&D FOR OTHER REASONS THAN YOUR STATUS

ND
Transgender
Sexual orientation (men who have
Sex worker
Prisoner
None of the above
Migrant worker
Member of an indigenous group
Internally displaced person
Injecting drug user
0.00%
20.00%
40.00%
60.00%
Discrimination and psychological manipulation

Of the total respondents 31.6% reported having been manipulated or pressured by their
partner, husband or wife using their HIV status. 40.2% reported being sexually rejected
because of their HIV status; in the case of women 14% reported being psychologically
manipulated often and 18.9% of women reported being rejected a few times due to
their HIV status.
Figure 16: Discrimination and psychological manipulation
How often been to psychological pressure/manipulation

by husband/wife/partner which your HIV status was
used?
ND
Once
Often
Never
A few times
0.00%
20.00%
40.00%
60.00%
Discrimination by other people living with HIV
80.00%
The results show 73% of people say they have never been discriminated against by
other people with HIV. More than half of people (56%) reported never having been
discriminated against by people living at home, husband or wife.
Figure 17: Discrimination by other people living with HIV
How often have you been descriminated

against by other people living with HIV?
80.00%
A few times
60.00%
Never
40.00%
Often
20.00%
Once
0.00%
A few
times
Never
Often
Once
ND
ND
If you have suffered discrimination, why do you think it happened?

43.50% of people report that people are not afraid to be infected with HIV through them,
which is closely linked to discriminatory perception. 56.98% of people claim that the
people who know them, know about how HIV is transmitted and do not fear being
infected by casual contact. 33.95% of people think that having HIV is shameful and
should not associate with it; 29.77% report that they have been deemed religiously or
moral judgment. 88.84% reported not looking sick.
Figure 18: If you have suffered discrimination, why do you think it happened?
WHY DO YOU THINK IT HAPPENED?

I look sick
Religious beliefs
YES
HIV is shameful
NO
Infect them in casual contac

I dont know
Disapprove of my lifestyle or
Afraid of getting infected with
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
ACCESS TO WORK, HEALTH AND EDUCATION

Forced to change residence or unable to rent
Regarding having to move from home, 38% of people said they had to, 29% of people
have lost their jobs. 62.7% of all the people who answered the interview had a job.
63.71% reported having lost their job because of their HIV status and other reasons.
51% of the people say it was because of discrimination by the employer and coworkers, and 10% were forced to quit due to health problems.
Figure 19: Forced to change residence or unable to rent
HOW OFTEN HAVE YOU BEEN FORCED TO CHANGE YOUR

PLACE OF RESIDENCE OR UNABLE TO RENT
ACCOMMODATION?
ND
A few times
Once
Never
Often
Often
Once
ND
Never
A few
times
0.00%
20.00%
40.00%
60.00%
80.00%
The reason for loosing employment was

From all interviewees 29% said they have lost their job or source of income.
Of the persons who had lost their job or source of income 63.71% said it was because
of their HIV diagnosis and other reasons; of these 51% said discrimination was your
boss and coworkers.
Figure 20: The reason for loosing employment was
THE REASON YOU LOST YOUR JOB
WAS BECAUSE...
ND
Not sure why
For (an) other reason(s)
Both because of your HIV status and
other reason(s)
Because of your HIV status
0.00%
20.00% 40.00% 60.00% 80.00%
Change the nature of work or refuse promotion

From the persons who gave their response (291), 31% said they have been refused a
work opportunity or employment due their HIV status.
Of all interviewed, 298 gave response about having to change the nature of their work
or being refused a promotion due their HIV status, 34.56 % of these people answered
positively because they have had to change nature or description of work or refused
promotion once at least, more than half report that has been discrimination by their
employers and co-workers (54.37%).
Figure 21: Change the nature of work or refuse promotion
REASON YOUR JOB DESCRIPTION/NATURE CHANGED/BEEN
REFUSED PROMOTION DUE TO HIV
ND
Because you felt obliged to stop
working due to poor health
Because of discrimination by
your employer/co-worker
Because of another reason
Because of a combination of
discrimination and poor health
0.00%
20.00%
40.00%
60.00%
Have you been expelled, rejected at school because of your HIV status
Regarding discrimination in schools, 73% of people stated that they have not been
discriminated against because of their HIV status, considering that the HIV test is not a
requirement for admission to study, so it is presumed that the HIV diagnosis is not
known in schools; 59% said that their children have been suspended from school
because of the parents diagnosis, 38% have no children in school.
Figure 22: Have you been expelled, rejected at school because of your HIV status
REJECTED AT SCHOOL BECAUSE HIV STATUS

80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
A few times
Never
Not
applicable
Often
Once
55% of the people interviewed has not been denied family planning services, only 13%
have been denied; taking into account that 61% are sexually active, 30.7% reported not
apply to this question; it is also important that civil society level are identified which are
planning methods available to the population that seeks, as being requested and how
they are offering. 93% reported that there has been denied access to sexual and
reproductive health for HIV status and 6.2% of respondents said that if you have been
denied this health service
SELF STIGMA (HOW SOMEONE FEELS REGARDING SELF RESPECT AND FEARS)
This section of the interview reflects on self-esteem of people.
Of those interviewed 56.2% reported feeling ashamed, 67% felt guilty, 27% blame
others, 47% say they have low self-esteem, 9.30% think they should be punished, and
28% had suicidal feelings.
Figure 23 Feelings experienced by HIV status
FEELINGS EXPERIENCE BY HIV STATUS

Feel suicidal
Feel should be punished
9.3%
Low self-esteem
47%
Blame others
67%
Blame myself
56.28%
Ashemed
0.00%
20.00%
40.00%
60.00%
80.00%
This section covers activities that people with HIV have reported stopping due to their
HIV diagnosis. Thirty-nine percent reported that they preferred not to attend social
gatherings, this was higher among women; 36.74% reported being isolated from family
and friends, 18.1% decided to stop working, 15.3% decided not to apply to a job or job
promotion, 20.23% discontinued study or did not take the opportunity to study due to
their HIV status, 26.2% decided not to marry, 20% decided not to have sex, which is
comparable to the report of 24% which reported no sexually activity; 43% decided not
to have children, 16.7% avoided going to the clinic when necessary, 12% avoid going to
the hospital.
Figure24. As for the routine activities that people with HIV interviewed have stopped making its
diagnosis
ACTIVITIES STOPPED DUE DIAGNOSIS BY HIV

Avoided going to hospital when I need to
Avoided going to clinic when I need to
Diced not to have sex
YES
Not to get married

Withdrew for education/training or
NO
Not apply for a job/work/promotion

Took a decision to stop work
Isolated my self from my family and/or
Not to attend social gathering
0%
50%
100%
When questioned about being fearful in some situations, 60.47% feared being targeted
by gossip, 47.44% fear being insulted, harassed or verbally abused; 51% fear being
harassed or physically threatened. 49% fear being attacked physically.
Fifty-nine percent of people expressed fear that someone would not want to engage in
an intimate relationship with them because their HIV status, which can lead to not
sharing their diagnosis and can cause being at risk of reinfection when engaging in
these unprotected relationships or infect another person (which is punishable in Belize).
RIGHTS, LAWS AND POLICIES

Of those interviewed, 27% had heard of the Declaration of Commitment on HIV / AIDS,
which protects the rights of people living with HIV It should be noted that of the people
who have heard of the Declaration only 21% have had the opportunity to discuss the
contents of the declaration.
It was inquired about possible situations that may have happened to people because of
their diagnosis with HIV: 6.28% reported having been forced to undergo medical and
health procedures, 7% were denied health or life insurance, 1.40% have been taken to
court, 2% have been required to disclose their diagnosis to enter another country, 1%
had to disclose their diagnosis to apply to a nationalization or residents in others
countries, 1.40% were quarantined in other countries. 88% said none of the above
situations had happened to them.
Twenty percent of all respondents stated that some of their rights were violated as a
person living with HIV; of these people whose rights have been violated, more than half
have sought a claim for damages or compensation, of these that pursued a claim
81.63% of them have started the process in the last 12 months. Of the persons who did
not do an official claim 43.24% said they did not proceed with legal action for lack of
funding.
From persons whos response was that they did not file a law suit, the respondents
were asked if they have approached a government official to take action on their behalf
for the abuse of their right. 70.27% of them said yes. Of these17 people sought the
help of a national politician to take action against the violation of their rights
MANAGEMENT CHANGE
50% of people have educated, challenged or confronted someone who was stigmatized,
that reflects well on the empowerment of people with HIV in the country. 62.5% of
people reported knowing of an organization or group that can help in the event of stigma
and discrimination.
In asking the following question the respondents had the option to choose more than
one answer, they were asked what type of organizations or groups they knew, , of
those who responded ( N=269) 67% answered that they know of a network of people
with HIV, 58% know about a support group for people living with HIV, 41.3% know
about human rights organizations, 43.5% known about NGOs , 5% expressed about
knowing other entities, including BFLA, government clinics including Cleopatra White.
Figure 25: What type of organization or group do you know
ORGANIZATION OR GROUP DO YOU KNOW

A legal practice
Other
UN organization
Faith-based organization
National nongovernment organization
International nongovernment organization
National AIDS council or committee
A human rights organization
Local nongovernment organization
People living with HIV support group
Network of people living with HIV
0%
20%
40%
60%
80%
From 269 people who know of an organization for people with HIV, 109 requested help
from them to solve a problem of stigma or discrimination.
The 62.09% of those persons gave support to other people with HIV. Of those reached,
128 referred to belong to a support group or an organization for people with HIV,
despite knowing a claimed 269; which may indicate they are aware of not choose to
join.
When asked if they are involved in programs or projects that assist others with HIV,
15.35% affirmed, despite the 62.09% reported having supported other people with HIV,
reflecting who support particularly and not part of an organization that identifies them.
10% of respondents referred to be involved in development of work policies and

guidelines.
TEST / DIAGNOSTICS
When asked about the reason did persons tested 50.5% of interviewed people stated
that they got tested for HIV because they wanted to know their status, 16.51% stated
that they got tested because of illness or death of their partner, 15.35 because their
partner was positive or because they have HIV-related symptoms; 6.5% got tested
because of pregnancy and 14.7% referred due to suspected HIV-related symptoms; in
this question they had the option to select more than one answer.
Figure 26: Why did you get tested for HIV
WHY WERE YOU TESTED FOR HIV

Other
Employment
To prepare for a
Referred by a clinic for
Pregnancy
Referred due to suspected
Husband/wife/partner/family
Illness or the death of
I just wanted to know
0.00%
20.00%
40.00%
60.00%
50% of those interviewed stated that they did their HIV test because they wanted to
know their status.
The 85.35% of the interviewees have referred tested by choice (voluntary) indeed, the
8.60% reported making the decision but under pressure from others, to 3.02% will be
forced to take the test, 2.79% was made tested without their knowledge.
Figure27. It was your decision to be tested for HIV
DECISION TO BE TESTED FOR HIV

Yes, I took the decision myself to be
tested
I was tested without my knowledge-I
only found out after the test had
I was made to take an HIV test
I took the decision to be tested, but it
was under pressure from others
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Private laboratories do not provide pre and post counseling in Belize, yet 52% of the
respondents received counseling before and after testing, 48% received no counseling,
or only got pre or post counseling.
DISCLOSURE AND CONFIDENTIALITY

In relation to the disclosure of the diagnosis to other people or groups of people,
66.98% of people claimed to have revealed addressed themselves to their partner, wife
or husband, 22.32% reported that the question does not apply, by assuming that there
have a partner, the 1.40% reported that someone else told you without your consent.
The 73.72% told the adults in your home, 7% asked someone else to tell with the
consent and 5.58% reported someone without their consent; the 41.86% it said children
from their home, 28% have not told the diagnosis to children and 21% did not apply
(without children at home), to 3.49% said someone else without their consent .
The 63.95% of the respondents reported their status to other people with HIV directly
and 7.67% said someone else without their consent. 34% told their friends and
neighbors about their diagnosis, 20% still comment and 25.58% reported their diagnosis
without her consent. 32% reported their diagnosis to their co-workers, 16% reported that
their partners do not know their diagnosis, 13.72% revealed their diagnosis someone
without their consent, 29% said that the question did not apply, coinciding with the 23%
people who are unemployed.
The 30.23% of interviewer persons told to their bosses about his diagnosis. The 9.76%
said that they told their customers, the 3.49% reported someone without their consent.
The 6.74% has told his fellow drug users diagnosis and 2.79% reported it without your
consent. The 9.76% told the religious leaders of his church, 64% reported not apply to
the question. 61% of respondents said they have told the health workers about their
status, to 5.12% revealed someone without their consent, 16% relates to the question
does not apply. The 53.02% told the social worker and 5.12% said it was someone else
without their consent.
From total of people a 16.23% reported that they would reveal their teachers, 14% to
the teacher someone without their consent and 21% reported that their teachers do not
know their diagnosis said.
The 78.60% of the interviewees refers not apply to the disclosure of the diagnosis to
one government official said 2.33% and 2.09% in someone else said without their
consent. The 3.02% has told the media their diagnosis and 1.16% told someone else to
the media without their consent.
The pressure group and individuals to disclose their diagnosis often uncomfortable for
people with HIV and is a way of violating their rights, 69% of those interviewed reported
having ever been pressured to disclose their diagnosis, 31% some once was pressed.
When asked if they believe that a health professional has revealed his diagnosis without
your consent, 8.84% said yes, 50.23% are not sure. The 54.88% of the persons
addressed concerns not know if their medical records are confidential.
How would you describe the reaction of people when they found out about their HIV
status, which reflects the perception of people, 17.67% said their partners had reacted
severally and 25.34% said very discriminatory, 33.49% said their family had acted
together, the 27.90% said children behaved your home in the usual manner similar to
35.58% compared to the reaction to the friends and neighbors who did not change their
attitude; one 37.67% of the support they gave other people with HIV with much
solidarity, 26.28% reported that the attitude of reaction coworkers were neutral or did
not change, 20% reported discrimination by their bosses to know their diagnosis is
marked . Usually health workers are very supportive to people with HIV and was
reflected in a 44% of people said they received addressed attitudes of solidarity and a
lot of solidarity, 51.93% reported a supportive response from social workers
TREATMENT
77% of people describe their health at the time of the interview between good and
excellent. 67% of respondents are taking antiretroviral therapy; 44.42% of people with
HIV interviewed are taking medication to prevent opportunistic infections. 58% report
that they have had a constructive discussion on their choice of treatment, 47% have had
a conversation with health professionals in relation to sex education, sex, emotional
wellbeing and drug use.
Figure 28. How you describe your health at moment
HOW YOU DESCRIBE YOUR HEALTH STATUS

Poor
Fair
Excelent
Good
Very good
Very good
Good
Excelent
Fair
Poor
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%
HAVING CHILDREN
In relation to having children, 54% reported having them, of which 5.58% are also
diagnosed with HIV; 49.53% of the respondents had received counseling about
reproductive options since I know their HIV diagnosis (127 women, 84 men and 2
trans), 15% received advice not to have children, 5% have felt cohesive to sterilized,
more women than men; 86% of people you take ART concerns that are not condition
the
provision
of
antiretrovirals
using
a
form
of
contraception.
Questions that only women were made in relation to some practices that have been
forced by their HIV positive, the 3.28% reported that he forced an abortion, as to the
availability of ART during pregnancy to prevent vertical transmission 20% said it was not
positive when she was pregnant so had no need of antiretroviral medication, 11%
reported to have received treatment during pregnancy, 7% did not know existed this
treatment.
CONCLUSIONS
1. The women who participated in this study had greater opportunity to access
primary education than the male respondents; but the men had greater access to
secondary and technical education.
2. Most of the people interviewed stated that they were not excluded from any
social, religious and family activities, but 4 out of 10 reported having taken the
decision not to participate in social activities because of their HIV diagnosis.
3. According to the interviewees they perceived that other people spoke about
them, have been verbally abused because of their HIV diagnosis together with
other reasons; those who say that they have not been discriminated because of
their HIV diagnosis state that they have been discriminated because of their
sexual orientation.
4. Persons who reported having been victims of discrimination say that it is because
other people believe they can infect them by casual contact with them and are
afraid of being infected; this reflects the lack of knowledge of the population in
relation to the means of HIV transmission.
5. The interviewees stated that they had to move from their place of residence
because of their diagnosis; many have lost their job and feel that it is because of
discrimination by their bosses and co-workers; This situation puts them in a
position of social and economic vulnerability, they have even been denied a
promotion because of their diagnosis among other reasons.
6. People feel ashamed, guilty and have a low self-esteem in relation to their HIV
diagnosis some have even had suicidal feelings; which directly affects the
acceptance of their diagnosis and the disclosure of the same even if they are
disclosing their status to health providers to access services, they sometimes
prefer not to attend services so as not to feel discriminated, which limits the
improvement of health and life projects and family life.
7. The respondents have heard about laws that could protect people with HIV but
do not engage in these bills; yet half of those stated that they have educated and
confronted the people who have been discriminated against, important
phenomenon is that people know about organizations that work in area of HIV
but do not go to them to make complaints, or join them, but they support other
people with HIV personally, not as part of an organization.
8. The study shows that there is little culture of complaint with discrimination cases
and many have not sued for lack of financial resources, some have even
resorted to public officials to assist them in this process.
9. Of the respondents who have children, more than half of the children have been
suspended from school because of the parents HIV diagnosis; this reflects a
clear ignorance of the subject by the teachers and leaders of schools.
10. The study shows that people interviewed are aware of their diagnosis; have been
directly involved in sharing their diagnosis at home, friends, work and study
center; but also expressed doubt that health personnel have the confidentiality of
their diagnosis and medical history.
11. It shows that health services have given options on the subject reproduction for
those knowing their diagnosis, few have received direct suggestion as to not
have children and treatment is not subjected to a form of contraception.
RECOMMENDATIONS
1. Identify what legal processes that benefit people with HIV that are pending or
have been stagnant due to advocacy is done through social participation of the
affected population to get these laws transformed and be directly linked to the
relation to HIV diagnosis.
2. Deepen the existing national legal framework to ensure compliance with the
human rights of people with HIV in Belize. In turn the results of this study provide
a basis for advocacy and place the issue on the public agenda, emphasizing the
modification or adaptation of the legal framework for the security and respect for
human rights.
3. Educate and sensitize staff of health services, public assistance agencies, the
media and schools, to increase awareness of the HIV and means of transmission
of infection to reduce discrimination against people when in contact with these
entities.
BIBLIOGRAPHY
1. Public Survey Stigma and Discrimination, 2013, Belize 2013; USAID PASCA.
2. Progress Report 2014, UNAIDS.
3. Belize HIV Strategic Plan 2012- 2016.
4. Belize HIV Operational Plan 2012- 2014.

5. Regional Stigma and discrimination Unit the Pan- Caribbean.
6. Global status Report of 2012 for Belize.

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Persons Living with HIV Stigma Index: Belize INDEX 2013

PEOPLE LIVING WITH HIV STIGMA INDEX:

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

Ms. Mariana Mansur

Ms. Melissa Sobers

Ms. Guadalupe Huitron

Belize Red Cross:

Dr. Deisy Mndez Garca

Hand in Hand Ministries:

Ms. Nadia Armstrong

Mr. Kendale Trapp

Collaborative Network of persons Living

In coordination with REDCA+ Regional Program

Technical group/ M&E:

Mr. Evelio Cocom, Data Entry

Consultant: Reynaldo DAubuisson Arrieta

Persons Living with HIV Stigma Index: Belize INDEX 2013

International Planned Parenthood Federation

Collaborative Network of Persons Living with HIV of

Global Network of People Living with HIV

International Community of Women Living with

Human Immunodeficiency Virus

United States Agency for International Development

Action AIDS Project of Central America

Pan American Social Marketing Organization

Joint United Nations Programme on HIV/AIDS

United Belize Advocacy Movement

Men who have Sex with Men

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

Definition of the sample

Persons Living with HIV Stigma Index: Belize INDEX 2013

Persons Living with HIV Stigma Index: Belize INDEX 2013

The tools of the data

Sex, age, year of HIV diagnosis, marital status, group

Persons Living with HIV Stigma Index: Belize INDEX 2013

Experienced discrimination in the last 12 months in

Access to work, health and

Ways in which discrimination occurred in different

Self-stigma and fears

Ways which Stigma to HIV is lived or perceived;

Rights, laws and policies

Knowledge of current legislation and policies in the

Ways of reacting to the authorities in cases of

Experiences related to the circumstances of HIV

Sharing of HIV status and

Notification of HIV status and handling

Use of anti-retroviral drugs.

Family life and having

The desire to have children and the support given

Persons Living with HIV Stigma Index: Belize INDEX 2013