SSDDIM Reduction

SSDDIM: Stigma, Shame, Denial, Discrimination, Inaction, Mis-action. These components overlap in different ways for individuals living with or personally affected but HIV/AIDS. SSDDIM negatively impacts access to treatment, testing rates, information and knowledge sharing. It significantly hinders efforts to slow, halt, and reverse the spread of the virus and leads to various other complications in tackling HIV. SSDDIM must be decreased in a meaningful way before AIDS can be defeated in Africa and beyond.

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Despite the now available significant body of knowledge, technology, information and resources for the prevention, management and mitigation of HIV/AIDS, the world is still witnessing high levels of infections and deaths. To a great extent, high levels of HIV/AIDS related death and infection are  attributed to  Stigma, Shame, Denial , In-action, Mis- action  (SSDDIM) which are conspiring to limit  the effectiveness of HIV prevention, treatment and impact mitigation efforts at individual, family, community, national and global levels. Indeed, HIV/AIDS related stigma and discrimination has been identified as one of the top five barriers to achieving universal access to HIV prevention, treatment, care and support (UNAIDS 2008 Report on the Global AIDS Epidemic). The fear of stigma and discrimination makes people living with HIV/AIDS less likely to seek care; treatment and disclose their HIV status to their sexual partners (Mills, 2006) hence undermining the HIV & AIDS response efforts.  On the other hand, because of stigma, there is a low level of knowledge of one’s own and of partner’s HIV sero-status which is one of the significant driving forces of the HIV epidemic in Africa. The low level of testing among couples, the lack of disclosure of HIV status to the partner and the low condom use in marriage put the uninfected partner at elevated risk. Lack of couple counselling, failure of disclosure and fear of domestic violence, discrimination or marital discord is hampering prevention intervention programs such as comprehensive VCT and PMTCT.

At the Global Race to SAVE Lives from HIV & AIDS Conference held on 25-29 August, 2009 in Mukono Uganda, the Delegates noted with concern that there are six related evils, namely Stigma, Shame, Denial, Discrimination, Inaction, and Mis-action (SSDDIM), working in partnership to frustrate HIV/AIDS efforts. These evils take advantage of many people’s lack of accurate information, appropriate attitudes, skills and services on HIV&AIDS to prevent individuals, families, communities and whole nations from adopting safer, healthier and life defending behaviours, practices, policies and programmes. Because of SSDDIM, the Delegates observed that there is:

  • Inaccurate and negative fear, ridicule and hate (overt or concealed) of persons known or rumoured to be living with HIV because they are inaccurately regarded as ‘deliberate sources’ of HIV infection, contagion and transmission;
  • Irrational and paralyzing fear of quick death from HIV/AIDS by many of the people diagnosed as HIV positive and by many of their family members, care givers, guardians, employers, educators, service providers and by others in the general population;
  • Inaccurate and exclusive association of one’s HIV positive status with sexual immorality (without taking into consideration other sources of infection and transmission beyond sex and without acknowledging the fact that “not all ‘sexual saints’ are free from HIV infection” and that “not all ‘sexual sinners’ are HIV positive”;
  • Inaccurate and unfair association of one’s HIV positive status and initiation of Anti-Retroviral Treatment (ART) with lack of faith in God and in Miracles; and
  • An inaccurate, inadequate and ‘self-righteous’ way many behaviour change communicators, faith leaders, politicians and other opinion shapers communicate on HIV/AIDS prevention using the “ABC” message –a way that ends up worsening the SSDDIM situation and driving HIV & AIDS underground.

The Conference further noted that because of the SSDDIM, many people still fear to know their HIV status (voluntarily and routinely). Many others who know their HIV status as positive still fear to disclose to their sexual partners, their family members, service providers, mentors and to their spiritual and reproductive health advisers and thus remain cut off from the much needed support that would help them to participate effectively in breaking the HIV transmission chain and in making other decisions that would enhance their safer, healthier, longer, more productive, more peaceful and more fulfilling living. Many others who venture to disclose do it too late again due to the SSDDIM situation for effective HIV/AIDS prevention, care, treatment and impact mitigation to take place.

The Conference concluded therefore that the six related evils of Stigma, Shame, Denial, Discrimination, Inaction and Mis-action (SSDDIM) at individual, family, local community, national, continental and global levels are the real reasons behind our less than desirable results in HIV/AIDS prevention, care, treatment and impact mitigation. SSDDIM is the reason why for every two HIV positive people put on ART, five more people get newly affected with HIV. SSDDIM is the reason why two to three HIV positive people (qualifying for ART) remain un-reached and untreated for every one HIV positive person put on ART. SSDDIM is the reason why many countries are rushing to criminalize HIV infection and transmission of HIV preferring to blame more and support less. SSDDIM is the reason why many communities, many countries and many places of worship, residence, work, education, business and leisure do not have life-defending, life-protecting, life-enhancing and life-saving policies, plans, programs, partnerships and adequate budgets that  would show ownership of the HIV and AIDS Challenge. SSDDIM is  one of the key  reasons why many of  the 2001 Abuja targets, 2010 Universal Access and 2015 MDGs remain largely unmet in many at –risk, most affected and most vulnerable communities and countries  and yet  politicians , policy makers and state leaders in various sectors  are not under any reasonable pressure to explain that state of affairs  to their people or to give accountability on SSDDIM reduction & SAVE multiplication progress and challenges to their constituents in their state- of- the nation addresses and in their election campaign manifestos.

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This information on The Challenge of HIV/AIDS Stigma, Shame, Denial, In-action, Mis- action (SSDDIM) is excerpted from the GWG Strategic Plan. To view or download the Strategic Plan, click here.

To access a short SSDDIM booklet presented by Canon Gideon B Byamugisha, the Goodwill Ambassador on HIV & AIDS (Christian AID) and director of FOCAGIFO, the GWG Secretariat, click here: ssdim-book.