Internship Notes: The Workshops

Weeks 7 & 8

After the first half of the summer spent preparing for the workshops, we were finally able to start the workshops. The workshops on HIV discrimination and stigma were conducted in the city of Celaya about an hour drive from SMA. They were done here because there is larger population and an HIV clinic (CAPASITS), so the presentation might be able to help some people. We had thought our participants would come equally from the General Hospital of Celaya and the local health dept., but we did not have the support of neither the General Hospital nor CAPASITS. Fortunately, the local health dept. of Celaya were extraordinairely helpful, and they provided all the participants and support that we needed.

The drive into Celaya from San Miguel de Allende.

To begin, we had three main goals with the workshop. Hopefully, we thought, they would be realistic, and something that could be delivered by the end of the day. 1) Create consciousness about stigma and discrimination against HIV/AIDS. 2) Expand knowledge about the rights of people living with HIV. 3) Identify strategies to reduce discrimination and stigma in the medical setting. With that, we were off...

The workshop was a 5-hour event conducted at a hotel in Celaya, a very nice set-up supported by the Guanajuato Health department. Starting at 9am people started filtering in, signing-in, mingling, all of the necesities of any decent mandated training. The day started with the surveys that I had them fill-out, this was my part of the project the stats that we could count up later if you will. The survey asked about general demographics, as well as some questions pertaining to perceptions, knowledge, and behavior concerning people with HIV.

The first day they had us in the hotel bar, a little cramped but fine nonetheless


The second through fifth workshops were done in the hotels actual conference rooms...

We had various anti-discrimination type posters up in the room of the workshop, creating an ambience of compassion, or something. This one says: "When you discriminate... you look VEEERY BAD"

Then into the workshop... starting off, all participants have a little paper that designate them a role to play. The role's are of those people who CENSIDA has termed key populations (poblaciones claves) as well as "general population." Throughout the workshop, Juan and María would ask them to embody the role, and think from the given perspective. From there, on into the "meat."

The first part was section guided by Juan on stigma, talking about historically stigmatized groups, and the etymology of the word (Ancient Greeks) and how they problem presents itself in México. Juan talks about four elements of stigma which include negative evaluation, rejection, isolation, and jokes. By telling stories of his own experiences he is able to explain how examples of stigma arise in their everyday life, sometimes without them being aware.

At this point we come up with a list of nicknames of the "key populations." For men who have sex with men, sex workers, transgender, injection drug users, and people living with HIV. You can imagine the longlists we compiled from all five workshops, the creativity humans have in name calling is impressive. Names that we have heard a lot in the day-to-day, that are often derogatory, yet we hear nonetheless. This part tended to be a lighter, people shouting out these"bad words," semi-hesitant, awkard, interspersed with nervous laughter. The participants, know as we do, that the words are disrespectful in nature, yet that does not seem to affect their presence. After this exercise, we had one of those"reflection moments," especially for those that drew a card that had one of those key populations.

Juan doing his thing, keepin' the crowd moving

Once stigma has been covered, María moves in to talk about how that stigma can become discrimination. Stigma being the thought, discrimination being the physical manisfestation of that thought. We start going over ways people discriminate in the medical setting; isolation, different treatment, longer wait, etc. Also, she covers a bit about internalized stigma, and when people feel deserving of different treatment, it can start to fulfill expectations, creating a nasty cycle that perpetuates the problem.

María and the Internalized E-Stigma

At this point, a lot of talk from Juan and María, but we wanted to share the voice of real people who had gone through this. We had wanted HIV patients from Celaya to come speak, but as the cooperation with CAPASITS had been so poor, that wasn't happening. Instead, we showed a video made by a Latino HIV support group in the Bay Area called "A todos nos afecta," (It affects us all). The video was a general overview of a lot of HIV related themes, but there were some poignant parts that would really highlight what the workshop was trying to focus on. Folks with HIV shared experiences of being discriminated against, or looking down upon for who they were. The voices complemented the power point presentations on the general themes of stigma and discrimination.

"A Todo Nos Afecta" Video

After the video, the participants were provided a hearty breakfast from the hotel. Thank you state health department. During the break, Juan, María and I had a chance to talk and interact a little bit more with the participants. For example; we learned that one lady had been to a similar type training five years ago... one that included speakers who were HIV+. Another lady, told us that she had done a similar study on stigma and discrimination in the General Hospital of Celaya for her thesis. Interesting pieces that added to our understanding of the situation with the HIV + patient in Celaya.

Hearty breakfast.

Following the break, Juan would jump into the universal precautions section of the training. One of the valid concerns people have is to be protected while they perform their work. The point here was to explain that universal precautions are UNIVERSAL, for everybody, so you can't pick and choose how you are going to be protecting yourself depending on the patient. That of course, is different treatment a primary source of discrimination. Some participants have seen providers appearing like "astronauts"  with all the gear that they have on. The moral here, protect yourself with all patients, not just the ones who present as a "key population."

The penultimate block of the workshop was where María covered the rights of people living with HIV. We presented various cases of ethical issues, and asked the participants to decide on which side of the issue they agreed upon. María would then talk about the issue in the context of the laws of Mexico, and what were the legals rights of the people in these situations. 

Presenting the ethical issue. 

María used three issues: 1) Should a principal have the right to fire a teach who identifies as homosexual. 2) Should a boss/supervisor have the right to demand a HIV test from all employees. 3) Should a doctor have the right to tell an HIV+ women who is pregnant to terminate her pregnancy. Once the issue was presented we asked those in favor to stand on the right side of the room, those against to stand on the left side of the room. Then she would have them debate, and have them try to explain their rational.

Separating the room

After the first day, we realized that people who attend the workshop may have already dranken the kool-aid, and were on board with the message of compassion. To create some debate, we had all the "key population" folk stand on the easy side, and all the others, those of the "general population" stand on the devil's advocate side. That way, we could some what re-inact moral debate's that occur outside everyday. The devil's advocates were good, it wasn't hard to see that the arguments they used were familiar to everybody in the room.

Devil's advocates.

María explaining laws and the legal piece after one of the debates.

For the final exercise, we had them get together in their tables and think about one of the "key population" folk at their table. We had them think of how their work environments would present to this person, and brainstorm of ideas that could reduce discrimination. Basically, what can be done to improve this persons experience at where they work.

Group presenting their future recommendations.

Another group presenting.

And that was a wrap. We gave them the second half of my survey, as the groups finished presenting and let them leave once they finished.

This of course, has been a brief overview of how the workshops went, each one was unique and had a different feel to it. The overview would be incomplete without explaining the role's of key supporting characters. 

Ray- AV guy. Ray was with us throughout the workshops working the power point and video and just making sure the whole electronic situation was under control.

Dra. Ligia Padilla- The public health director of the local health jurisdiction. I am not exaggerating when I say it couldn't have happened without her help. She was enthusiastic, and supportive every step of our journey. If, or when I come back to Mexico, it is people like her that I want to be working with. 

Dra. Jose- The HIV coordinator of the local health jurisdiction. She was also present at every workshop, and was helpful and filling in gaps where we couldn't. One of the big surprises that we found was that few people knew what to do in the event of a needle stick, or even what the CAPASITS was. She gave a brief overview of their program, and let the participants know that they could go to the clinic if an accident every occurred.

Ray, Me, Dra. Ligia, María, Dra. Jose and Juan after the last workshop.