“It is especially important to think of stigma as a social and cultural phenomenon linked to actions of whole groups of people in the developing world, where bonds and allegiances to families, village and neighbourhoods and community abound” – L. Gilbert¹

 

What is the problem?

Stigma refers to a mark of shame, disgrace or disapproval, which results in an individual being rejected, discriminated against, and excluded from participating in a number of different areas of society¹. As a disease, HIV/AIDS experiences a disproportionately high rate of stigma relative to other conditions, with more than 50% of men and women in developing countries reporting discriminatory attitudes towards sufferers of AIDS and HIV². High levels of stigma are problematic as they not only damage personal economic, social and familial lives, but also limit access to preventative measures, care and treatment³. Indeed, a study conducted in Botswana found that 23% of surveyed individuals would not buy food from a HIV-positive shopkeeper, with a further 54% of recently HIV-positive individuals expecting to experience discrimination as a result of their condition¹. Such stigma is troubling as it acts as a barrier against HIV testing and eventual treatment. This in turn damages the likelihood that the United Nationals sustainable development goal to end the AIDS epidemic by 2030 will be reached². While stigma can affect access to care on the community level, self-discrimination by individuals has also been shown to reduce adherence to ARV therapies^2. Thus, stigma can be considered an individual-level barrier to ARV access.

This figure, published by UNAIDS in 2015, demonstrate the link between HIV discriminatory attitudes and HIV testing in third world countries. Regions of Cote d’lvoire that report high levels of HIV stigma also report low levels of HIV testing.

Why is there AIDS stigma?

Much of the stigma that surrounds HIV & AIDS has persisted from the 1980s. During this time, the HIV prognosis was poor and very little was known about how the infection was transmitted. Some truths, and some misconceptions, about HIV are in the quiz below. See how many you can get correct.

http://goo.gl/UABRHG

How does stigma affect access to care?

Stigma against AIDS has a deep negative psychological impact on affected individuals, their families and communities. This AIDS-related stigma can reduce use of antiretroviral therapy, with a study by Sayles, Wong, Kinsler, Martins and Cunningham ³ finding HIV/AIDS positive patients were 2.5 – 9.6 times less likely to adhere to antiretroviral therapy if they experienced high levels of stigma. Indeed, the World Health Organisation (WHO) cites stigma to be the leading cause of low antiretroviral maintenance, low international testing rates and reluctance to release HIV/AIDS status⁴. As Rankin, Brennan, Schell, Laviwa and Rankin ⁵ observe:

‘stigma is of the utmost concern because it is both the cause and effect of secrecy and denial, which are both catalysts for HIV transmission’ (p. 247)

Watch the confronting video of an African mother who was rejected from her community because of her status.

Source: https://vimeo.com/97728053

What are the challenges to overcoming HIV/AIDS stigma?

Some of the main challenges include:

• The criminalization of HIV non-disclosure. Criminalisation of HIV non-disclosure discourages people from getting tested for fear of discrimination⁶.
• Discrimination in health care settings.  At least one negative belief about HIV/AIDS is held by 80% of Thailand healthcare workers. Many members of society look up to the attitudes of healthcare workers as role models of society⁴.
• Poor access to justice. Many people who face workplace or social discrimination never take the issue to court6.

What can be done?

Stigma against HIV/AIDS positive patients can be fought in three ways: through education, advocacy and exposure7. Education includes informing people about their stigma, including their unconscious biases and stereotypes7. Advocacy involves actively fighting for the rights of people living with HIV/AIDS7. This could be achieved by rallying against the criminalization of HIV status, or against discrimination in the healthcare setting. Finally, stigma can be fought through exposure. Exposure involves exposing the non-stigmatised group to the stigmatised group, in order to humanise the stigmatised group and reduce in-group out-group bias.

 

References

1. Wolfe WR, Weiser SD, Leiter K, Steward WT, Percy-de Korte F, Phaladze N, et al. The Impact of Universal Access to Antiretroviral Therapy on HIV Stigma in Botswana. American Journal of Public Health [Internet]. 2008 02/09/accepted;98(10):1865-1871. Available from: PMC
2. United Nations. Sustainable development goals [Internet]. 2015 [cited 2016 7/4]. Available from: http://www.un.org/sustainabledevelopment/
3. Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. Journal of general internal medicine. 2009;24(10):1101-1108.
4. Rankin WW, Brennan S, Schell E, Laviwa J, Rankin SH. The stigma of being HIV-positive in Africa. PLoS Med. 2005;2(8):e247.
5. Mahajan AP, Sayles JN, Patel VA, Remien RH, Ortiz D, Szekeres G, et al. Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS (London, England). 2008;22(Suppl 2):S67-S79. Available from: PM
6. Joint United Nations Programme on HA. Fast-track: ending the AIDS epidemic by 2030. Geneva: UNAIDS. 2014.
7. Coombe C. Keeping the education system healthy: Managing the impact of HIV/AIDS on education in South Africa. Current issues in comparative education. 2000;3(1):14-27.

Cover photo from Gideon Mendel. Available from: http://gideonmendel.com/