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The challenge of stigma
12 May 2004. IRIN PlusNews. Republished courtesy of IRIN PlusNews.
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Stigma associated with HIV/AIDS is exceptionally complex, with far-reaching consequences, social scientists said at a conference on the social aspects of HIV/AIDS research in South Africa this week.
"Socially stigmatising beliefs about AIDS impede HIV prevention, diagnosis, and care," researcher Seth Kalichman said at the four-day meeting of the Second African Conference of Social Aspects of HIV/AIDS Research held in Cape Town.
From Kalichman's study in two townships outside Cape Town, he found that stigmatising beliefs were prevalent, and associated with misinformation and mythical conceptions of HIV/AIDS.
"We discovered that people that hold traditional beliefs about the cause of AIDS, such as the belief that AIDS is caused by spirits and supernatural forces, are more likely to stigmatise people living with HIV/AIDS," he told PlusNews.
"This clearly indicates that HIV/AIDS education efforts may effectively reduce AIDS stigmas among people who hold these traditional beliefs," he said.
The study showed that people who had participated in Voluntary Counselling and Testing (VCT) were less likely to stigmatise people with HIV/AIDS.
"We don't believe that testing reduces stigma, but we can clearly see that people that are less likely to stigmatise others, are more likely to get tested," said Kalichman.
The more people knew about HIV/AIDS, the less likely they were to stigmatise others. Yet education did not do away with stigma. "The amount of education they had, had no bearing on whether they stigmatised others or not," he noted.
Other research illustrated an emerging trend of health workers stigmatising patients by treating them with little regard for sensitivity or confidentiality.
In research on the impact of stigma in the South African health care system, 53 percent of respondents said health workers were a major source of AIDS-related stigma. Fifty percent of the health workers surveyed admitted that AIDS patients were sometimes denied services and certain rights.
Namposya Nampanya-Serpell, the outgoing UNAIDS country coordinator for Zambia, presented a paper on the correlation between access to treatment and uptake of antiretroviral therapy (ART). She concluded that the lack of privacy in Zambian HIV/AIDS clinics was a disincentive to treatment.
Concerns over confidentiality by hospital staff in South Africa's east-coast province of KwaZulu-Natal were a barrier to accessing free HIV/AIDS medical care for themselves, according to research by Kerty Uebel. McCord's Hospital, in the port city of Durban, offered staff members free HIV-related care, including confidential counselling and testing, opportunistic infection prophylaxis and ART, yet a significant proportion had not utilised the services.
"Even health workers didn't trust in the systems to keep their results confidential," noted another researcher.
Concern was expressed at the conference, organised by South Africa's Human Sciences Research Council (HSRC), about how stigma affected normal, healthy behaviours and societal norms.
"Normal practices like breast feeding, having children, getting married, all become difficult territory to negotiate once you know you are HIV positive, but you refuse to disclose," said researcher Abdoul-Haman Tobou.
One example cited in Tobou's research was the situation of a young woman who feared to disclose her status, and as a result of hiding her drugs, could not adhere to treatment. "Is availability of ART enough?" asked Tobou.
In the struggle to stem the tide of HIV/AIDS, stigma manifested itself in other harmful ways.
Researcher Placide Tapsoba, of the Horizons Programme of the Population Council in Ghana, presented findings of research on stigma as an obstacle to prevention and care of AIDS and STD in marginalised populations.
Tapsoba's research looked at men who have sex with men (MSM) and found that most of the circumstances under which this practice begins fell within the extended family, between an older man (the initiator) and a younger boy, usually for money.
"Local researchers are not interested in researching MSM - there is no government, nor donor, interested in doing anything about this group," said Tapsoba.
A group of researchers from the HSRC's Social Cohesion and Integration Unit, Harriet Deacon, Inez Stephney and Sandra Prosalendis, presented interim findings of a literature review on the social context and history of stigma in South Africa.
"HIV/AIDS stigmatisation acts reinforce other forms of social exclusion and inequality. Like leprosy or racism, they legitimise dominant power relations," said Deacon. "We need more research on the history of disease stigmatisation - we cannot separate them from their own politics, nor history."
Stigma presented huge barriers to VCT and disclosure, care and reducing new infections, yet the biggest problem exacerbating stigmas, according to Kalichman, was the lack of public support for programmes.
"Not only in Africa is leadership a huge obstacle to tackling stigma - in America we have very conservative leadership, and money for AIDS has gone down the tubes because of lack of public support, simply because of the stigma," he commented.
"We need to integrate anti-stigma issues in wide-ranging interventions to improve access to care, including housing, employment, government benefits and health care systems," the HSRC study concluded.
This item is delivered to the English Service of the United Nations' Humanitarian Information Unit but, may not necessarily reflect the views of the UN |
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