AFRICA: The challenge of stigma
[ This report does not necessarily reflect the views of the United Nations]
Stigma is the enemy
CAPE TOWN, 12 May (PLUSNEWS) - Stigma associated with 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 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.