HIV/AIDS Related Stigma and Discrimination against PLWHA in Nigerian Population

Background

HIV/AIDS remain a major public health concern in Nigeria. People living with HIV/AIDS (PLWHA) face not only personal medical problems but also social problems associated with the disease such as stigma and discriminatory attitudes. This study provides an insight into HIV/AIDS related stigma and discrimination against PLWHA in Nigeria.

Methods

The data for this study was extracted from the 2013 Nigeria Demographic and Health Survey conducted by the National Population Commission. All men and women aged 15–49 years, permanent residents and visitors of the households were eligible for the interview. Several questionnaires were used in the survey, some covering questions on HIV/AIDS.

Results

A total of 56 307 men and women aged 15–49 years participated in this national survey. About half of the population in Nigeria have HIV stigma. Younger persons, men, those without formal education and those within poor wealth index are more likely to have stigma towards PLWHA. In addition, married people are more likely to have stigma on PLWHA and are more likely to blame PLWHA for bringing the disease to the community. Also about half of the population discriminates against PLWHA. However, those with higher levels of education and those from higher wealth index seem to be more compassionate towards PLWHA. About 70% in the population are willing to care for relative with AIDS, even more so among those with higher level of education.

Conclusion

There is a high level of HIV stigma and discrimination against PLWHA in the Nigerian population. Education seems to play a major role in the society with respect to HIV stigma and discrimination against PLWHA. Educating the population with factual information on HIV/AIDS is needed to reduce stigma and discrimination towards PLWHA in the community.     

"All I eat is ARVs": the paradox of AIDS treatment interventions in central Mozambique

The number of people on antiretroviral treatment in Mozambique has increased by over 1,500 percent since it first became free and publicly available in 2004. The rising count of "lives saved" seems to portray a success story of high-tech treatment being provided in one of the poorest contexts in the world, as people with AIDS experience dramatic recoveries and live longer. The "scale-up" has had significant social effects, however, as it unfolds in a region with a complicated history and persistent problems related to poverty. Hunger is the principal complaint of people on antiretroviral treatment. The inability of current interventions to adequately address this issue leads to intense competition among people living with HIV/AIDS for the scarce resources available, undermining social solidarity and the potential for further community action around HIV/AIDS issues. Discourses of hunger serve as a critique of these shortcomings, and of the wider political economy underlying the HIV/AIDS epidemic.     

Do junior academic bioethicists have an obligation to be activists?

Activism and bioethics have enjoyed a somewhat strained relationship. In this paper, I consider activism specifically from the perspective of junior academics. I will argue that although there may be a prima facie duty for bioethicists to be activists, countervailing considerations for junior academics may mean that they, in particular, should refrain from undertaking activist activities. I will argue this on the basis of two key claims. First, I argue that activism may come at a potential cost to the academics who undertake it, and that these costs are potentially of greatest detriment to junior academics undertaking activism. Second, I argue that junior academics are likely to be less effective activists than established academics. Moreover, undertaking activism as a junior academic may prevent one from becoming an effective activist later. Finally, I will discuss the implications of this argument for activist commitments later in one’s career.     

AIDS and evidence: interrogating [corrected] some Ugandan myths

Uganda is invoked as a metaphor for a host of arguments and insights about HIV/AIDS. However, much of what has been asserted about the country is not based on the available evidence. This paper reviews findings by epidemiologists and anthropologists, and draws on the author's experiences of researching in the country since the early 1980s. It comments on various myths about HIV/AIDS in Uganda, including myths about the origin and dissemination of the disease, about the links between HIV/AIDS and war, and about declining rates of infection. It shows that much less is known about Uganda than is commonly supposed, and it offers some alternative hypotheses for interpreting HIV prevalence and incidence data. In particular it draws attention to the importance of mechanisms for social compliance. It concludes by raising concerns about the current enthusiasm for provision of anti-retroviral drugs.     

AN UNEQUAL ACTIVISM FOR AN UNEQUAL EPIDEMIC?1

This paper observes that a substantially large moral duty of dealing with the AIDS situation in Africa has been placed on the drug companies and argues that this approach is inequitable. Using the poverty-AIDS relationship and the human rights framework it argues for a more balanced AIDS activism, which puts equal pressure on all potential stakeholders in the war against AIDS. It argues that this redistribution of the HIV/AIDS moral burden is perhaps the only hope for curbing the African AIDS epidemic that continues to ravage communities on that continent.     

HIV, gender, race, sexual orientation, and sex work: a qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada

Background

HIV infection rates are increasing among marginalized women in Ontario, Canada. HIV-related stigma, a principal factor contributing to the global HIV epidemic, interacts with structural inequities such as racism, sexism, and homophobia. The study objective was to explore experiences of stigma and coping strategies among HIV-positive women in Ontario, Canada.

Methods and Findings

We conducted a community-based qualitative investigation using focus groups to understand experiences of stigma and discrimination and coping methods among HIV-positive women from marginalized communities. We conducted 15 focus groups with HIV-positive women in five cities across Ontario, Canada. Data were analyzed using thematic analysis to enhance understanding of the lived experiences of diverse HIV-positive women. Focus group participants (n = 104; mean age = 38 years; 69% ethnic minority; 23% lesbian/bisexual; 22% transgender) described stigma/discrimination and coping across micro (intra/interpersonal), meso (social/community), and macro (organizational/political) realms. Participants across focus groups attributed experiences of stigma and discrimination to: HIV-related stigma, sexism and gender discrimination, racism, homophobia and transphobia, and involvement in sex work. Coping strategies included resilience (micro), social networks and support groups (meso), and challenging stigma (macro).

Conclusions

HIV-positive women described interdependent and mutually constitutive relationships between marginalized social identities and inequities such as HIV-related stigma, sexism, racism, and homo/transphobia. These overlapping, multilevel forms of stigma and discrimination are representative of an intersectional model of stigma and discrimination. The present findings also suggest that micro, meso, and macro level factors simultaneously present barriers to health and well being—as well as opportunities for coping—in HIV-positive women''s lives. Understanding the deleterious effects of stigma and discrimination on HIV risk, mental health, and access to care among HIV-positive women can inform health care provision, stigma reduction interventions, and public health policy. Please see later in the article for the Editors'' Summary     

Ethnography, art, and death

A problem facing anthropologists, given the centrality of memory and imagination to all social life, is how to access memory and the imaginary when there is no independent access to consciousness. Moreover, the discipline has 'largely failed to distinguish itself' in response to understanding HIV/AIDS ( Annual Review of Anthropology 30 , 2001: 163). In response to these observations I would argue that orthodox approaches are limited and we need to create new forms of collaborative research and representation with regard to understanding experiences of illness. Accordingly this article attempts to bring to life the interior dialogue of persons living with HIV/AIDS through performance by 'mapping' the city of Kampala through its emotions and memories rather than buildings and streets.     

HIV/AIDS and the Gendering of Stigma in Tamil Nadu,South India

Drawing on the seminal theoretical work on stigma by Goffman, this article analyzes stigma through the lens of Parker and Aggleton, who call for the joining of Goffman and Foucault to better grasp relationships among stigma, power and social inequality. Studies on the social impact of HIV/AIDS globally have demonstrated that women tend to be blamed for the spread of HIV/AIDS, and as a result, HIV-positive women face greater stigma and discrimination than HIV-positive men. Based on ethnographic research among 50 HIV-positive women in South India in 2002–2003 and 2004, my research supports this standard argument. However, my findings suggest that the gendering of stigma and discrimination is more complex and context specific. The gendering of stigma varies depending on the social context of private versus public spheres. The tendency to stigmatize women is due in part to cultural constructions of gendered bodies and not only to a gendered double standard of sexual morality, as has been previously reported. Even when a cultural argument about women’s wayward sexuality is evoked, this rhetoric must be understood in part as a strategy to mask economically motivated responses, rather simply being attributed to sexist ideology per se.     

Correlates of Social Exclusion and Negative Labeling and Devaluation of People Living with HIV/AIDS in Rural Settings: Evidence from a General Household Survey in Zambézia Province,Mozambique

Background

Increased HIV/AIDS knowledge and access to antiretroviral treatment (ART) have been hypothesized to decrease HIV stigma. However, stigma persists as a barrier to HIV services uptake. We studied the relationship between stigma, knowledge and attitudes towards HIV and its treatment, and confidence in the legal system (legal rights certitude).

Methods

We analyzed data from a household survey of 3749 randomly sampled female heads of households in 259 enumeration areas across 14 districts of Zambézia Province, Mozambique. The questionnaire included questions about beliefs, attitudes and behavior towards PLWHA, HIV transmission knowledge, treatment-related beliefs, and legal rights certitude. Factor analysis distinguished two stigma constructs: Negative labeling and devaluation (NLD) and social exclusion (SoE). Multivariable linear regression was used to determine the association between stigma, knowledge of HIV/AIDS, treatment-related beliefs, and legal rights certitude, while controlling for variance in socio-demographics.

Results

A 4-point increase in knowledge about HIV transmission was associated with more than a 3 unit decrease in NLD and SoE stigma scores (p<0.001). Given HIV transmission knowledge, a 25-point increase in legal rights certitude was associated with a 4.62 unit drop in NLD stigma (p<0.001); we did not detect an association between legal rights certitude and SoE stigma. Knowing at least one HIV positive person was associated with lower SoE (−3.17, 95% CI: −5.78, −0.56); no association with NLD (p = 0.1) was detected. ART efficacy belief was associated with higher NLD and lower SoE (2.90 increase and 6.94 decrease, respectively; p≤0.001).

Conclusion

Increasing knowledge about HIV transmission and access to ART are likely to reduce stigma, but neither of the two is a panacea. Raising community awareness of the legal rights of PLWHA might improve the efficacy of stigma reduction efforts. Strategies that focus on specific domains of stigma might be more effective than generic stigma reduction strategies.     

Indian agency admits publishing "wrong" HIV figures

The National AIDS Control Organization, India's top government agency responsible for tracking HIV infection, admitted that it published inaccurate figures of new HIV cases detected in the country over the past 3 years. It is noted that the agency estimated that 3.5 million people were infected, based on a sentinel screening program aimed at determining the HIV prevalence rates among high-risk communities and the general population. However, the Joint Action Council, the nongovernmental association monitoring the government's HIV program has questioned these findings. The Council claimed that the agency downplayed several figures and that its reports do not reflect reality. This is because the agency's surveillance figures suggested that the states of Kerala, Punjab, and West Bengal detected no new cases of HIV over the past 2-4 years. Moreover, epidemiologists have long suspected that thousands of infected people may be dying of HIV-related illnesses but are being missed by India's poor death recording system.     

Re-Validation of the Van Rie HIV/AIDS-Related Stigma Scale for Use with People Living with HIV in the United States

There is little consensus about which of the many validated human immunodeficiency virus (HIV) stigma scales should be regularly used, with few being re-validated in different contexts or evaluated for how they compare to other, existing HIV stigma scales. The purpose of this exploratory study was to re-validate the Van Rie HIV/AIDS-Related Stigma Scale, originally validated in Thailand and using a third-person wording structure, for use with people living with HIV in the United States. Adult HIV clinic patients completed a survey including the Berger and Van Rie scales, and measures of social support and depression. Eighty-five of 211 (40%) eligible participants provided data for both stigma scales. Exploratory factor analyses identified three factors to the Van Rie scale: Loss of Social Relationships (new subscale), Managing HIV Concealment (new subscale), and Perceived Community Stigma (original subscale). These subscales were moderately inter-related (r = 0.51 to 0.58) with acceptable to excellent reliability (Cronbach’s alpha = 0.69 to 0.90). The Van Rie subscales were also moderately inter-correlated with the Berger subscales (r = 0.44 to 0.76), had similar construct validity, and tended to have higher mean stigma scores when compared with Berger subscales that were conceptually most similar. The revised Van Rie HIV-related Stigma Scale demonstrates good validity and internal consistency, offering a valid measure of HIV stigma with a three-factor structure. The third-person wording may be particularly suitable for measuring stigmatizing attitudes during an individual’s transition from at-risk and undergoing HIV testing to newly diagnosed, a time when experiences of discrimination and processing issues of disclosure have not yet occurred. The stigma mechanisms for individuals making this transition have not been well explored. These scenarios, combined with the observed non-response to the Berger Enacted Stigma subscale items (a surprise finding), highlight gaps in our understanding of HIV stigma and how best to measure it.     

United Nations system efforts to support the response to AIDS in China

In the last two years, we have seen a remarkable intensification in the response to AIDS in China. A number of organizations have joined and contributed to the efforts of the Chinese government in responding the AIDS epidemic in China. This article specifically describes the role of the United Nations in supporting and strengthening those responses.Achievements of the United Nations (UN) highlighted in the article include: strengthened leadership and political commitment to respond to AIDS; improved HIV/AIDS surveillance and information; expanded prevention efforts; improved treatment, care and support to people living with HIV and increased resources for AIDS programs. Additional roles of e., one national plan on AIDS; one national coordinating authority for AIDS; and one monitoring and evaluation system for AIDS. In addition, the UN system is expected to strengthen alignment and harmonization of activities of all international organizations and improved accountability and oversight. Remaining challenges identified include increasing awareness of AIDS and reducing stigma and discrimination; reducing vulnerability and risk behaviour among specific groups;providing improved treatment, care and support for people living with HIV; promoting stronger engagement by civil society, and; addressing the gender dimensions of AIDS.     

Potential initiators of HIV-related stigmatization: ethical and programmatic challenges for PMTCT programs

HIV/AIDS continues to constitute a serious threat to the social and physical wellbeing of African mothers and their babies. In the hardest hit countries of sub-Saharan Africa, more than 60% of all new HIV infections are occurring in women, infants and young children.Mother-to-child transmission (MTCT) constitutes 90% of new HIV infections among infants and young children. Most of these infection scan be prevented. However, the social stigma of HIV/AIDS insidiously continues to undermine the success of prevention programs.Ironically, some attributes or characteristics of prevention of mother-to-child transmission (PMTCT) programs may in fact serve as catalysts to the stigmatization process. This paper identifies and discusses six potential initiators: (1) Routine HIV testing, (2) Six months exclusive breastfeeding, (3) Incentives, (4) Home visits, (5) Location of PMTCT program, and (6) PMTCT terminology. In all these areas, there are practical strategies that may be applied to reduce the chances of being stigmatized. These strategies are introduced and discussed.     

Fertility Desires among Men and Women Living with HIV/AIDS in Nairobi Slums: A Mixed Methods Study

Objectives

Fertility desires require new understanding in a context of expanding access to antiretroviral therapy for people living with HIV/AIDS in Sub-Saharan Africa. This paper studies the fertility desires and their rationales, of slum-dwelling Kenyan men and women living with HIV/AIDS who know their serostatus, but have different antiretroviral therapy treatment statuses. It addresses two research questions: How do people living with HIV/AIDS consider their future fertility? What factors contribute to an explanation of fertility desires among people living with HIV/AIDS.

Methods

A mixed methods study (survey [n = 513] and in-depth interviews [n = 41]) with adults living with HIV/AIDS living in Nairobi slums was conducted in 2010. Regression analyses assess independent relationships between fertility desires and socio-demographic factors. Analyses of in-depth interviews are used to interpret the statistical analyses of fertility desires.

Results

Our analyses show that fertility desires are complex and ambivalent, reflecting tensions between familial and societal pressures to have children versus pressures for HIV (re-)infection prevention. More than a third (34%) of men and women living with HIV expressed future fertility desires; however, this is significantly lower than in the general population. Factors independently associated with desiring a child among people living with HIV/AIDS were age, sex, number of surviving children, social support and household wealth of the respondent.

Discussion

Increasing access to ART is changing the context of future childbearing for people living with HIV/AIDS. Prevailing values mean that, for many people living with HIV/AIDS, having children is seen as necessary for a “normal” and healthy adult life. However, the social rewards of childbearing conflict with moral imperatives of HIV prevention, presenting dilemmas about the “proper” reproductive behaviour of people living with HIV/AIDS. The health policy and service delivery implications of these findings are explored.     

The politics of marginalization: The appropriation of AIDS prevention messages among injection drug users

This essay addresses the space between a cultural critique and a class analysis of HIV transmission. It explores how injection drug users, as a disempowered group, resist hegemony through dissent. Distrust of the medical establishment and severe social and legal constraints force injection drug users to reconstruct the AIDS message. Economic and political survival inflates the need for trust and reciprocity within their social network. This makes the meaning of AIDS a continually ambiguous one for drug users. The ways in which dissent to domination is enacted and the effect this has on HIV prevention is explored.IfI'm that fucked up where I'll put a life-threatening drug into myself knowing it's dangerous, I really can't deal with a society that's telling me I deserve it. It takes all my strenght. The moral majority says it's God's way of taking care of these things. I hear too much of that. Drug addicts don't even want to talk about it [AIDS] because of the fear. I talk to people about it and they tune out. I can see their eyes glazing over.-A recovering addict     

The HIV epidemic in China: history, response, and challenge

The first case of AIDS was reported in 1985 in China, but by the early 21st century, the government estimated that there were 840,000 citizens living with HIV/AIDS. The number is increasing rapidly. The major risk groups are injection drug users (IDUSs; 43%) and former plasma donors (27%), but rates among heterosexual groups are rising rapidly.Sentinel surveillance was initiated in 1986, and now includes IDUs, men-who-have-sex-with-men, sexually transmitted disease clinic attendees, antenatal women, long-distance truck drivers, and .sex workers. Although the government was slow to respond to the epidemic in the late 20th century, it has made a vigorous response in the early 21st century.Components of that response include implementation and evaluation of harm reduction programs for IDUs, education to increase knowledge and reduce stigma, treatment and social support for rural and poor HIV/AIDS patients, widespread testing, and increased funding for HIV/AIDS programs. International agencies have been generous in their support of the government initiatives. To successfully combat the epidemic, China needs to develop and train the necessary infrastructure to implement its intervention programs, particularly in the rural areas, to vigorously combat stigma and discrimination, support research especially in the universities and research institutions other than the China Centers for Disease Control, develop a system for efficient exchange of research and program information, and update legislation to reflect the current situation.     

The HIV epidemic in China: history, response, and challenge

INTRODUCTION One-quarter of the world’s population, 1.3 billion people, live in China. The majority of the population is Han Chi- nese (91.9%), while the rest are a mix of different minor- ity groups living primarily in southern and western China [1]. The GDP per capita is $5,600 per year, but at least 10% of the population lives below the poverty line. Just less than 15% of the GDP is in agriculture, with the re- mainder in industry/construction and services. The total health expend…     

The HIV epidemic in China: history, response, and challenge

The first case of AIDS was reported in 1985 in China, but by the early 21st century, the government estimated that there were 840,000 citizens living with HIV/AIDS. The number is increasing rapidly. The major risk groups are injection drug users (IDUSs; 43%) and former plasma donors (27%), but rates among heterosexual groups are rising rapidly. Sentinel surveillance was initiated in 1986, and now includes IDUs, men-who-have-sex-with-men, sexually transmitted disease clinic attendees, antenatal women, long-distance truck drivers, and sex workers. Although the government was slow to respond to the epidemic in the late 20th century, it has made a vigorous response in the early 21st century. Components of that response include implementation and evaluation of harm reduction programs for IDUs, education to increase knowledge and reduce stigma, treatment and social support for rural and poor HIV/AIDS patients, widespread testing, and increased funding for HIV/AIDS programs. International agencies have been generous in their support of the government initiatives. To successfully combat the epidemic, China needs to develop and train the necessary infrastructure to implement its intervention programs, particularly in the rural areas, to vigorously combat stigma and discrimination, support research especially in the universities and research institutions other than the China Centers for Disease Control, develop a system for efficient exchange of research and program information, and update legislation to reflect the current situation.