Stigma and discrimination play significant roles in the development and maintenance of the HIV epidemic. It is well documented that people living with HIV and AIDS experience stigma and discrimination on an ongoing basis. This impact goes beyond individuals infected with HIV to reach broadly into society, both disrupting the functioning of communities and complicating prevention and treatment of HIV. This paper reviews the available scientific literature on HIV/AIDS and stigma in South Africa, as well as press reports on the same subject over a period of 3 years. Analysis of this material indicates that stigma drives HIV out of the public sight, so reducing the pressure for behaviour change. Stigma also introduces a desire not to know one's own status, thus delaying testing and accessing treatment. At an individual level stigma undermines the person's identity and capacity to cope with the disease. Fear of discrimination limits the possibility of disclosure even to potential important sources of support such as family and friends. Finally, stigma impacts on behaviour change as it limits the possibility of using certain safer sexual practices. Behaviour such as wanting to use condoms could be seen as a marker of HIV, leading to rejection and stigma. All interventions need to address stigma as part of their focus. However, the difficulty of the task should not be underestimated, as has been shown by the persistence of discrimination based on factors such as race, gender and sexual orientation.
The HIV epidemic presents challenges including orphans and a large mass of children rendered vulnerable by the epidemic and other societal forces. Focus on orphaned and vulnerable children (OVC) is important, but needs accurate definition. Twelve focus group interviews of service providers, leaders in these communities, OVC and their caretakers were conducted at six project sites across Botswana, South Africa and Zimbabwe to extend this definition. The loss of a parent through death or desertion is an important aspect of vulnerability. Additional factors leading to vulnerability included severe chronic illness of a parent or caregiver, poverty, hunger, lack of access to services, inadequate clothing or shelter, overcrowding, deficient caretakers, and factors specific to the child, including disability, direct experience of physical or sexual violence, or severe chronic illness. Important questions raised in this research include the long-term implications for the child and community, and the contribution of culture systems.
South Africa is in the midst of a devastating HIV-AIDS epidemic and most new HIV infections occur among young adults and adolescents. The current study examined risk behaviors and HIV risk factors among young people living in a Black South African township. Using community-based outreach methods of street intercept and facility-based surveying, 113 men and 115 women age 25 and younger responded to an anonymous survey. Results showed that men (68%) and women (56%) reported HIV-related high risk sexual behaviors. Although knowledge about HIV transmission was generally high, there was evidence that misconceptions about AIDS persist, particularly myths related to HIV transmission. For young men, HIV risk factors were associated with fewer years of education, lower levels of AIDS-related knowledge, condom attitudes, and Dagga (marijuana) use. Among young women, HIV risk factors were associated with beliefs that condoms get in the way of sex and rates of unprotected vaginal intercourse. Despite adequate general AIDS knowledge and risk sensitization, South African youth demonstrated high rates of sexual practices that place them at risk for HIV infection. There is an urgent need for behavioral interventions targeted to young South Africans living in the most economically disadvantaged areas.
The article explores the idea of therapeutic citizenship in relation to the experiences of men who attend support groups for people living with HIV or AIDS (PLHIV). At a rural South African health facility offering free antiretroviral (ARV) medicines, support groups aim to empower HIV-positive clients through knowledge and skills that enable them to adhere to their ARV regimen. Members are exhorted to abandon their 'traditional' health and gender beliefs in favour of a biomedical understanding and approach to health; to embrace participation in a support group for PLHIV; and to actively challenge HIV stigma through the public disclosure of their HIV-test result. Fourteen months of ethnographic fieldwork conducted in Bushbuckridge, Mpumalanga Province, South Africa, investigated how men negotiated these efforts - normally characterised in the academic literature as 'therapeutic citizenship' - in relation to men's socio-cultural definitions of masculinity. The findings reveal that most of the men gained the knowledge and skills necessary to adhere to treatment. Although they generally behaved in a disciplined way, they remained doubtful about their commitment to the particular kind of 'HIV identity' that a support group conferred on them. Men who embrace this identity must abandon their previous masculine lifestyles and conform to the support group's messages concerning what it means to be a 'responsible' HIV patient. The research documents some of the challenges men experience in negotiating these conflicting demands. The discussion draws on personal accounts by the participants to illustrate the ambivalence of men towards their 'HIV identity' and to belonging to a support group.
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