Comparing HIV-related symbolic stigma in six African countries: Social representations in young people’s narratives

Abstract

HIV-related symbolic stigma arises from moralistic value judgements attached to people living with HIV and has negative consequences from both public health and human rights perspectives. Relatively little is known about cross-national variation in symbolic stigma. With the purpose of informing stigma reduction efforts within and across settings, we compared social representations of HIV in six African countries with estimated adult HIV prevalence rates ranging from 1 to 33%. Our study used a unique data source, namely a stratified random sample (n=586, ~5%) from 11,354 creative ideas contributed from six countries to a continent-wide HIV-related scriptwriting contest held between February and April2005. The narratives were written by equal numbers of males and females aged 10–24 in urban and rural areas of Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso and Senegal. We combined three analytical approaches: descriptive statistics on certain quantifiable characteristics of the narratives, thematic data analysis, and a narrative-based approach. The association of HIV with outsiders (“othering”)and preoccupation with the circumstances of infection are more common in lower prevalence countries but vary substantially in tone depending on the sociocultural context. The highest proportion both of moralising narratives and of narratives with pessimistic outcomes come from South-East Nigeria and, to a lesser extent, from Kenya, countries with prevalence levels of 3.9 and 6.1% respectively, in which evangelical Christian movements, including Pentecostalism, have sizeable followings. The data provide a rare cross-cultural overview of symbolic stigma, identify country-specific needs, and point to strategies for future programming. Social representations from the highest prevalence countries, Swaziland and Namibia, and from lower prevalence Burkina Faso offer potential models for the framing of HIV in ways that serve to increase social proximity and counteract symbolic stigma.

Disclosure in times of ART: A relational analysis of social practices

“…Motivations for testing have also changed as the chance to benefit from early treatment has transformed HIV into a chronic but manageable disease. Stigma has been slightly reduced, though this largely depends on the social context as well as regional HIV prevalence levels (Winskell, Hill & Obyerodhyambo 2011). People who disclose may more easily receive support from PLWHA organizations and support groups when facing adverse reactions from their families, since such organizations now operate all over Africa.…”

Le conseil post-test encourage-t-il les PVVIH à partager leur statut sérologique? Pratiques et suggestions des conseillers au Burkina Faso Does post-test counseling support PLHIV in disclosing their HIV status? Practices and propositions by counselors in Burkina Faso

“…La littérature montre que les principaux motifs de non partage du résultat demeurent la peur de la stigmatisation par l'entourage (Deribe, Woldemichael, Bernard & Yacob 2009;Ssali, Atuyambe, Tumwine, Segujja, Nekesa, Nannungi, et al 2010). Au Burkina Faso, la stigmatisation attestée dès le début de l'épidémie s'est amendée au cours des années 2000, sans toutefois disparaître (étude ONUSIDA) (Winskell, Hill & Obyerodhyambo 2011). Un ensemble d'enquêtes récent montre que les femmes notamment mettent en place des stratégies complexes pour gérer le partage du statut VIH en évitant les effets de la stigmatisation (Desclaux, Msellati & Sow 2011 Pour ce qui concerne le partage du statut sérologique par les femmes dépistées dans le cadre de la PTME, une étude réalisée à Abidjan a montré qu'il a lieu préférentiellement à des moments clé (fin de la grossesse, reprise des relations sexuelles, sevrage), ce qui souligne l'importance d'un conseil à ces périodes, et qu'il peut être une occasion très importante de parler de santé sexuelle, de planification familiale et de santé de la reproduction (Desgrées du Loû 2011).…”

Sexual stigma and symbolic violence experienced, enacted, and counteracted in young Africans’ writing about same-sex attraction

“…Notwithstanding Parker and Aggleton (2003), symbolic dimensions of stigma e including, for example, the ideologies, images, and narratives that undergird the negative framing of minority populations (Feagin and Bennefield, 2014) e have to date received relatively limited attention by stigma scholars working within the field of sexual health. This may be due, in part, to the fact that these dimensions are routinely subsumed within definitions of structural stigma under the rubric "cultural norms"; the term "symbolic stigma", meanwhile, is used in stigma theory to denote a different phenomenon (Winskell et al, 2011). In this paper, we accord particular attention to heterosexist symbolic violence, not least because we believe it is potentially amenable to influence through communication efforts.…”