HIV Stigma and Moral Judgement: Qualitative Exploration of the Experiences of HIV Stigma and Discrimination among Married Men Living with HIV in Yogyakarta

Abstract

It is well acknowledged that human immunodeficiency virus stigma (HIV stigma) challenges people living with HIV globally. There is a scarcity of information about determinants of HIV stigma and discrimination among married men in the Indonesian context. This study aimed to explore factors that contribute to stigma and discrimination against HIV-positive men married to women in Yogyakarta, Indonesia. Face-to-face in-depth interviews were conducted to collect data from participants using a snowball sampling technique. A framework analysis was used to guide the analysis of the data. HIV stigma framework was also applied in the conceptualisation and the discussion of the findings. The findings indicate that participants experienced external stigma within healthcare facilities, communities and families. This external stigma was expressed in various discriminatory attitudes and behaviours by healthcare professionals and community and family members. Similarly, participants experienced anticipated stigma as a result of HIV stigma and discrimination experienced by other people living with HIV. Individual moral judgement associating HIV status with amoral behaviours and participants’ negative self-judgement were determinants of perceived stigma. The current findings indicate the need for training programs about HIV stigma issues for healthcare professionals. There is also a need to disseminate HIV information and to improve HIV stigma knowledge among families and communities.

HIV and stigma in the healthcare setting

“…Stigma and prejudice are considered essentially as “one animal” with stigma focusing on targets and concerned with individual‐level characteristics and prejudice focusing on processes for perpetrators, individual discriminatory actions and group‐level characteristics (Phelan, Link, & Dovidio, 2008). Some moral values can result in discrimination/prejudice (Yang et al, 2007; Killen & Cooley, 2014), and PLHIV's own moral judgement can result in internalised HIV stigma (Mahamboro et al., 2020). HIV‐related stigma interacts with structural inequities and may be exacerbated for populations marginalised due to their risk behaviours (e.g.…”

Getting Indonesia’s HIV epidemic to zero? One size does not fit all

“…Where trust may have been built between a patient and staff at the time of HIV diagnosis, patients then face significant barriers when required to receive treatment elsewhere, in services and environments unaccustomed to managing key populations living with HIV and where higher levels of stigma may exist. 17–20 Some NGO services have developed ART delivery schemes as satellites of government facilities to deliver comprehensive HIV/STI and same-day-start services that attract key populations. However, there can still be challenging transport and stock control issues.…”

“…Stigma is arguably the greatest barrier to ending AIDS in Indonesia. 6,9–13,15–20,22–25,27,28,36,40,41 The gap between HIV diagnosis and engaging in HIV treatment in Indonesia is stark. In a UNAIDS population-based survey 2011–2016, that asked members of the general population in Indonesia, aged between 15–49 years, if they would purchase vegetables from a shopkeeper living with HIV, well over two-thirds of the population answered “no”.…”

Peningkatan Pengetahuan Remaja Mengenai Narkoba, Seks Bebas, dan HIV Menggunakan Kerangka Kerja Theory Of Planned Behavior

“…Kedua perilaku tersebut, penggunaan narkoba dan perilaku seks bebas, beresiko untuk menularkan HIV. Penyakit yang masih dianggap sebagai sebuah aib tersebut, termasuk di Indonesia, masih dianggap sebagai ganjaran dari perbuatan amoral yang telah dilakukan penderita (Irmayati et al, 2019;Mahamboro et al, 2020;Shaluhiyah et al, 2014). Akibatnya komunitas urban, tidak terkecuali masyarakat kota Surabaya yang menganut nilai Jawa dengan kolektivitasnya, mengambil sikap dengan 'mengucilkan' penderita.…”