People Living With HIV and AIDS on the Brink: Stigma—A Complex Sociocultural Impediment in the Fight Against HIV and AIDS in Botswana

Abstract

HIV-related stigma is a life-altering phenomenon. The consequence of the stigmatization process sets apart stigmatized person(s) as a distinct category, leading to various forms of disapproval, rejection, exclusion, labeling, stereotyping, and discrimination. Stigma of HIV-positive people in Botswana is a complex social phenomenon associated with the disease itself and the behaviors that lead to infection. This is a synthesis paper based on the literature review on HIV- and AIDS-related stigmatization of HIV-positive people in Botswana and in-depth interviews with people living with HIV and AIDS (PLWHAs). I examine the literature on HIV- and AIDS-related stigmatization and subsequent discrimination and the implications for intervention programs for people living with HIV and AIDS. The findings from the literature and in-depth interviews show that HIV-AIDS-related stigma is deeply embedded in societal structures and culture which promote nonacceptance of those branded HIV positive. This often is reinforced at a practical level by pervasive negative attitudes toward PLWHAs. Recommendations argue for the adoption of Healthy Relationship. This intervention seeks to promote and strengthen decision-making skills among PLWHAs and programs that promote destigmatization of, and tolerant attitudes toward, PLWHAs.

Where Will This Illness Take Me? Reactions to HIV Diagnosis From Women Living With HIV in Kenya

“…Other studies echo similar findings that fear of stigma can drive people away from knowing their HIV status (Meiberg, Bos, Onya, & Schaalma, 2008;Nthomang et al, 2009), limiting HIV prevention (Ikorok & Akpabio, 2007;UNAIDS/WHO, 2008). Citing widespread stigma against people with AIDS, women in this study were strategic about to whom they disclosed their HIVpositive status.…”

“…Identifying women's reactions to HIV diagnosis offers an opportunity to ward off self-stigma (Maman et al, 2009). Stigma can tremendously increase the psychological burden of HIV illness and lead to non adherence to HIV treatment, loss to follow-up, and unnecessary early death (Medley, Kennedy, Lunyolo, & Sweat, 2009;Nthomang et al, 2009). Personal experiences from the lives of women can be beneficial to health care providers as they offer guidance in pre-and post-HIV testing, including subsequent HIV treatment and follow-up.…”

“I did not know about all these”: Perceptions regarding safer conception methods by women living with HIV in Gaborone, Botswana

“…Although Botswana has a long-standing HIV care program and has offered ART for over 15 years, women in this study described internalized stigma and anticipated stigma and discrimination from healthcare providers as challenges to greater SC uptake. Previous studies in Botswana have reported that stigma impacts HIV testing, disclosure, ART uptake, and adherence [47][48][49][50][51]. The desire for childbearing can create a conflict for WLHIV who wish to fulfill personal desires for children and cultural expectations of motherhood but also face strongly perceived community and provider disapproval associated with HIV and reproduction [40,[52][53][54].…”

Psychometric assessment of HIV stigma in patients attending a tertiary facility: An initial validation of the Berger HIV stigma scale in a Ghanaian perspective

“…Ghana missed the target of the UNAIDS agenda 90-90-90 and many health workers have come to understand and believe that unless programmes are implemented to begin to address HIV-related stigma as well as treatment and management, overcoming the disease will be unsurmountable [ 10 – 12 ]. HIV stigma is considered as a social phenomenon, based on the categorisation and stereotyping of PLWHIV, influencing loss of status and discrimination [ 13 , 14 ]. HIV related stigma is socially shared knowledge about the devalued status of PLWHIV [ 15 ].…”