Perceived, anticipated and experienced stigma: exploring manifestations and implications for young people’s sexual and reproductive health and access to care in North-Western Tanzania

Abstract

Young people - particularly girls and young women in sub-Saharan Africa - face significant challenges accessing sexual and reproductive health information and services. These challenges are shaped in part by sociocultural factors, including stigma. This paper presents findings from a qualitative study that explored the micro-level social process of stigma surrounding young people's sexual and reproductive health in two communities in Tanzania. Respondents described an environment of pervasive stigma surrounding the sexual and reproductive health of unmarried young people. Stigma manifested itself in multiple forms, ranging from verbal harassment and social isolation to physical punishment by families, community members, peers and healthcare providers. Respondents perceived that stigma was a barrier to young people accessing sexual and reproductive health services and identified excessive questioning, scolding and requirements to bring sexual partners or parents to receive services at health facilities as obstacles to accessing care. The pervasiveness and complexities of stigma surrounding young people's sexual and reproductive health in the two study communities and its potential consequences for health suggest both a need for care in using the term stigma as well as further studies on the feasibility of incorporating stigma-reduction strategies into young people's sexual and reproductive health programmes.

Exploring associations between adolescent sexual and reproductive health stigma and HIV testing awareness and uptake among urban refugee and displaced youth in Kampala, Uganda

“…For instance, in a study by Nyblade et al in Tanzania, pervasive stigma experienced by unmarried young people was a barrier to accessing SRH services. 24 Hall et al developed a stigma scale that considers the effect of social, cultural, and religious norms associated with young women's utilisation of SRH services in Ghana. 25 Their Adolescent SRH Stigma Scale focuses on adolescent sexual activity, pregnancy, abortion, and contraceptive use and associated negative community norms, values, and beliefs (stigmatising lay attitudes); mistreatment and discrimination (enacted stigma); and feelings of shame and blame (internalised stigma).…”

Facilitators and Barriers to Linkage to HIV Care and Treatment among Female Sex Workers in a Community-based HIV Prevention Intervention in Tanzania: a qualitative study

“…There is also a need for community sensitisation that highlight the importance of support systems for people living with HIV, to enhance acceptance of those who are diagnosed with HIV (26). It is known that healthcare providers’ stigma towards people living with HIV can be a reflection of the broader negative social norms embedded in the community (27). Thus, addressing the drivers of HIV stigma especially attitudes towards people living with HIV and a lack of awareness on what constitutes stigma is critical to increasing linkages to HIV care.…”

“…These findings point to the need for communicating thorough information to FSWs on what to expect when they visit the clinic, including whom they will see and when, and if possible the average time they should expect to spend at the clinic for each visit and their rationale (31). Besides, scepticism regarding the location of the clinic-space and the hours of operation shows the pervasive nature of anticipated stigma, especially the expectation that when other people see them will gossip, point fingers, or discriminate them (27). The findings further point to the potential for initiation of pre-ART outreach services through FSWs’ existing networks.…”

Negotiating social norms, the legacy of vertical health initiatives and contradicting health policies: a qualitative study of health professionals’ perceptions and attitudes of providing adolescent sexual and reproductive health care in Arusha and Kilimanjaro region, Tanzania

“…Unmarried women accessing sexual and reproductive health services are particularly vulnerable to stigma [1]. Research from Tanzania suggests pervasive community-level stigma surrounding the sexual and reproductive health of unmarried adolescents, prompting shame, social and physical isolation, verbal harassment and physical punishment [27]. The stigmatization of adolescents by health care professionals and in communities has been found to significantly impact their access to sexual and reproductive health services in low-and middle-income countries.…”