Stigma rises despite antiretroviral roll-out: A longitudinal analysis in South Africa

Abstract

a b s t r a c tStigma is a recognised problem for effective prevention, treatment, and care of HIV/AIDS. However, few studies have measured changes in the magnitude and character of stigma over time. This paper provides the first quantitative evaluation in Africa of the changing nature of stigma and the potential determinants of these changes. More specifically, it evaluates the dynamic relationship between stigma and (1) increased personal contact with people living with HIV/AIDS and (2) knowing people who died of AIDS. Panel survey data collected in Cape town 2003 and 2006 for 1074 young adults aged 14-22 years were used to evaluate changes in three distinct dimensions of stigma: behavioural intentions towards people living with HIV/AIDS; instrumental stigma; and symbolic stigma. Individual fixed effects regression models are used to evaluate factors that influence stigma over time. Each dimension of stigma increased in the population as a whole, and for all racial and gender sub-groups. Symbolic stigma increased the most, followed by instrumental stigma, while negative behavioural intentions showed a modest increase. Knowing someone who died of AIDS was significantly associated with an increase in instrumental stigma and symbolic stigma, while increased personal contact with people living with HIV/AIDS was not significantly associated with any changes in stigma. Despite interventions, such as public-sector provision of antiretroviral treatment (which some hoped would have reduced stigma), stigma increased among a sample highly targeted with HIV-prevention messages. These findings emphasise that changes in stigma are difficult to predict and thus important to monitor. They also indicate the imperative for renewed efforts to reduce stigma, perhaps through interventions to weaken the association between HIV/AIDS and death, to reduce fear of HIV/AIDS, and to recast HIV as a chronic manageable disease.

Patient and Provider Perspectives on HIV and HIV-Related Stigma in Dutch Health Care Settings

“…This is reflective of what is termed instrumental stigma. 59 Thus, the issue does not appear primarily to be prejudice; the issue appears to be a disproportionate fear of infection, and indeed, in our study, health care providers showed a kind of ambivalence. On the one hand, they wanted to provide good care to patients.…”

“…58 In fact, most of the health care providers in our study did not express explicit negative attitudes about PLWH with accompanying moral judgments-something termed symbolic stigma. 59 Instead, most reported a fear of potential occupational infection resulting in the application of differential precautions and labeling of files. This is reflective of what is termed instrumental stigma.…”

It's hard work, but it's worth it: the task of keeping children adherent to isoniazid preventive therapy

“…Stigma, particularly HIV-related stigma, has been extremely resistant to interventions, including the impact of the roll-out of antiretrovirals and large public education programmes, with at least some evidence to suggest that stigma may be increasing in the Western Cape. 25 IPT is being distributed to those who are interested, but all three clinics identifi ed problems, particularly around staffi ng. As staff numbers are reduced, waiting times increase and staff unfamiliar with the patients may distribute the IPT, breaking down important interpersonal connections.…”

Application of brain multi-b-value diffusion-weighted imaging (DWI) in adolescent orphans from AIDS families

“…3 Living in a unique social environment, orphans with AIDS endure double pressure of disease and family and therefore are a vulnerable group. HIV-positive adolescent orphans mentioned in this article were born with HIV.…”