HIV This Week

Dlamini PS, Kohi TW, Uys LR, Phetlhu RD, Chirwa ML, Naidoo JR, Holzemer WL, Greeff M, Makoae LN. Verbal and physical abuse and neglect as manifestations of HIV/AIDS stigma in five African countries. Public Health Nurs 2007;24:389-99.

Dlamini and colleagues aimed to explore the experience of HIV-related stigma for people living with HIV in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. The authors conducted a descriptive study using 43 focus groups (n=251 participants), which included male and female people living with HIV from both rural and urban areas and nurses working with people living with HIV. Participants were asked to relate incidents of HIV-related stigma that they had experienced or observed. Focus group discussions were taped, and data were content analyzed to identify examples of abuse (verbal and physical abuse and neglect) related to HIV stigma. Data analysis also explored targets of abuse, abusers, and consequences of abuse. Participant reports documented extensive verbal and physical abuse and neglect or negating ( disallowing of access to services and opportunities) experienced by people living with HIV and observed by nurses caring for them, and identified negative consequences experienced by people living with HIV whose HIV-positive status was disclosed to family, friends, or community members. The authors conclude that health care workers who encourage people living with HIV to disclose their HIV status must carefully consider the implications of encouraging disclosure in an environment with high levels of stigma, and must recognize the real possibility that persons living with HIV may experience serious verbal and physical abuse as a consequence of disclosure.

Editors’ note: In this five-country study, verbal abuse was common but physical abuse less so. The authors anticipate that, in contrast to the high HIV prevalence communities in which this study was conducted where many individuals, families, and health workers have already been confronted with their own feelings about HIV, there would be a higher incidence of abuse in communities where AIDS is less common. Neglect, including by health care workers, was also reported. Governments need to firmly address the problem of abuse, by explicit polices backed up by a system for monitoring their implementation and effects.

HIV continues to constitute a serious threat to the social and physical wellbeing of African mothers and their babies. In the hardest hit countries of sub-Saharan Africa, more than 60% of all new HIV infections are occurring in women, infants and young children. Mother-to-child transmission constitutes 90% of new HIV infections among infants and young children. Most of these infections can be prevented. However, the social stigma of HIV insidiously continues to undermine the success of prevention programmes. Ironically, some attributes or characteristics of prevention of mother-to-child transmission (PMTCT) programmes may in fact serve as catalysts to the stigmatization process. This paper identifies and discusses six potential initiators: (1) Routine HIV testing, (2) Six months exclusive breastfeeding, (3) Incentives, (4) Home visits, (5) Location of PMTCT program, and (6) PMTCT terminology. In all these areas, there are practical strategies that may be applied to reduce the chances of being stigmatized. These strategies are introduced and discussed.

Editors’ note: This paper describes a Malawian PMTCT programme that unintentionally discloses its clients’ HIV-positive status, thus compromising its ability to protect their right to privacy and confidentiality and contributing to their stigmatization. Lack of attention to the sociocultural and political tapestry in which women live will lead to similar negative results as PMTCT programmes are scaled up. This paper makes several suggestions on practical ways to better protect confidentiality and increase community acceptance, all of which could lead to increased programme uptake.