HIV This Week

Abdool Karim Q, Meyeer-Weitz A, Mboyi L, Carrara H, Mahlase G, Frohlich JA, & Abdool Karim SS. The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal. South Africa Global Public Health . 2008; 3(4):351 - 365.

This study aims to understand the influence of AIDS stigma and discrimination, and social cohesion to HIV testing, and willingness to disclose an HIV status. A cross-sectional, interviewer administered survey ( N= 594) was conducted. Independent sample t -tests explored the mean differences between sex and age groups on stigma, discrimination, and social cohesion measurement. Logistic regression models were fitted with the above independent variables, and the binominal dependent variables: having had a test, willingness to have a test and disclose a positive status. The mean age of participants was 25.3 years and 60% were women. Only 28% had an HIV test, 63% were willing to have a test, and 82% reported a willingness to disclose an HIV status. High levels of stigma and discrimination were anticipated from the community, less so from their partners, and very little from families. Low levels of social distance exist towards people with HIV, membership to social networks seems limited, and inadequate social support for people with HIV was reported. The analysis indicates that AIDS stigma and discrimination, and inadequate social cohesion, limit access to voluntary counselling and testing, inhibit disclosure, and are, thus, barriers to care, support and prevention. Interventions need to extend the focus on information and education to strengthen social capital within a participatory and sustainable development framework.

Editors’ note: If they were to test HIV-positive, over 85% of respondents in this rural household survey anticipated support and compassion from their families but thought the community would gossip about them (86%), assume they have been unfaithful (84%), judge them as promiscuous (83%) or not pray for them (63%). Strong family cohesion could be a platform from which to extend and strengthen other forms of social capital, such as social cohesion, trust, and networks in the community to facilitate social support for people living with HIV and confront AIDS stigma. Without broad-based community mobilisation to address stigma and discrimination in this and similar settings, HIV testing uptake will remain low and uptake of antiretroviral treatment limited, despite beliefs that families will care and love their members who are found to be HIV-positive.