http://www.globalhealth.org/reports/report.php3?id=258&type=newsletter
Field Note

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Stigma: A Complex Phenomenon in HIV/AIDS Prevention and Care

By Comfort J. Mokgothu
USA

While stigma is not easily understood nor readily addressed in our
society, it is however, not new to us, nor is it unique to HIV/AIDS.
We have always had prejudice and discrimination against people who are
ill or perceived to be ill. For example, leprosy was viewed as divine
punishment for moral misconduct in earlier centuries when people were
forcibly excluded from both civil and religious society. A person with
stigma is considered somewhat less human and undesired in the eyes of
society. This complex phenomenon, founded on fear and misinformation,
is associated with HIV/AIDS because the disease is life threatening
and we are afraid of contracting HIV, which again is associated with
behaviors that are considered deviant.

Stigma's enduring profile across time, cultures and circumstances and
our collective inability as a nation, to more adequately confront
stigmatization in relation to HIV/AIDS, has adversely affected the
fight against the AIDS pandemic. We have observed how individuals
within society known or suspected of being infected with HIV suffer
exclusion, isolation and even expulsion from work. This has resulted
in patients feeling ambivalent about seeking medical care since it
would involve disclosing their condition. Therefore, it is very
essential for our health-care providers and AIDS counselors to be
supportive of patients dealing with the burden of stigma. Clients are
more likely to seek follow-through with HIV testing services that they
perceive as nonthreatening, nonjudgmental and most of all responsive
to their needs and circumstances.

Our health-care providers in hospitals and clinics must be inviting,
and have people who model behavior in this area. Demonstrating respect
for confidentiality and providing care for patients with various
cultural backgrounds and beliefs in our health institutions can help
confront the negative HIV/AIDS stigma in our society. To underestimate
the insidious power of stigma is risking the very success of effective
HIV prevention and care interventions.

People who are not tested in a timely manner because they have
previously experienced or fear that they might come to experience
judgmental attitudes from health-care providers, should be viewed as a
tangible example of stigma's impact on our ability to effectively
treat HIV/AIDS, hence there is no treatment without diagnosis.

Stigma is deep rooted in the intricate domains of ethnicity, culture,
sexuality and gender. It is not easily understood nor readily
addressed. However, we must continue to be vigilant in ensuring that
our HIV interventions and programs are not inadvertently stigmatizing
to the groups for whom they are intended. We need to educate our
people, young and old, about how HIV is and is not transmitted, to
curb stigma, which usually flourish in an environment of ignorance and
half-truths.