Sunday, January 31, 2016

'The Mercurial Piece of the Puzzle': Understanding Stigma & HIV/AIDS in South Africa

Although stigma and its relationship to health and disease is not a new phenomenon, it has not been a major feature in the public discourse until the emergence of HIV. The range of negative responses associated with the epidemic placed stigma on the public agenda and drew attention to its complexity as a phenomenon and concept worthy of further investigation. Despite the consensus that stigma is one of the major contributors to the rapid spread of HIV and the frequent use of the term in the media and among people in the street, the exact meaning of 'stigma' remains ambiguous. The aim of this paper is to briefly re-visit some of the scholarly deliberations and further interrogate their relevance in explaining HIV-related stigma evidenced in South Africa. In conclusion a model is presented. Its usefulness - or explanatory potential - is that it attempts to provide a comprehensive framework that offers insights into the individual as well as the social/structural components of HIV-related stigma in a particular context. As such, it has the potential to provide more nuanced understandings as well as to alert us to knowledge-gaps in the process.

...Given the negative effects of the ‘third epidemic’, scientists and activists have put a vast amount of effort into reducing its impact and educating the public that ‘stigma’ and discrimination are socially objectionable (Sengupta, Banks, Jonas, Miles & Smith 2011; Steinberg 2008). Anti-discriminatory legislation was put in place to protect the rights of PLWHA and ‘anti-stigma’ educational campaigns mounted – putting ‘stigma’ as a concept on the public agenda. The educational initiatives introduced ‘stigma’ into the public's discourse and emphasised its offensiveness and undesirability. The end result today is that most people are aware of the negative attributes of the concept and its social unacceptability, and therefore – I would venture to suggest – there has been a reported decrease in ‘stigma’, particularly as evidenced by results from nationwide surveys (Shisana, Rehle, Simbayi, Zuma, Jooste, Pillay-van-Wyk, et al2009). However, as pointed out in this article, the reality on the ground is that despite the introduction of ART, stigma continues unabated, and is often disguised in different, more elusive forms (Abrahams & Jewkes 2012; Naidoo, Uys, Greeff, Holzemer, Makoae, Dlamini, et al2007). Further evidence to substantiate the on-going existence of stigma is provided in the latest Gap Report (UNAIDS 2014).

There is no dispute that growing awareness that it is unacceptable to discriminate against people with HIV is an important step forward, but it is not quite the same thing as a real reduction in stigmatising attitudes and behaviours. For these reasons, 12 years later I concur with Stein (2003), who argued that HIV stigma has not in fact diminished but has, rather, become another ‘dirty secret’. This further problematises its ‘measurement’ and raises the question about ‘how to measure a hidden truth?’...

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By:  Gilbert L1.
  • 1 PhD, is Emeritus Professor of Health Sociology at the Department of Sociology , University of the Witwatersrand , Johannesburg , South Africa.
  •  2016 Dec;13(1):8-16. doi: 10.1080/17290376.2015.1130644. 

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