EFFECTS OF STIGMATIZATION ON HIV / AIDS PATIENTS

Introduction

1.1 Background Of The Study

The HIV pandemic and its ravaging effects was a great shock to the world at large. It succeeded in making the social stratification among humans expand and this stratification cuts across the entire existence of human race because there is no known reversal or cure for the virus for now.

HIV/AIDS is probably the most stigmatized disease in human history. If we do not appreciate the nature and impact of stigma, none of our interventions can be successful (Cameron, 2007). The pandemic had re-defined and still redefining the structure of the family in several parts of the world, particularly in sub-Saharan Africa. The first two cases of HIV/AIDS in Nigeria were identified in 1985 and were reported at an international AIDS conference in 1986. In 1987, the Nigerian Health Sector set up the National AIDS Advisory Committee, which was shortly followed by the establishment of the National Expert Advisory Committee on AIDS (NEACA) (UNDP, 2009).

The global HIV pandemic continues to grow, with an estimated 35 million infected persons worldwide (UNAIDS, 2013). Globally, it is estimated that nearly half (15.5 million) of people living with HIV. Since the beginning of the epidemic, almost 78 million people have been infected with the HIV virus and about 39 million people have died of HIV. Globally, 35.0 million (33.2− 37.2 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15− 49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide (USAID, 2013).

HIV stigma and discrimination adversely affect every aspect of life for people living with HIV and their families. In many settings, an HIV diagnosis still can be as devastating as the illness itself, leading to job loss, school expulsion, violence, social ostracism, loss of property, and denial of health services and emotional support. People living in fear are less likely to adopt preventive behavior, or come in for testing, disclose their status to others, access care and adhere to treatment.

With the face of the pandemic changing worldwide and the advent of highly active antiretroviral therapy (HAART), HIV has changed from a sub-acute and fatal infection to an important but chronic illness in the developed world (Klein et al. 2003). HAART improves the quality of life and has changed the perspective that persons with HIV have about their life expectancy and their future (Preau et al. 2007). Due to this shift in perspective and these medical advances afforded by HAART, HIV-positive patients have new opportunities, such as the possibility of parenthood and increased life expectancy. These improvements also create the very real possibility of challenges in dealing with out- of-date beliefs held by health care professionals, friends, and family about these patients and their medical prognosis and ability to give birth to a baby who does not have HIV. HIV/AIDS stigmatization may be the most salient of these challenges.

HIV/AIDS stigmatization is defined as the prejudice, discounting, discrediting and discrimination directed at people perceived to have AIDS or HIV, their loved ones and associates and the groups and communities with which they are affiliated (Herek and Capitanio 1998). Stigma is a socially constructed experience, where the stigmatized individual does not feel wholly integrated or accepted into the culture or society (Goffman 1963). Berger et al. (2001) propose that HIV stigma includes both the perception of societal attitudes toward HIV and the personal experience of HIV stigma. Regardless as to whether a person has objectively experienced HIV stigma, the perception of HIV stigma is what appears to be most strongly related to these negative outcomes (Kinsler et al. 2007; Rao et al. 2008; Remien et al. 2006; Riggs et al. 2007). Perceived HIV stigma is related to increase perceived stress (Remien et al. 2006; Riggs et al. 2007). Previous literature on HIV-positive populations has found that perceived HIV stigma from health providers reduces attempts to access health care services, which may significantly impact the health of HIV- positive persons (Kinsler et al. 2007).

Mental health variables may also be relevant to the experience of HIV stigma. HIV-positive patients are at higher risk for depression than HIV-negative individuals, due to the compounding factors of medical illness and social marginalization (Catz et al. 2002). In mixed-gender samples, HIV stigma is associated with decreased self-esteem, lack of self-efficacy, hopelessness, and increased psychological distress (Emlet 2006; Lee et al. 2002; Rao et al. 2008).

Similarly, anxious symptoms could occur because of stressful events such as stigmatization or discrimination (e.g. Au et al. 2004). Psychological distress is also important to assess because it is associated with poor coping, disease progression and quality of life outcomes among HIV-positive patients, and perceived lack of support among HIV-positive individuals (Catz et al. 2002; Emlet 2006; Prachakul et al. 2007; Remien et al. 2006).

Although lack of support from others has previously been measured as a broad construct, little research has examined specific forms of negative judgment that may also be associated with HIV stigma for HIV-positive patients such as experiences of being judged for trying to become pregnant despite HAART’s profound effect on reducing mother-to-child HIV transmission and increasing maternal life expectancy. HIV stigma may be exacerbated by HIV-positive patients’ demographic overrepresentation within socially marginalized groups, such as ethnic minority groups, and persons with low income or lower educational level (Ogilvie et al. 2007; Remis et al., 2006).

Wingood et al. (2007), in a sample of 366 predominantly African- American HIV-positive patients in the USA, found that HIV stigma and acts of discrimination adversely affected the patient’s mental, sexual, and physical health. In a similar sample, Blake et al. (2007) found that HIV-positive patients recalled experiencing shame and humiliation when obtaining health care and from their family and friends when they disclosed their HIV status. Similarly, in a longitudinal study of 29 HIV-positive African-American patients, all participants had experienced HIV stigma (Buseh and Stevens 2006). Buseh and Stevens (2006) noted that stigma partially arose from the treatment HIV- positive patients received from society’s institutions, including lack of regard from staff members in official places like hospitals, welfare offices, and prisons. However, patients who had social support from family members were more resilient to the negative effects of HIV-related stigma.

1.2 Statement Of The Problem

People with HIV are not living full lives and there are very few things that they can do just because they have HIV. Crucially, most people with HIV find that they are not loved, accepted and supported by those close to them.

Public attitudes to the victims of the virus is more pathetic that the virus itself. In most social groups, stigmatization against people with HIV/AIDS is more pronounced than the ever-existing social stratification based on disability, ethnicity, gender or sexuality. Due to the fact that we do not live in a perfect world, people with HIV massively come across stigma, prejudice and discrimination. This can often be the worst part of living with HIV.

Living with HIV now is a very different experience to living with HIV ten or twenty years ago. And living with HIV in the Nigeria is quite different to living with HIV in some other parts of the world, especially developed nations of the world. With the more deadly virus called ‘Ebola’, attention had shifted a bit from HIV/AIDS to this new disease that kills within a month if not taken care of. Yet, the emergence of ‘Ebola’ had not reduced the stigmatization that comes with the virus. It was, however, gathered that during the peak of the Ebola crises in Nigeria, people that were sick and tested in hospital jumped for joy when they heard it was HIV/AIDS they had and not Ebola. This, however, have not reduced the stigmatization that comes with the virus on the patients.

1.3 Research Questions

1. What are the coping strategies employed by people living with HIV/AIDS?
2. What are the various forms of stigmatization that they experience?
3. Is there any correlation between the stigmatization of the patients of HIV/AIDS and their living condition?
4. Has the stigmatization of the patient of HIV/AIDS affected their economic productivity?

1.4 Objectives Of The Study

The main aim is to examine the effect of stigmatization on HIV/AIDS patients in Alimosho Local Government. The objectives, however, are as follow:

1. To examine the coping strategies employed the patients of HIV/AIDS
2. To discover the level of stigmatization HIV patients in Alimosho Local Government encounter
3. To examine if there is a correlation between HIV patients and their living conditions
4. To investigate if the stigma has any effect on their productivity level and;
5. Understand the role of social structures (e.g. family, economic, and cultural institutions) in creating and perpetuating HIV/AIDS related stigmatization.

1.5 Significance Of The Study

Stigma and discrimination towards people with HIV has been associated with negative health problems ranging from increased depressive symptoms to engaging in risky sexual behaviour (Kinsler, Wong, Sayles, Davis & Cunningham, 2007; Sayles et al., 2008; Vanable, Carey, Blair &Littlewood, 2006). Furthermore, experiencing stigma or discrimination in a healthcare setting has been found to adversely affect the health behaviours of people living with HIV such as accessing treatment, seeking testing for HIV or HCV, and adhering to medical regimes (Butt, 2008; Fortenberry et al., 2002; Pascoe & Smart Richman, 2009).

Due to the ongoing impact of stigma and discrimination, it is important that our understanding of these issues is current, and develops alongside changes in the provision of healthcare, in order to provide the best quality care to HIV patients. This report will review the existing evidence on HIV-related stigma and discrimination in the health care sector, with specific emphasis on analyzing the experiences and implications of this for people living with HIV.

The findings of this study will be of immense benefit to the Government and bodies like non-governmental organizations (NGO’s), Human Rights Activists etc. Specifically it will help the government of Nigeria to plan, given that; the problems faced by people living with HIV/AIDS are exposed and adequately addressed. More so, orientation will further be given to the public about the virus and how one could acquire it, as many have some unscientific myths about the virus and those having it. This study will proffer solution to how those living with the virus could be less-stigmatized as the stigma kills faster than the virus itself.

1.6 Definition Of Terms

Stigmatization

The shame or disgrace attached to something regarded as socially unacceptable. There may be a feeling of ‘us and them’. People who are stigmatised are marked out as being different and are blamed for that difference. Fear of this happening can lead to people with HIV being nervous about telling others that they have HIV or avoiding contact with other people. They may end up suffering in silence instead of getting the help they need.

Patient

A person who is receiving medical treatment, especially in a hospital. It could also mean a person who is affected by a disease or ailment.