Trends and Levels of HIV/AIDS-Related Stigma and Discriminatory Attitudes: Insights from Botswana AIDS Impact Surveys

Abstract

For a very long time now, people living HIV and AIDS have been stigmatized and discriminated against and these negative attitudes have been observed to deter people from seeking health care services such as participating in voluntary counselling and testing and prevention of mother-to-child transmission (Nyblade and Field, 2002). UNAIDS (2007) argued that in many countries and communities, the stigma associated with HIV and the resulting discrimination can be as devastating as the illness itself: abandonment by spouse and/or family, social ostracism, job and property loss, school expulsion, denial of medical services, lack of care and support, and violence. It found that these consequences, or fear of them, mean that people are less likely to come in for HIV testing, disclose their HIV status to others, adopt HIV preventive behaviour, or access treatment, care and support. If they do, they could lose everything. Previous research (for example, Alonzo and Reynolds, 1995) has found that HIV-related stigma originates from several sources. First, HIV and AIDS are associated with the deviant behaviour that is suspected to have caused the HIV-positive status. Second, that the individual was irresponsible to have contracted HIV. Third, that it is the individual’s immoral behaviour that caused HIV and AIDS. Finally, that HIV and AIDS are contagious and threatening to the community. One of the major challenges for studying HIV/AIDS-related stigma discrimination is how to best measure the concept of “stigma”. At the moment, as USAID (2006) rightly stated: “...measures that can both describe an existing environment, and evaluate and compare interventions, are lacking” (p.2). A wide range of questions are used to measure stigma. There is a need to correctly measure stigma for a variety of reasons. USAID (2006) has summarized why there is a need to measure stigma and the reasons are summarized below. One such reason is the fact that anti-stigma interventions that have been designed and implemented need to be evaluated to determine if the intervention is effective or not. Another equally important reason for measuring stigma is to identify effective models and take them to scale. Measurement of stigma allows researchers to test the hypothesis that stigma would decline if antiretroviral drugs were more widely available. These are some of the reasons for developing a tested and validated measure of stigma.