HIV stigma is a social construction founded on a mixture of myths, misinformation, fear and ignorance, as well as some real life experiences of the disease. In spite of the bio-medical and social work that has been done to fight HIV, stigma and discrimination remain like two towers blocking progress to effectively respond to the epidemic. The fight against HIV will not be won on the medical front if the social phenomena that propagate the disease are not addressed.
In Africa, a continent where HIV is predominantly transmitted through heterosexual sex, being HIV positive is seen as a sign of promiscuity. Being infected is seen as a curse and in such a context naturally carries shame with it.
Lack of access to antiretroviral (ARV) drugs and other therapies that prolong life for people living with HIV (PLHIV) has only worsened levels of stigma within society. HIV is perceived as a death sentence. Many people are afraid of the disease, and they turn their fear into disdain and discrimination of anything associated with HIV, including people living with the disease.
In many instances, people who are open about their status are poor and impoverished. This has a major impact on the negative perception of PLHIV, who are stigmatised not only for carrying the virus but also for their poverty. As a result, most prefer silence.
People's experiential knowledge of HIV in Africa often consists of the pain that they have seen their loved ones experience as they die of the disease, and this undoubtedly influences their attitude. Many people prefer to live without knowing their HIV status. The majority of infected people in Africa do not live with HIV — instead, they die of the disease, intensifying the belief that to have HIV equals death. The conspiracy of silence surrounding the disease is so entrenched and pervasive that burials often happen without a single mention of the disease.
Due to the nature of the illness, people with AIDS may need a great deal of intensive care and support. If these people are to receive the expert and compassionate care that they undoubtedly deserve, one paramount issue that has to be addressed is that of stigmatization and coping behaviors among health care workers. When caring for the chronically ill, unprejudiced, sympathetic and comprehensive care is essential as it helps maintain psychological health, and prevents pain and suffering.
In most African countries, the health care infrastructure has inadequate facilities, inadequate manpower and poor logistics such as drug supplies and other equipment. Low quality of services has further worsened the levels of stigma within society. High levels of poverty also prevent the infected and affected from accessing services. In many local settings throughout Africa, HIV is frequently still equated with hopelessness and death.
Such perceptions of HIV have fuelled prejudice towards people living with the virus. Where there is stigma against PLHIV, they retreat, driven by both internal and external stigma. As a result, millions of people living with HIV are at risk of infecting their partners because stigma forces them to choose silence.
Stigma discourages infected and affected people, and their partners and families, from seeking counselling and other services that may prolong their lives.
According to UNAIDS executive director Dr Peter Piot, "It is unfortunate that we are still hampered by our old enemy: stigma. Eliminating stigma must be central. It is about breaking silence, and breaking silence means breaking secrecy, not confidentiality, about AIDS." Breaking the culture of secrecy about HIV is essential in combating stigma. An intensive and appropriate communication campaign could go a long way to reducing stigma in Africa.
The media is central to such an initiative. Such a programme would have to utilise all the channels available to encourage a positive change in the perception of HIV. Otherwise, HIV stigma will remain the biggest hidden killer in African today.
Until people in Africa accept and tackle HIV just like any other disease, they will continue to be reduced in numbers like animals drinking from a poisoned well.