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In Africa stigma lives off silence
Masimba Biriwasha
November 30, 2006
http://www.healthdev.org/kc/
This article is extracted from Unveiling the truth: Shedding
light on HIV stigma and discrimination, a collection of essays and
reports written during the XVI International AIDS Conference in Toronto,
August 2006. The full report is available at: www.hdnet.org
"Millions of people living with HIV are at risk of infecting
their partners because stigma forces them to choose silence."
"HIV is just like
any other disease and until people accept and tackle it, we will continue
to be reduced in numbers like animals drinking from a poisoned well"
– Sazini Ndlovu, a sex worker and member of the Hwange AIDS Project,
The Daily News [Zimbabwe], 15 August 2001
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.
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 stigmatisation and coping behaviours 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.
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