Academic journal article Journal of Health Population and Nutrition

Prevalence of, and Factors Associated with, HIV/aids-Related Stigma and Discriminatory Attitudes in Botswana

Academic journal article Journal of Health Population and Nutrition

Prevalence of, and Factors Associated with, HIV/aids-Related Stigma and Discriminatory Attitudes in Botswana

Article excerpt

INTRODUCTION

Botswana has the highest prevalence of HIV in the world. About 36.2% of pregnant women were HIV-positive in 2001, though this figure declined to 35.4% in 2002 (1). The impact of HIV/AIDS is substantial and has resulted in a tremendous increase in costs. One of the major impacts of HIV/AIDS is that of stigma and discrimination against those living with the disease.

Right from the beginning, the epidemic of HIV/AIDS has been accompanied by an epidemic of fear, ignorance, and denial, leading to stigmatization of, and discrimination against, people with HIV/AIDS and their family members (2). HIV/AIDS-related stigma and the resulting discriminatory acts create circumstances for spreading HIV (3). The fear of being identified as HIV-positive prevents people from learning their serostatus, changing unsafe behaviour, and caring for people with HIV/AIDS.

A study in Botswana and Zambia found that stigma against HIV-positive people and fear of mistreatment prevented people from participating in voluntary counselling and testing and programmes to prevent mother-to-child transmission (4). The authors argued that stigma and its resulting discrimination also intensify the pain and suffering of people with HIV/ AIDS and their families.

There exists little or no research on how people with HIV/AIDS, or those suspected of having HIV/AIDS, are perceived and treated in Botswana because of their illness. It is quite evident from studies done elsewhere that people with HIV/AIDS are unfairly treated and/or discriminated against because of their actual or suspected HIV/AIDS status (1,2,5-7). Discrimination against people with or suspected of having HIV/AIDS is not just wrong and unjust, it is also an ineffective public-health measure. The Government of Botswana Vision 2016 envisages a compassionate, just and caring nation (8). To achieve this goal, HIV/AIDS-related stigma and discrimination need to be addressed.

HIV in Botswana is mainly transmitted through heterosexual intercourse. Most young people in Botswana become sexually active before marriage, many of them in their teens. The average age at first intercourse is 17.5 years, the average age at first marriage is 19.0 years, and the average age at first birth is 18.6 years (9). Unequal gender relations sustain the epidemic of HIV/ AIDS in the sense that there exists exploitative sexual relationship between adult males and teenagers; the misuse of power and money in sexual relations; and rape and other forms of violence against women (10). Because girls entering into relationships with older men are relatively ignorant and submissive rather than equal partners, they are unable to negotiate safer sex. Too high pregnancy-related school drop-out rates suggest the high incidence of unprotected sex in the country.

People with HIV/AIDS may become implicitly associated with stigmatized behaviour, regardless of how they actually became infected. People with HIV/AIDS are stigmatized, ostracised, rejected, and shunned, and may experience sanctions, harassment, and even violence because of their infection or association with HIV/AIDS (3). Discrimination may stem from fear due to lack of knowledge about how HIV/AIDS can or cannot be transmitted. Since discrimination often includes public restrictions and punishing actions, it can be more frequently identified (3). Stigma is often rooted in social attitudes. In this study, variables of social attitudes were used for investigating the prevalence of HIV/AIDS-related stigma and discrimination in Botswana and the factors associated with it.

Individuals with HIV/AIDS are stigmatized because their illness is: (i) associated with deviant behaviour; (ii) viewed as the responsibility of the individual; (iii) tainted by a religious belief as to its immorality and/or thought to be contracted via morally-unsanctioned behaviour and, therefore, thought to represent a character blemish; (iv) perceived to be contagious and threatening to the community; (v) associated with an undesirable and an unaesthetic form of death; and (vi) not well-understood by the lay community and viewed negatively by healthcare providers (11). …

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