Academic journal article Journal of Health Population and Nutrition

Internalized HIV/AIDS-Related Stigma in a Sample of HIV-Positive People in Bangladesh

Academic journal article Journal of Health Population and Nutrition

Internalized HIV/AIDS-Related Stigma in a Sample of HIV-Positive People in Bangladesh

Article excerpt


From the beginning, since its first diagnosis, HIV/ AIDS has been recognized as a disease associated with fear and stigma (1). Stigma, one of the greatest barriers to preventing new infections of HIV, is a major cause hindering efforts in HIV/AIDS-prevention programmes, HIV testing, and access to treatment (1,2). Although stigma is the major significant barrier, little empirical research has been conducted on this issue.

HIV/AIDS-related stigma is a complex multidimensional issue that varies from individual to individual because of the different perspectives about the disease. People living with HIV/AIDS (PLHA) are not different in this aspect.

Goffman defined stigma as a powerful social label, stemming from a discrediting attribute of the individual, which radically changes their social identity (3). Several other authors have divided stigma into two kinds: 'felt' stigma, also known as 'perceived' or 'internal' stigma, and 'external' or 'enacted' stigma (4-8). According to Brown et al., 'felt' or 'perceived' or 'internal' stigma refers to real or imagined fear of societal attitudes and potential discrimination arising from a particular undesirable attribute, disease (such as HIV), or association with a particular group or behaviour (e.g. homosexuality and promiscuity) (5). 'Enacted' or 'external' stigma, on the other hand, refers to the actual experience of discrimination (6,8). The two kinds of stigma are interlinked. For example, people experience discrimination because of stigma; discrimination leads to internal stigma; and internal stigma again reinforces and legitimizes stigma (9). Of the two kinds of stigma, internalized stigma receives less attention from researchers and programme planners (4).

Since HIV/AIDS-related internalized stigma has an impact on the well-being of PLHA and can hinder his/her participation in most community and social activities, this study focused on measuring internalized stigma among a group of diverse PLHA in Bangladesh. In our study, internalized stigma was defined as the product of internalization of shame, blame, hopelessness, guilt, and fear of discrimination associated with being HIV-positive (4).

Results of studies showed that internalized stigma may discourage PLHA from seeking care (7) and may increase the levels of their loneliness compared to the general population (10,11). PLHA who feel stigmatized also feel anxiety, depression, and alienation, and these feelings of anxiety, depression, and alienation are associated with disruptions in normal social relationships (12). These findings describe the crucial effects of internalized HIV/ AIDS-related stigma on the mental health of PLHA and suggest the need for conducting more research on this issue. Gender relationships also play an important role in experiencing stigma. Studies have documented women's vulnerability of experiencing HIV/AIDS-related stigma and discrimination (13,14).

Historically, Bangladesh is a patriarchal society where men exercise control over women's sexuality and their access to services. Men tend to be the main decision-makers within the family, and the social norms and responsibilities allow men to control women's behaviour. As a result of gender inequality and social structure, women living with HIV/AIDS are more at risk of experiencing stigma.

Although the prevalence of HIV/AIDS in Bangladesh remains low, the number of PLHA has been steadily rising. According to the 2010 United Nations General Assembly Special Session (UNGASS) country report, 1,745 HIV cases were detected in Bangladesh, and 250 new cases were detected in 2009 (15). While the number of PLHA has been increasing day by day, research on HIV/AIDS stigma has so far been limited. An extensive review of literature found no published articles focusing on internalized stigma among PLHA in Bangladesh. This is a pioneering study in Bangladesh, which focuses on internalized stigma among the PLHA. …

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