Addressing Stigma for better, holistic HIV programming

Author: Mamoletsane Khati, November 4 2013     Over three decades into the epidemic in Southern Africa, one would be tempted to think that HIV and AIDS related stigma is a thing of the past.  However, this is not the case.

 Stigma is still one of the biggest challenges facing the HIV/AIDS response and it remains a persistent and pernicious problem in any discussion about the epidemic. People living with HIV and AIDS (PLWHA) across Southern Africa continue to suffer gross marginalization, resulting in low uptake of and poor adherence to prevention and treatment services.

 Although it is well known that stigma impacts negatively on the response, only a few studies have demonstrated an association between stigma and increased risk behavior. One such study was the National stigma Index Study conducted in Swaziland in 2011. The study identified factors such as inadequate involvement of the health sector in addressing stigma and discrimination, attachment of HIV and AIDS to immorality and criminalisation of HIV prevention, cultural and traditional norms as the still fueling stigma in the country.

 In Swaziland, which according to the UNAIDS Report on the Global AIDS Epidemic 2013 has an estimated HIV prevalence of 26.5% for adults aged 15 to 49, the general public impression is that HIV related stigma was no longer a challenge as most people have been able to access the HIV treatment.   However, consultations with PLWHA point to the contrary. PLWHA suffer various forms of stigma resulting into gross human rights violations and affecting access to services.

 As a communication for development organisation, Panos Institute Southern Africa (PSAf) aimed to support elimination of HIV related stigma by implementing a media fellowship intervention. PSAf conducted a media training workshop to raise journalists’ appreciation of stigma and discrimination, and facilitate investigative reporting on the impact of HIV related stigma on the general HIV response. Selected journalists were granted fellowships to do in-depth articles on stigma. This was part of a regional “Give Stigma the Index Finger: Understanding and responding to stigma” project which was implemented by the International Planned Parenthood Federation.  

 The PSAf experience in Swaziland presents a number of lessons, including the following:

Limited appreciation on the impact of stigma on the HIV/AIDS Response

It was evident that there is inadequate appreciation of the impact of stigma and discrimination on programme delivery as well as the human rights of PLWHA.  A strong media can help overcome stigma and discrimination. The project enhanced the skills of journalists to communicate on the issues around stigma in Swaziland; improving media coverage of HIV related stigma and discrimination. 

Inadequate collaboration between PLWHA and the Media

Establishing and sustaining good relationships between PLWHA and journalists can improve communication on stigma and related social issues.  In most cases, PLWHA shy away from journalists they do not have good relationships with. Once PLWHA and journalists interact openly, there is a guarantee that public and policy debates will increase. This was true in Swaziland where there has also been good and encouraging reactions and feedback from public sector agents.

Limited dialogue to address stigma in service delivery institutions

Dialogues on HIV related stigma with policy makers, community members and leaders could also enhance stigma reduction. In most cases, PLWHA struggle to access the HIV and AIDS services due to inadequate support from the social level. This makes it easy for an individual to self-stigmatize themselves.

In addition to devastating the familial, social, and economic lives of individuals, HIV and AIDS stigma also hinders access to prevention, care, and treatment services. Community, national, and global actors have had limited success in alleviating the deleterious effects of HIV and AIDS stigma. There is therefore need to focus our attention on addressing stigma in order to help achieve targets set in the UNAIDS strategy for 2011 to 2015 of “Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths.”

Mamoletsane Khati is PSAf Regional Manager for Health and Development. She can be contacted through email on Mamoletsane@panos.org.zm. This article was first published in the Zambia Daily Mail newspaper.