AIDS: COMBATING THE SCOURGE AND THE STIGMA

BY FAGBENRO WINIFRED

REVIEWED BY OWOLABI EMMANUEL

When hearing or talking about HIV/AIDS, one cannot avoid the issue of stigma surrounding it. From the very first cases of HIV infections in the 1980s, social responses of fear, denial, stigma and discrimination have accompanied it. This has spread rapidly, giving rise to anxiety and prejudices against the groups most affected as well as individuals infected and affected. The stigmatization of individuals infected and affected by HIV and the eventual discrimination, which they suffer, are the tragic consequences of HIV disease. HIV/AIDS and stigma are most of the time like siblings, tightly interwoven in many communities causing more pain and agony to the afflicted, making them feel hopeless, isolated and that they are better of dead than living on with the disease.

Before we dive into this article, let’s first define these terms: HIV, AIDS and stigma

HIV

The Human Immunodeficiency Virus (HIV) is virus which attacks the immune system. When it enters the body system via contact with the infected person’s body fluids like blood, saliva, semen or vaginal fluid, the virus attacks and destroys the immune cells, specifically the CD4 cells, a type of T-cell. There are three stages of HIV infection:

1. Acute infection: occurs 2-6 weeks after infection. Infected persons usually present flu-like symptoms.
2. Chronic stage: The virus is still active but reproduces at a slower rate. Previous symptoms may disappear. This stage can last for up to ten years. However, if the patient is on antiretroviral therapy, they would not progress to the last stage.
3. Advanced stage: The virus has weakened the immune system completely, leaving the body susceptible to opportunist infections like Cytomegalovirus, Toxoplasmia gondii, Herpes Simplex virus, Mycobacterium tuberculosis, Mycobacterium avium complex, e.t.c.

AIDS

Acquired Immune Deficiency Syndrome is the final stage of HIV infection. A person with HIV is said to have progressed to AIDS when the number of their CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3). (Normal CD4 counts are between 500 and 1,600 cells/mm3.) or they develop one or more opportunistic infections regardless of their CD4 count. Without ART, the person can survive for about three years. A person with HIV can develop AIDS if:

1. He/she is not aware they are infected.
2. He/she is not on ART.
3. He/she is on ART but it is not effective.

STIGMA

Stigma refers to the negative or discriminatory attitude against a person or a group of people due to social status, traits or certain medical conditions. This often stems from fear or lack of understanding about the condition.

WHY AND HOW HIV/AIDS STIGMA HAPPENS

HIV is a condition which carries a lot of stigma as there are a lot of myths to how its contacted, making people fear and avoid those living with HIV/AIDS. There is also a lot of moral judgement against them due to its nature of transmission, I.e, by sexual intercourse, which makes people sees HIV-infected persons as ‘sinful’ or ‘impure’. A study showed that younger persons, men, those without formal education and within the poor index are more likely to have stigma towards PLWHA, however those with higher levels of education and those from higher wealth index seem to be more compassionate towards PLWHA with about 70%  willing to care for relative with AIDS.

People living with HIV can experience stigma and discrimination from friends, family, school, work and even from health care centers through:

• Isolation from family or community events.
• Refusal to have physical contact with those living with HIV.
• Refusal to provide medical care and services.
• Assuming they are ‘sinful’ and the disease is as a result of divine punishment.
• Believing those who get infected are sexually loose or drug addicts.

Consequences of stigma and discrimination against people living with HIV/AIDS

 Jonathan Mann in 1987 referred to AIDS stigma as the ‘third epidemic and this is true as stigma and discrimination does more harm than good to HIV-positive persons and combating its spread.  As they experience more discrimination, especially from loved ones, they may internalize the stigma and bigotry they face, contributing to a negative self-image. In some cases, those with HIV may also have great fear and worry around the potential revelation of their condition to their community because of the injustice and discrimination they may face. Almost 8 in 10 adults living with HIV report developing feeling self-stigmatization according to a Centers for Disease Control (CDC) study, leading to feeling of isolation, shame, despair and fear of disclosure.

Those who experience stigmatization also find it challenging to talk to others about their condition and to seek treatment and testing materials. They end up suffering in silence as the disease worsens. Even if they wanted to get treated, there is a chance they get terminated from their place of work just because they have HIV. Stigmatization can prevent people from employing or seeking services from HIV-infected persons which leads to poverty, making them unable to afford treatment.

At the community level, transmission rates would also increase due to fear of being seen going for testing, allowing undiagnosed individuals to unknowingly spread the infection. With reduced productivity among the infected and hospitalizations that could have been avoided, there would be an increased economic burden on the government and the working population.

 THE WAY FORWARD

Fortunately, there has been a lot of efforts against stigmatization over the years. In 2014, the then President of Nigeria, Goodluck Jonathan, signed The HIV/AIDS Anti-Discrimination Act into law which makes it illegal to discriminate against people based on their HIV status. It also prohibits any employer, individual or organization from requiring a person to take an HIV test as a precondition for employment or access to services. Also in 2012. UNAIDS came up with seven key programme to every HIV response:

1. Stigma and discrimination reduction
2. HIV-related legal services
3. Monitoring and reforming laws, regulations and policies on HIV.
4. Legal literacy (“know your rights”).
5. Sensitization of law makers and law enforcement agents.
6. Training for health-care providers on human rights and medical ethics for HIV.
7. Reducing discrimination and violence against women in the context of HIV.

We can also do our part to put an end to stigma and the HIV pandemic by:

• Educating ourselves on HIV and it transmission
• Creating awareness
• Debunking all myths on HIV. People should be made to understand that they cannot be infected via:
  • Physical contact with HIV-Positive persons
  • Sharing clothes with them
  • Sharing plates and utensils with them
  • Using the same toilet with them e.t.c
• Encouraging PLWHA to seek support and treatment
• Supporting NGOs and the government in providing affordable and efficient health care, protection and testing.

REFRENCES

• What Are HIV and AIDS? (n.d.). HIV.gov. https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids

• UNAIDS. (n.d.). Nigeria passes law to stop discrimination related to HIV. https://www.unaids.org/en/resources/presscentre/featurestories/2015/february/20150211_nigeria_law

• Stigma and HIV. (2024, April 16). HIV. https://www.cdc.gov/hiv/health-equity/index.html

• JOdimegwu, C. O. (2002). PREVALENCE AND PREDICTORS OF HIV-RELATED STIGMA AND KNOWLEDGE IN NIGERIA: IMPLICATIONS FOR HIV/AIDS PREVENTION INITIATIVES. In Harvard School of Public Health, Department of Population and International Health. https://www.hsph.harvard.edu/wp-content/uploads/sites/114/2012/10/RP210.pdf

• Dahlui, M., Azahar, N., Bulgiba, A., Zaki, R., Oche, O. M., Adekunjo, F. O., & Chinna, K. (2015). HIV/AIDS Related Stigma and Discrimination against PLWHA in Nigerian Population. PloS one, 10(12), e0143749. https://doi.org/10.1371/journal.pone.0143749

• Mph, Z. S. (2021, November 23). What to know about HIV stigma and discrimination. https://www.medicalnewstoday.com/articles/hiv-stigma
• Joint United Nations Programme on HIV/AIDS (UNAIDS). (2012). Key programmes to reduce stigma and discrimination and increase access to justice in national HIV responses. https://www.unaids.org/sites/default/files/media_asset/Key_Human_Rights_Programmes_en_May2012_0.pdf