By: Leah Kennedy
I have spent my last 5 weeks in Ghana working on an infectious disease unit at 37 Military Hospital. Most patients who are admitted to this unit have developed opportunistic infections related to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Most patients present with opportunistic infections such as: Tuberculosis and Meningitis. The age range varies among the patients I work with. For example, I have nursed a patient as young as two years of age as well as individuals in their early sixties. HIV/AIDS is the primary diagnosis that I have observed among my patients. Fortunately, I am privileged to be able to work with and learn from incredible people. I can honestly say that I have learned more about myself along with valuable life lessons from the people I have been caring for. My patients have been kind enough to open their hearts and share their personal stories with me. I have come to learn the harsh truth about the worries and daily struggles Ghanaians often face in relation to HIV/AIDS and the stigma that closely links the disease.
According to the U.S. Department of Health & Human Services (2014), HIV is one of the most serious and fatal diseases in human history. With time, HIV causes a condition called acquired immunodeficiency syndrome, which is better known as AIDS. In 2011, the World Health Organization (WHO) stated that since the beginning of the AIDS epidemic almost 70 million people have been infected with the HIV virus and approximately 35 million people have died of AIDS.
When an individual is diagnosed with HIV, their immune system cannot fight off most viruses and infections that the body would normally be able to combat. An individual can live symptom free for decades (U.S. Department of Health & Human Services, 2014). Over time, HIV can destroy many cells that help the body fight against infections and diseases. When the immune system can no longer do this, the HIV infection will lead to AIDS (U.S. Department of Health & Human Services, 2014).
When an individual is diagnosed with AIDS they are considered to be in the latent stage of HIV. Individuals at this stage of HIV have severely damaged immune systems, which in turn put them at risk for opportunistic infections such as Tuberculosis.
Over the years research on the stigma of the disease has explored negative social attitudes and discriminating behaviors towards affected individuals. “HIV disease is viewed more negatively than many other stigmatized conditions, such as mental illness and other physical health problems” (Sengupta, Banks, Jonas, Miles, & Smith, 2011, p. 2). Stigma and discrimination against AIDS remain significant factors that influence the lives of individuals living with and who are affected by HIV. Stigma is said to be the most limiting factor that negatively influences primary and secondary HIV/AIDS prevention and care. Holzemer and Uys (2004) supported this statement through examining the connection between stigma and the health of those affected. Stigma “reportedly interferes with voluntary testing and counselling, and with accessing care and treatments, thereby increasing suffering and shortening lives” (Holzmer & Uys, p.165).
On a more personal level the above statements prove to be true. While speaking with my patients, I found stigma to be a common theme. Several individuals I spoke with were honest and admitted that their families were not aware of their health status. One man explained that if anyone were to ever find out about his health status people in his community would shun him and his family. The implications of stigma related to HIV/AIDS goes further than I could have imagined. For example this gentleman spoke about how the probability of losing his job is definite. Furthermore, once word spreads, people in his community will no longer buy and exchange goods from his wife. The following are statements made by this particular male patient:
How will I feed my family with no income? My children will be forced out of school, the torture they will endure will be relentless. What if my wife of 21years chooses to leave me? I and my family will be broken and left with nothing.
The man I speak of was newly diagnosed with AIDS and had been hiding his diagnosis during his stay in the hospital for over 2 months. The burden of his hardship was written all over his face as he asked me for advice. Disclosure in itself is a risk; I learned that his concerns were similar among the other individuals I spoke with. Many patients have minimal social support in place; the fact that they are even in hospital is something in itself. Individuals in Ghana often choose to avoid health care facilities once they fall ill in fear of testing positive for the disease. The stigma that surrounds HIV/AIDS is a global issue that must be acknowledged. Many health care workers in Africa have come to the conclusion that “unless stigma is conquered, the illness will not be defeated” (Holzemer & Uys, 2004, p. 165).
However, thanks to research surrounding the stigmas associated with AIDS, we are now more aware of the many underlying factors that may be causing the negative views on HIV/AIDS to surface at the community and/or social level. Such factors include a “lack of knowledge or understanding about the illness; misconceptions about how HIV is transmitted; lack of access to treatment; how media shapes the reporting on the epidemic; the incurability of AIDS; and existing prejudice and fear toward specific groups” (Sengupta et al., 2011, p. 2). This is an important factor to consider as research suggests that HIV/ AIDS stigma is a barrier associated with disclosure and negative health outcomes. As a result, those affected with HIV/AIDS are less likely to partake in HIV preventive behaviors and HIV care-seeking behaviors (Sengupta et al., 2011).
As a result from the negative health outcomes resulting from HIV/AIDS stigma has made it necessary for HIV prevention and treatment programs to gain a greater focus on efforts to reduce HIV/AIDS stigma.
On a social level it is important to become aware and develop an understanding on the varying stigmas associated with HIV/AIDS and how we can overcome these barriers. Furthermore, updating our current knowledge on how to reduce HIV/AIDS stigma is an important step in understanding the scale of HIV/AIDS stigma reduction efforts that are currently available.
Holzemer, W. L., & Uys, L. R. (2004). Managing AIDS stigma. Journal of Social Aspect of HIV/AIDS, 3(November), 165-174.
Sengupta, S., Banks, B., Jonas, D., Miles, M. S., & Smith, G. C. (2011). HIV Interventions to Reduce HIV/AIDS Stigma: A Systematic Review. AIDS & Behavior, 15(6), pp. 1075–1087. doi:10.1007/s10461-010-9847-0.
U.S. Department of Health & Human Services. (2014). HIV/AIDS 101. Retrieved from http://aids.gov/hiv-aids-basics/
World Health Organization. 2011. Retrieved from http://www.who.int/gho/hiv/en/