ABSTRACT
This
research work investigates the Nigerian community attitude towards
Stigmatization and Discrimination against people living with HIV/AIDS in
Alimosho Area of Lagos State. Two hundred and fifty person who are currently
living with HIV/AIDS were interviewed through administration of questionnaires
in the area of study. Frequency tables and regression model were used in the
analysis of data collected from the field. Three hypotheses were tested in this
study. There are two major findings of this study; firstly, that the Nigerian
Community attitudes have a positive impact on stigmatization and discrimination
against people living with HIV/AIDS. However, it is expected that HIV/AIDS
positive person that are stigmatized and discriminated have community attitudes
surrounding and influencing them. Secondly, that those people who disclosed
their HIV/AIDS status are gossiped about; verbally harassed and neglected by
the Nigerian society. The project thus recommends the following: firstly,
instead of neglect, gossip and verbal harassment, there should be intimate
relationships of men who are HIV/AIDS negative with people who are living with
HIV/AIDS that will eventually culminate into marriages in the Nigerian society.
Finally, people with HIV/AIDS positive should be embraced by those who are free
from HIV/AIDS virus in every Nigerian community.
Key Words: Stigmatization,
Discrimination, HIV/AIDS Status, and Community attitude.
TABLE OF
CONTENT
Front Page i
Title Page ii
Certification
iii
Dedication
iv
Acknowledgement v
Table of content vi
Abstract ix
CHAPTER
ONE: INTRODUCTION
1.1
Background to the Study 1
1.2 Statement
of the Problem 5
1.3
Research Questions 6
1.4 Objectives
of the Study 6
1.5 Significance
of the Study 7
1.6
Definition of Terms 8
CHAPTER
TWO: LITERATURE REVIEW AND THEORETICAL EXPLANATION
2.0 Introduction 9
2.1.1 Compensation
Strategy 8
2.1.1 Stigma is Experience at the Individual and
Societal Level 11
2.1.2 HIV/AIDS Stigma is a Global Problem 12
2.1.3 Stigma
is an Obstacle to HIV Prevention, Care, and Treatment 14
2.1.4 Empirical Studies 17
2.2 Theoretical
Orientation 27
2.3 Statement of Hypotheses 30
CHAPTER THREE: RESEARCH
METHODOLOGY
3.0 Introduction 31
3.1 Area of Study 31
3.2 Research Design 31
3.3
Data Collection 32
3.4 Method of Data Collection 32
3.4.1: Primary Data 32
3.4.2. Secondary
Data 33
3.5 Sampling Techniques 33
3.6 Data Analysis and Interpretation 34
3.7 Field Experience 40
CHAPTER
FOUR: INTERPRETATION AND DATA ANALYSIS
4.0 Introduction 35
4.1. Result 35
4.1.1 Socio-Demographic Characteristics 35
4.3 Testing and Analysis of Hypotheses 46
4.3.1
Hypothesis One 46
4.3.2 Hypothesis Two 50
4.3.3 Hypothesis Three 52
4.4 Discussion of Hypothesis 55
CHAPTER
FIVE: SUMMARY, CONCLUSION AND RECOMMEDATION
5.0 Introduction 57
5.1 Summary 57
5.2 Conclusion 58
5.3 Recommendations 58
5.3.1 The Roles of the
Government 59
5.4 Contribution to
Knowledge 59
References 60
Appendix 63
CHAPTER
ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
The HIV pandemic and its ravaging effects was
a great shock to the world at large. It succeeded in making the social
stratification among humans expand and this stratification cuts across the
entire existence of human race because there is no known reversal or cure for
the virus for now.
HIV/AIDS is probably the most stigmatized
disease in human history. If we do not appreciate the nature and impact of
stigma, none of our interventions can be successful (Cameron, 2007). The pandemic had re-defined and still
redefining the structure of the family in several parts of the world,
particularly in sub-Saharan Africa. The first two cases of HIV/AIDS in Nigeria
were identified in 1985 and were reported at an international AIDS conference
in 1986. In 1987, the Nigerian Health Sector set up the National AIDS Advisory
Committee, which was shortly followed by the establishment of the National
Expert Advisory Committee on AIDS (NEACA) (UNDP, 2009).
The global HIV pandemic continues to grow,
with an estimated 35 million infected persons worldwide (UNAIDS, 2013).
Globally, it is estimated that nearly half (15.5 million) of people living with
HIV. Since the beginning of the epidemic, almost 78 million people have been
infected with the HIV virus and about 39 million people have died of HIV.
Globally, 35.0 million (33.2–37.2 million) people were living with HIV at the
end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with
HIV, although the burden of the epidemic continues to vary considerably between
countries and regions. Sub-Saharan Africa remains most severely affected, with
nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of
the people living with HIV worldwide (USAID, 2013).
HIV stigma and discrimination adversely affect
every aspect of life for people living with HIV and their families. In many
settings, an HIV diagnosis still can be as devastating as the illness itself,
leading to job loss, school expulsion, violence, social ostracism, loss of
property, and denial of health services and emotional support. People living in
fear are less likely to adopt preventive behavior, or come in for testing,
disclose their status to others, access care and adhere to treatment.
With the face of the pandemic changing
worldwide and the advent of highly active antiretroviral therapy (HAART), HIV
has changed from a sub-acute and fatal infection to an important but chronic
illness in the developed world (Klein et al. 2003). HAART improves the quality
of life and has changed the perspective that persons with HIV have about their
life expectancy and their future (Preau et al. 2007). Due to this shift in
perspective and these medical advances afforded by HAART, HIV-positive patients
have new opportunities, such as the possibility of parenthood and increased
life expectancy. These improvements also create the very real possibility of
challenges in dealing with out- of-date beliefs held by health care professionals,
friends, and family about these patients and their medical prognosis and
ability to give birth to a baby who does not have HIV. HIV/AIDS stigmatization
may be the most salient of these challenges.
HIV/AIDS stigmatization is defined as the
prejudice, discounting, discrediting and discrimination directed at people
perceived to have AIDS or HIV, their loved ones and associates and the groups
and communities with which they are affiliated (Herek and Capitanio 1998).
Stigma is a socially constructed experience, where the stigmatized individual
does not feel wholly integrated or accepted into the culture or society
(Goffman 1963). Berger et al. (2001) propose that HIV stigma includes both the
perception of societal attitudes toward HIV and the personal experience of HIV
stigma. Regardless as to whether a person has objectively experienced HIV
stigma, the perception of HIV stigma is what appears to be most strongly
related to these negative outcomes (Kinsler et al. 2007; Rao et al. 2008;
Remien et al. 2006; Riggs et al. 2007). Perceived HIV stigma is related to
increase perceived stress (Remien et al. 2006; Riggs et al. 2007). Previous
literature on HIV-positive populations has found that perceived HIV stigma from
health providers reduces attempts to access health care services, which may
significantly impact the health of HIV- positive persons (Kinsler et al. 2007).
Mental health variables may also be relevant
to the experience of HIV stigma. HIV-positive patients are at higher risk for
depression than HIV-negative individuals, due to the compounding factors of
medical illness and social marginalization (Catz et al. 2002). In mixed-gender
samples, HIV stigma is associated with decreased self-esteem, lack of
self-efficacy, hopelessness, and increased psychological distress (Emlet 2006;
Lee et al. 2002; Rao et al. 2008).
Similarly, anxious symptoms could occur
because of stressful events such as stigmatization or discrimination (e.g. Au
et al. 2004). Psychological distress is also important to assess because it is
associated with poor coping, disease progression and quality of life outcomes
among HIV-positive patients, and perceived lack of support among HIV-positive
individuals (Catz et al. 2002; Emlet 2006; Prachakul et al. 2007; Remien et al.
2006).
Although lack of support from others has
previously been measured as a broad construct, little research has examined specific
forms of negative judgment that may also be associated with HIV stigma for
HIV-positive patients such as experiences of being judged for trying to become
pregnant despite HAART’s profound effect on reducing mother-to-child HIV
transmission and increasing maternal life expectancy. HIV stigma may be
exacerbated by HIV-positive patients’ demographic overrepresentation within
socially marginalized groups, such as ethnic minority groups, and persons with
low income or lower educational level (Ogilvie et al. 2007; Remis et al.,
2006).
Wingood et al. (2007), in a sample of 366
predominantly African- American HIV-positive patients in the USA, found that
HIV stigma and acts of discrimination adversely affected the patient’s mental,
sexual, and physical health. In a similar sample, Blake et al. (2007) found
that HIV-positive patients recalled experiencing shame and humiliation when
obtaining health care and from their family and friends when they disclosed
their HIV status. Similarly, in a longitudinal study of 29 HIV-positive
African-American patients, all participants had experienced HIV stigma (Buseh
and Stevens 2006). Buseh and Stevens (2006) noted that stigma partially arose
from the treatment HIV- positive patients received from society’s institutions,
including lack of regard from staff members in official places like hospitals,
welfare offices, and prisons. However, patients who had social support from
family members were more resilient to the negative effects of HIV-related
stigma.
1.2 STATEMENT OF THE PROBLEM
People with HIV are not living full lives and
there are very few things that they can do just because they have HIV.
Crucially, most people with HIV find that they are not loved, accepted and
supported by those close to them.
Public attitudes to the victims of the virus
is more pathetic that the virus itself. In most social groups, stigmatization
against people with HIV/AIDS is more pronounced than the ever-existing social
stratification based on disability, ethnicity, gender or sexuality. Due to the
fact that we do not live in a perfect world, people with HIV massively come
across stigma, prejudice and discrimination. This can often be the worst part
of living with HIV.
Living with HIV now is a very different
experience to living with HIV ten or twenty years ago. And living with HIV in
the Nigeria is quite different to living with HIV in some other parts of the
world, especially developed nations of the world. With the more deadly virus
called ‘Ebola’, attention had shifted a bit from HIV/AIDS to this new disease
that kills within a month if not taken care of. Yet, the emergence of ‘Ebola’
had not reduced the stigmatization that comes with the virus. It was, however,
gathered that during the peak of the Ebola crises in Nigeria, people that were sick
and tested in hospital jumped for joy when they heard it was HIV/AIDS they had
and not Ebola. This, however, have not reduced the stigmatization that comes
with the virus on the patients.
1.3 RESEARCH QUESTIONS
1. What
are the coping strategies employed by people living with HIV/AIDS?
2. What
are the various forms of stigmatization that they experience?
3. Is
there any correlation between the stigmatization of the patients of HIV/AIDS
and their living condition?
4. Has
the stigmatization of the patient of HIV/AIDS affected their economic
productivity?
1.4 OBJECTIVES OF THE STUDY
The main aim is to examine the effect of
stigmatization on HIV/AIDS patients in Alimosho Local Government. The
objectives, however, are as follow:
1. To
examine the coping strategies employed the patients of HIV/AIDS
2. To
discover the level of stigmatization HIV patients in Alimosho Local Government
encounter
3. To
examine if there is a correlation between HIV patients and their living
conditions
4. To
investigate if the stigma has any effect on their productivity level and;
5. Understand the
role of social structures (e.g. family, economic, and cultural institutions) in
creating and perpetuating HIV/AIDS related stigmatization.
1.5 SIGNIFICANCE OF THE STUDY
Stigma and discrimination towards people with
HIV has been associated with negative health problems ranging from increased
depressive symptoms to engaging in risky sexual behaviour (Kinsler, Wong,
Sayles, Davis & Cunningham, 2007; Sayles et al., 2008; Vanable, Carey,
Blair &Littlewood, 2006). Furthermore, experiencing stigma or
discrimination in a healthcare setting has been found to adversely affect the
health behaviours of people living with HIV such as accessing treatment,
seeking testing for HIV or HCV, and adhering to medical regimes (Butt, 2008; Fortenberry et al., 2002; Pascoe
& Smart Richman, 2009).
Due to the ongoing impact of stigma and
discrimination, it is important that our understanding of these issues is
current, and develops alongside changes in the provision of healthcare, in order
to provide the best quality care to HIV patients. This report will review the
existing evidence on HIV-related stigma and discrimination in the health care
sector, with specific emphasis on analyzing the experiences and implications of
this for people living with HIV.
The findings of this study will be of immense
benefit to the Government and bodies like non-governmental organizations
(NGO’s), Human Rights Activists etc. Specifically it will help the government
of Nigeria to plan, given that; the problems faced by people living with
HIV/AIDS are exposed and adequately addressed. More so, orientation will
further be given to the public about the virus and how one could acquire it, as
many have some unscientific myths about the virus and those having it. This
study will proffer solution to how those living with the virus could be
less-stigmatized as the stigma kills faster than the virus itself.
1.6 DEFINITION OF TERMS
STIGMATIZATION -
The shame or disgrace attached to something regarded as socially unacceptable. There may be a feeling of ‘us and them’.
People who are stigmatised are marked out as being different and are blamed for
that difference. Fear of this happening can lead to people with HIV being
nervous about telling others that they have HIV or avoiding contact with other
people. They may end up suffering in silence instead of getting the help they
need.
PATIENT
– A person who is receiving medical treatment, especially in a
hospital. It could also mean a person who is affected by a disease or ailment.
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