AIDS-related stigma in sub-Saharan Africa: Its contexts and potential intervention strategies

BACKGROUND: AIDS-related stigma discourages individuals who are aware of their HIV-positive status from sharing information about their status with their sexual partners and families, and makes it difficult to prevent the spread of the infection or to plan a secure future for surviving children and family members. It is essential that barriers to screening, prevention, and care are understood and removed so that persons living with HIV/AIDS can benefit optimally from available health and social services. OBJECTIVES: The objectives of this article are to summarize the literature on barriers posed by stigma to HIV/AIDS prevention and care in sub-Saharan Africa, to analyze the contexts in which AIDS-related stigma and discrimination are manifested, and to suggest potential prevention strategies. METHODS: The authors collected and reviewed published studies from standard research databases and reference lists of relevant articles. RESULTS: The ways in which AIDS stigma is overtly or covertly expressed are shaped by a range of social, cultural, political, and economic factors. Stigma plays into existing social inequalities and is manifested at all levels: in the wider society, in institutions, in families, and at the individual level. IMPLICATIONS FOR POLICY AND PRACTICE: Influences on AIDS-related stigma and discrimination are rooted in the structure of communities and societies, and therefore effective interventions should be based on a sound theoretical foundation and include attention to individual as well social and structural barriers. Given the diversity of cultures among the various countries in Africa, interventions to reduce AIDS stigma are likely to be more effective if they are context-specific and sensitive to the prevailing sociocultural and economic environment of each country.