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Stamping out stigma in HIV

  • 33 Comments

Nurses have vital roles in challenging prejudice and tackling the stigma associated with HIV – one that can be exacerbated by well-meaning campaigns and wider prejudices.

In this article

  • The prevalence of HIV infection
  • Why HIV is associated with stigma
  • How nurses can help tackle stigma and prevent HIV infection

Author

Rachel Lewis is development co-ordinator at Milton Keynes STaSS HIV/AIDS support service.

FREE for one week: Identifying and Testing Patients for HIV Infection CPD unit

Abstract

Lewis R (2011) Stamping out stigma in HIV. Nursing Times; 107: 10, early online publication.

Despite significant developments in the treatment of HIV infection, the condition is still heavily stigmatised. This article discusses why this is so, what can be done to help change negative attitudes towards people with HIV, and how nurses can help reduce stigma.

Keywords: HIV, stigma, discrimination, prevention

  • This article has been double-blind peer reviewed

5 key points

  1. The stigmatisation of people with HIV can be fuelled by racial, homophobic and drug-related prejudice
  2. Prioritising prevention messages for those considered high risk of HIV infection can add to the stigmatising effect
  3. Nurses can reduce stigma associated with HIV by acting as role models, providing non-judgemental care, and challenging prejudice
  4. People diagnosed with HIV are at risk of developing mental health problems, such as depression and suicidal thoughts
  5. It is unrealistic to rely on antidiscrimination legislation to counter stigmatisation of people with HIV 

Box 1. HIV Facts and Figures

  • Around 86,500 people were living with HIV in the UK in 2009;
  • Around a quarter of those infected were thought to be unaware of their diagnosis;
  • More than half of HIV diagnosed individuals accessing care in 2009 were infected via heterosexual sex;
  • 41% of the estimated total and an estimated 42% of new infections in 2009 were acquired through sex between men;
  • The highest proportion of recent infections in heterosexuals was in females aged 15-24 and males aged 25-34;
  • Half of adults diagnosed with HIV in 2009 were at a late stage of infection

Source: Health Protection Agency (2010)

Introduction

In 1998, Gugu Dhlamini was stoned and beaten to death in South Africa by people from her township community after speaking openly about her HIV status. Her death was largely due to ignorance and prejudice, and the stigma attached to HIV infection. While the idea that this could happen in the UK may seem unthinkable, ignorance and prejudice surrounding HIV is very much alive. Although HIV treatment has been widely available in the western world for the last decade, the stigma surrounding it still exists.

Nurses have an important role to play in helping to reduce stigma associated with HIV: specialist HIV nurses by acting as role models and raising awareness, and general nurses by providing non-judgemental care, using universal precautions, and challenging prejudice.

Stigma and HIV

The National AIDS Manual (2008) says: “People who are stigmatised are marked out as being different, and stigma is often attached to things which are seen as embarrassing or a danger. Stigma can be used as a way of denying dignity, respect and rights to some members of society, and can result in people being isolated or abused. It can lead to discrimination, where people are treated less well because of a characteristic they have.”

HIV stigma is particularly complex, fuelled by racial, homophobic and drug related prejudice and discriminatory behaviour. It is also a way for people to cope with irrational fears of catching the condition (Kelly, 2006). HIV is also a self-stigmatising condition. People with the virus often report feelings of guilt and self-loathing, internalising society’s views that they are at fault or deserving of retribution for risk taking and “immoral behaviours” (NAM, 2008).

Public messages

Messages from public health campaigns in the 1980s and 1990s were stark: if you catch HIV, you will die. According to the international HIV and AIDS charity Avert (2011) the language and imagery used in these campaigns also contributed to subliminal messages, with HIV regarded as:

  • A punishment for immoral behaviour;
  • A crime with innocent and guilty victims;
  • A war on a virus which must be fought;
  • A horror in which infected people are demonised and feared;
  • As otherness, where the disease is an affliction of those set apart. 

This approach was designed to frighten people into recognising the risk associated with HIV infection, but it also sowed the seeds of irrational fear. People did not fully accept the additional message that the infection could not be passed on through day-to-day contact, a message that continues to be poorly understood.

Myths surrounding HIV can contribute to the stigma attached to the condition. According to the NAM (2008) “The stigma associated with HIV is used to maintain some of the inequalities that already exist in society.’’

Targeted prevention messages 

HIV has been specifically associated with certain “risky” lifestyles and behaviours, such as homosexuality, drug addiction and prostitution.

The reported higher prevalence of HIV in some communities – such as black African communities and men who have sex with men (MSM) - makes it necessary to pay particular attention to these sections of the population. The National Institute for Health and Clinical Excellence has issued draft public health guidance on increasing the uptake of HIV testing among these groups (NICE 2010a; NICE 2010b); the final guidance is due for publication later this month.

Although it is well intentioned and may be necessary to prioritise prevention messages for those considered to be at high risk of infection, messages that only target certain communities can bring their own problems. Theycan add to the stigmatisation of people in these groups and make them reluctant to admit risk or reveal their HIV status. This targeting may also give people outside these groups a false sense that they are not themselves at risk of HIV provided they avoid the targeted groups.

Tackling stigma

Tackling stigma associated with HIV is vital because it can undermine attempts to stem the epidemic of HIV and AIDS worldwide. United Nations secretary-general Ban Ki-Moon (2008) has described stigma as the most important barrier to public action and a main reason why many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment.

If people fear being shunned by family, peers and the wider community, they are unlikely to come forward for testing, or hide the condition and avoid seeking support for long periods.

Preventing HIV

Denial often goes hand in hand with discrimination, and many people deny HIV exists in their community. Community inclusion projects, such as Celebr8 in Milton Keynes, should focus on changing attitudes to combat ignorance celebrates diversity in the community, with the message that everyone is equally valuable to society.

A national campaign, emphasising whole-society compliance with prevention messages is also needed, and the following areas need to be addressed:

  • Religious groups: HIV is often associated with alleged “morally unacceptable practices” leading to fear of judgement and exclusion. Working with religious leaders can help them understand HIV and related issues.
  • School and workplace education: Regular reinforcement of health promotion messages about HIV will prevent the “collective amnesia” about the condition.
  • HIV champions: Highly visible, HIV-positive role models can help break down stigma, yet there are very few in the UK. Involving people living with HIV in combating stigma could lead to a greater understanding of their needs and the negative effect of stigma.
  • Clinical education: This should include updates to enhance healthcare professionals’ knowledge and change negative attitudes. If people with HIV think they will be treated as “unclean” they will avoid seeking help, so they will not receive treatment or education to prevent onward transmission.
  • Universal precautions: The importance of practising universal precautions must be re-emphasised. It Infection with HIV, or any other blood borne virus, so it makes no sense to take precautions only with those known to be HIV positive, particularly since a quarter of people who are HIV positive do not know they have the virus;
  • Opt out HIV testing: One of the major successes of recent years has been in the shift towards opt-out testing in maternity services, leading to greater ‘uptake’ and allowing HIV status to be known before delivery. This has resulted in major reductions in vertical transmission (mother to child). Wider testing on this basis in healthcare settings could reduce the numbers of people who do not know they are HIV positive, and assist in reducing onward transmission.

Conclusion

Although it is unrealistic to think the stigma associated with HIV can be eliminated, we can reduce its effects by challenging misconceptions and judgemental attitudes. This will improve the quality of life of those living with HIV, and is likely to increase the uptake of both screening and treatment and people with HIV are also more likely to receive and act on information about preventing onward transmission. This has both human and financial benefits as the cost of preventing HIV transmission is considerably less than the cost of treating the condition. The message going forward must be “less blame, less shame, less stigma, less HIV”.

Nurses can only help to reduce HIV stigma if they are well informed about the condition. Specialist HIV nurses have increasing workloads, but in collaboration with other agencies that have a knowledge of and connection with the communities in which they work- could contribute to training. Well informed and compassionate nurses could do much to educate the public, and counter self-stigma in patients. 

  • 33 Comments

Readers' comments (33)

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  • I'm Gail Chretien from United State , I contacted HIV in 2009, I was told by my doctor that there's no possible cure for HIV. I started taking my ARV's, My CD4 was 77 and viral load was 112,450. I saw a website of Dr. Agbebaku, also I saw a lot of testimonials about him on how he uses herbal medicine to cure HIV. I contacted him and told him my problems, He sent me the herbal medicine and I took it for 14 days which was two weeks,after then I went for check-up and I was cured. The medicine has NO SIDE EFFECT, there's no special diet when taking the medicine. He also cure ALS, HEPATITIS B, CANCER, HERPES, DIABETES and lots more. here,s my contact +1(315) 795 1518 You can reach him on dragbebakuspellsolutiontemple@gmail.com. or call and WhatsApp [+2349053099479]. visit; https://www.facebook.com/naturalherbscureforhiv .

    Unsuitable or offensive? Report this comment


  • I'm here to testify about the great work Dr Tebor did for me. I have been suffering from (HERPES) disease for the past 5 years and had constant pain, especially in my knees. During the first year,I had faith in God that i would be healed someday.This disease started circulating all over my body and i have been taking treatment from my doctor, few weeks ago i came across a testimony of one lady on the internet testifying about a Man called Dr Tebor on how he cured her from Herpes Simplex Virus. And she also gave the email address of this man and advise anybody to contact him for help for any kind of sickness that he would be of help, so I emailed him telling him about my (HERPES Virus) he told me not to worry that i was going to be cured!! Well i never believed it,, well after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over me as Dr Tebor assured me that i will be cured,after some time i went to my doctor to confirmed if i have be finally healed behold it was TRUE, So friends my advise is if you have such sickness or any other at all you can contact Dr Tebor via email Teborherbalcenter@gmail.com You can also call or whatsApp his telephone number +2348153052125. Thanks once again Dr Tebor or website https://teborherbalcanter.wordpress.com

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  • I don't just know the reason why some people is finding it difficult to believe that there is a cure for herpes, i have been suffering from herpes since last three years with my boyfriend but today i am happy that am cure from it with the herbal medicine of Dr SMITH the great herbalist,i was browsing the internet searching for help when i came across a testimony shared by someone on how Dr SMITH cure his herpes with the use of herbs and i was so much in need of getting his treatment and i contact Dr Smith on the email that was provided in the comment and he sent me the herbs through UPS service and instructed me on how to use it. After we finished taken the herbs, (Me and my boyfriend) we went for checkup at the hospital and the result was negative and it shows that we are completely cure from the virus. At last Dr SMITH brought a smile to my face with his herbal medicine. I am so much happy today that we have someone like this great healer out there who is helping people with his herbal medicine, so my people out there kindly contact this great healer on his email: smithherbalcure@gmail.com. I will continue to publish his name on the internet for the good work he is doing. Once again his contact email is smithherbalcure@gmail.com or you can call and whatsApp him on his number +2348102652355. His website is smithherbalcure.wordpress.com

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  • Hello everyone i am happy to say that i was cure from HIV/AIDS by Dr Osato with his herbal medications after i tested positive july 2016 and ever since then i have been on medications to extend my living on earth. One faithful day i was searching on line if i could get some tips on how to cure my illness and i saw a comment on how Dr Osato cure HIV with herbs,i was surprise and i contact him on the email they provided on the comment and i explain my problem to him and he also prepare the herbs and send to me which i use for one week as i was instructed by him and after 2weeks i went to hospital for checkup and i tested Negative and i am fully cured from the disease and i am so greatful to Dr Osato.You can also reach Dr Osato on his email: OSATOHERBALCURE@GMAIL.COM or you can call and whatsapp him +2347051705853

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  • Hello friends herpes has cure but doctor said herpes has no cure until i met Lord Noble help me in my life. I was infected with Herpes Genital in 2010, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution,so that my body can be okay.until this faithful day as i was browsing the net I saw a testimony on how Lord Noble helped people in curing HERPES disease, quickly I copied his Email which is (lordnoblespellcaster @ gmail .com)or lordnoblespellcaster @ hotmail. com) or /whats app or call him + 1(817)755-0129 so i contacted him for solution for my Herpes,so Lord Noble told me that his going to prepare herbal medicine for my health,then he prepared the medicine and luckily after two week my herpes was be cured.Lord Noble is well recognize as one of the best herbalist doctor in the world, you don't have to be sad anymore or share your tears anymore on this disease when the cure have already be found by Lord Noble herbal medicine,he so cure HIV,CANCER, ALS,HEPATITIS B, DIABETIC,contact him whats app via +1(817)755-0129 today and you will smile again

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  • Hello friends herpes has cure but doctor said herpes has no cure until i met Lord Noble help me in my life. I was infected with Herpes Genital in 2010, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution,so that my body can be okay.until this faithful day as i was browsing the net I saw a testimony on how Lord Noble helped people in curing HERPES disease, quickly I copied his Email which is (lordnoblespellcaster @ gmail .com)or lordnoblespellcaster @ hotmail. com) or /whats app or call him + 1(817)755-0129 so i contacted him for solution for my Herpes,so Lord Noble told me that his going to prepare herbal medicine for my health,then he prepared the medicine and luckily after two week my herpes was be cured.Lord Noble is well recognize as one of the best herbalist doctor in the world, you don't have to be sad anymore or share your tears anymore on this disease when the cure have already be found by Lord Noble herbal medicine,he so cure HIV,CANCER, ALS,HEPATITIS B, DIABETIC,contact him whats app via +1(817)755-0129 today and you will smile again

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  • This is real take it serious, who will believe that a herb can cure ten
    years HIV in my body, i navel believe that this will work i have spend a
    lot when getting drugs from the hospital to keep me healthy, what i was
    waiting for is death because i was broke, one day i hard about this great
    man who is well know of HIV and cancer cure, i decided to email him,
    unknowingly to me that this will be the end of the HIV aids in my body, he
    prepare the herb for me, and give me instruction on how to take it, at the
    end of the two week, he told me to go to the hospital for a check up, and i
    went, surprisingly after the test the doctor confirm me negative, i thought
    it was a joke, i went to other hospital was also negative, then i took my
    friend who was also HIV positive to the Dr, after the treatment she was
    also confirm negative . He also have the herbs to cure cancer please i want
    every one with this virus to be free, that is why am dropping his email
    address, solutioncenterhome@gmail.com..solutioncenterhome@outlook.com also drazizaspelltemple85@gmail.com email his website http:aziza181477517.wordpress.com or call +2347087771434 or whats-app and he is a great man.he can also cure you from other diseases like herpes,,fibroid,,,cancer,,hepatitis B and many more.. thank you for saving my life I promise to always testify of your good work God bless you Sir

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  • my name is Ali Uiiah i am form Indian but i live in USA I want to write about my great Doc who put the smile on my face again I was just hopeless when my family doctor told me there is no cure to this sickness HSV2, this horrible sickness really stress me out anytime I have outbreak well I very happy to have a normal life again since I meet Lord Noble who pull me out from this bondage, I was searching for cure in the internet when I found out about this doctor on a lady post that she was cured by him, I email him for help also and explain everything to him, then I was told by him there is cure to HSV 2 and I was so happy deep inside my heart, I requested for medicine that was how he sent it down to me with UPS and I have the cure within 4day, I only take the herbal medicine for just 2 week according to the doc instructed, after everything I book for appointment for test I was so happy when I have my result I was completely cured that is why I am writing this out for people to know there is cure to this sickness you can also email the doctor through lordnoblespellcaster@hotmail.com or lordnoblespellcaster@gmail.com or you can call or whatspp him on this number + 1(817)755-0129 this is my email ailullah129@gmail.com if you want to ask any question about him my name is Ali Uiiah

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  • I still do not know how to stop thanking you Dr Tebor

    I can’t believe this. A great testimony that i must share to all HERPES SIMPLEX VIRUS patient in the world i never believed that their could be any complete cure for Herpes or any cure for herpes,i saw people’s testimony on blog sites of how Dr Tebor prepare herbal cure and brought them back to life again. i had to try it too and you can,t believe that in just few weeks i started using it all my pains stop gradually and i had to leave without the herpes the doctor gave to me. Right now i can tell you that few months now i have not had any pain, and i have just went for text last week and the doctor confirmed that there is no trace of any herpes system on my body. Glory be to God for leading me to this genuine to Dr Tebor I am so happy as i am sharing this testimony. My advice to you all who thinks that their is no cure for herpes that is Not true ,j Here is his email: (Teborherbalcenter@mail.com) or call his number or Whats-App his Mobile number: + 2348153052125 his website,,,, https://teborherbalcanter.wordpress.com

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  • Hello everyone, Now this is to everyone out there with different health
    challenges, as I know there are still a lot of people suffering from
    different health issues and are therefore looking for solution. I bring you
    Good news. There is a man called DR IRABOR a herbal practitioner who
    helped cure me from hiv/aids, this i had suffered from for the past
    2years and i have spent so much money trying to survive from it. I got my
    healing by taking the herbal medicine he sent to me to drink for about
    9days after i got in touch with him through a friend of mine.3days after
    completion of the dosage, I went for a medical checkup and I was tested
    HIV/AIDS NEGATIVE. I’m sharing this so that other people can know of
    this great healer called DR IRABOR because I got to know him through a
    friend he cured from HERPES VIRUS. I was made to understand that he can cure several
    other deadly diseases and infections. Don’t die in ignorance and don’t let
    that illness take your life. Contact DR IRABOR through his email ;
    driraborhabalhome@gmail.com You can also call him on:+2348159922297 Thank
    you DR IRABOR. Be kind enough to share as you received.

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  • My name is Roseline Jude, i want to tell the world about how i got cured from
    HIV Disease by Dr. Ozala. i was Infected with HIV Disease for so many years
    and i was tired of life because of the sufferings i was going through, so
    one faithful day a friend of mine gave me a contact of a herbal doctor who
    cured her cousin from HIV Disease and immediately i contacted the Doctor on
    his email address: (drozalaherbalcure@gmail.com) and his whatsapp: +2348156857280 , and
    immediately the Doctor sent me a herbal medicine and told me to take the
    medicine only at bed time with is at night and i did and immediately the
    HIV Virus DISAPPEARED and i was cured from HIV Disease, the name of this
    Doctor is Dr Ozala.. so if you are infected with HIV Disease or any other
    dangerous and uncurable Disease then Dr. Ozala is the right man to be
    contacted for the cure. so kindly contact him now on his email: (drozalaherbalcure@gmail.com) or His Whatsapp
    number: +2348156857280 ... once again, Dr. Ozala thank you very much for
    what you did for me am very grateful...

    Here is His website for other kind of cures;

    dr-ozala-herbal-cure.business.site

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  • I was diagnosed with herpes since I was a child. My mother has them too, and does nothing to stop the spread. it was hard to not kiss my children all the time, but they grow up knowing that “when mommy has a lip owie, she can’t kiss.” They give me kisses on my forehead instead and we have extra hugs. It was also very painful to not kiss my partner. However, I was 100% determined to not pass this on to anyone, especially those I love.I mostly want to thank those who feel the way I do.
    dr saibu health herbs home helped me and my family to find happiness and peace ,their herbal remedies for herpes works like miracle,i was totally cured of herpes virus within 5 weeks of usage . for your herpes cure contact them today
    order online via call or whatsapp +2348064438762 address...
    you can also email them via drsaibu2@gmail.com

    they also have cure to the following ...
    HIV and AIDS
    DIABETES
    CANCERS
    ALS
    god bless us all !!!

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  • My name is Roseline Jude, i want to tell the world about how i got cured from HIV Disease by Dr. Ozala. i was Infected with HIV Disease for so many years and i was tired of life because of the sufferings i was going through, so one faithful day a friend of mine gave me a contact of a herbal doctor who cured her cousin from HIV Disease and immediately i contacted the Doctor on his email address: (drozalaherbalcure@gmail.com) and his whatsapp: +2348156857280 , and immediately the Doctor sent me a herbal medicine and told me to take the medicine only at bed time with is at night and i did and immediately the HIV Virus DISAPPEARED and i was cured from HIV Disease, the name of this Doctor is Dr Ozala.. so if you are infected with HIV Disease or any other
    dangerous and uncurable Disease then Dr. Ozala is the right man to be contacted for the cure. so kindly contact him now on his email: (drozalaherbalcure@gmail.com) or His Whatsapp
    number: +2348156857280 ...
    once again, Dr. Ozala thank you very much for what you did for me am very grateful...

    Here is His website for other kind of cures;

    dr-ozala-herbal-cure.business.site

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  • Lets join hands together and eradicate HIV and HERPES from this planet earth. Anybody who still think there is no cure for hiv or herpes should deviate from it because a cure has been found by Dr OMOZE. He uses herbs to cure these diseases. I am a living testimony of Dr OMOZE, he use his herbal medicine to cure me from HIV and HERPES. I was infected with two difference disease HIV and HERPES VIRUS which cost me my relationship and i could not bear the pains of living with the disease and loosing my boyfriend. So i went in search of getting the cure and i saw a comment on YouTube on how Dr OMOZE, uses his herbs to cure people of HIV and other diseases. I quickly contact him on the email that was present on the comment and told him about my illness and he prepare my medicine and send it to me through UPS service and he gave me instructions on how to take it and after i finish taking the herbs,i went to the hospital for checkup and behold the test shows that am HIV and HERPES negative. The doctors at the hospital rejoice with me and ask for Dr OMOZE contact. If you are in need of help to get the cure from Dr OMOZE, you can contact him on email: (omozespelltemple666@gmail.com) or you can call or whatsapp him on (+2348102799582).

    DR OMOZE CAN ALSO CURE THE FALLOWING DISEASES.

    1 Cancer of all kind
    2 Hiv/aids
    3 Low sperm count
    4 Barrenness
    5 Hpv
    6 Herpes
    7 Genital Wart
    8 Rare disease
    9 Hepatitis
    10 Zika virus
    11 ALS
    12 IF YOU NEED YOUR EX LOVER BACK
    Once again thanks to Dr OMOZE
    Email{omozespelltemple666@gmail.com] or whatsapp [+2348102799582]

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