Tuesday, February 5, 2013

AIDS and Shame

AIDS and Shame
It is unfortunate that after more than 25 years since the discovery of the initial cases of AIDS the stigma that is associated with the disease has remained one of the most significant hindrances to public action. Regardless of the various awareness campaigns all over the world, including Africa, about the epidemic, people have remained adamant to test whether or not they have the virus. Additionally, for some of those who are diagnosed with the virus, they are still reluctant to seek medical treatment (Pieter, 72). There is still fear of the stigma and the social disgrace that has historically been associated with the disease. Different leaders in Africa has argued that a huge step has been made towards addressing the issue of shame that impends testing and seeking treatment for those infected with the disease. Some have suggested that their nations have seen a major achievement towards this end. However, this argument is unfounded based on the studies that have carried out even by international researchers that have revealed a major problem in as far as testing and treatment of the disease (Hunter, 15). This paper borrows from Sizwe's Test by Jonny Steinberg in proving the fact that regardless of the argument of most African leaders that huge steps have been made towards addressing the issue of Aids and shame, there remains a huge problem in that many people have continued to refuse testing and treatment.
According to Pieter (2006), various efforts are argued to have borne fruits in most African countries in as far as AIDS is concerned. Initiatives to create awareness have been launched in these countries, including some with support from the international community. The various initiatives as well as campaigns that have been used in the efforts to curb the spreading of the epidemic in Africa have reported positive results. Some of the campaigns and initiatives like the Abstinence be faithful, use a condom or ABC campaign have been in place for a long time. Research into these initiatives and others continue to reveal significant improvement in the creation of awareness among the African people regarding the presence of the disease and the importance of testing and treatment (Kelly and Birdsall, 1583).  
However, regardless of these supposedly positive efforts, AIDS remains a major problem in the continent because of the prevalence of stigma and the shame associated with the disease. People in most African countries are still not interested in knowing about the epidemic. Researchers have noted various cases of people who have refused to test or seek treatment in case they are found to have the virus (Mbonu, van den Borne and De Vries, 3). The shame that is associated with the diseases has had detrimental effects on the efforts to take fast and effective actions towards addressing the epidemic. According to the United Nations Secretary General, Ban Ki Moon, “Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world” (Lengauer, Altmann, Thielen and Kaiser, 2010:67). 
Regardless of any argument that significant steps have been made to stop discrimination of the people diagnosed with AIDS, discrimination is still prevalent in most African communities. Discrimination against those infected by AIDS refers to the situation where the individual is discriminated against, treated badly or oppressed due to their real or perceived HIV status. Stigma and discrimination attached to AIDS is the prejudice, abuse, negative attitudes, and maltreatment that are directed to those suffering from the disease (HIV/AIDS Policy Fact Sheet, 2). According to Iwelunmor and Airhihenbuwa (2012) there are various cases of individuals suffering from the disease being rejected by their families, peers and the society in general. Some have experienced poor treatment in education, healthcare and employment. Individuals have been fired from their employment, removed from their homes, and denied access to health care and social services because of their HIV status. Others have had their businesses affected just because they are diagnosed with the disease. This has been as a result of the shame that is associated with the disease (Hunter, 36).  
In some African communities, a person suffering from the diseases is feared because of the fear of infecting others. Some living with the disease are quarantined in fear of infecting others. Stigma and discrimination associated with the disease exists in every part of the continent regardless the fact that they manifest themselves in varying magnitudes. They manifest themselves in a different way across communities, religious groups and individuals. They happen alongside other kinds of stigma and discrimination like homophobia, racism, or misogyny (Mark, 561). They can even be directed to the people who are known to involve in what are taken as socially objectionable behaviors such as drug use and prostitution. In most of the African nations, AIDS has been associated with immorality and other negative social behaviors. As such, people fear to test in case they test positive and are discriminated against by their society (Mbonu, van den Borne and De Vries, 6).
Fear of infection exists which is coupled with the negative view of the people who are infected. There are number of factors that have been known to contribute to the stigma and shame that are attached to AIDS. One of the reasons is that the disease is life-threatening and this makes individuals to react to it in a negative manner.  Infection with the disease is associated with immorality and other socially unacceptable behaviors such as homosexuality, prostitution, drug abuse and promiscuity. Such behaviors are already shameful and stigmatized in the society. Most of the people who are infected with the disease are known to acquire it through sexual acts, which by themselves have a moral baggage (Hunter, 128).
In most African communities, individuals have also been misinformed in as far as the disease is concerned. Religious as well as moral beliefs in the society have caused people to belief that AIDS is as a result of moral fault that deserves punishment. The fact that this disease has appeared in the modern period also makes the stigma attached to it even worse. The fear and shame that was associated with the epidemic as it emerged in the 1980s is still fresh in the minds of many people (Mark, 561). From the time it emerged, a serious of strong and powerful images were utilized to justify and reinforce stigmatization and shame. Such images include: as a punishment for immorality and other antisocial behaviors, as a crime related to the guilty and innocent victims, as warfare in relation to a virus that had to be fought, as revulsion in which the infected should be feared and demonized, and as otherness in which is an suffering for the people set apart to suffer (Mbonu, van den Borne and De Vries, 8).
Shame and stigmatization has kept many people in the African continent from getting tested and treated for the disease, regardless of most having the knowledge of treatment programs such as antiretrovirals. A good illustration of this situation is given by Steinberg in Sizwe’s Test. Sizwe is aware of the availability and accessibility of ARVs, and even urges some of his people to get tested for the virus.  He is also one of the most people in the continent who are at risk of the virus because of having unprotected sex with many partners. However, just like many other individuals in his society, he refuses to test for the virus, although he is ready to settle down in marriage (Steinberg, 16-19).   
Various factors are playing a major role in most parts of the continent in the refusal to get tested and treated for the virus. Lack of privacy has emerged as one of the reasons for this problem. The lack of privacy coupled with low levels of literacy and a lack of understanding are contributing a great deal to the failure to seek intervention for the disease. Testing positive for HIV in such communities is a huge shame and all members of the community will know. Knowing one’s HIV status, in case it is positive is opening the door to negative attitudes, stigmatization and discrimination in such as community. People will always speak about those infected in a negative manner. This kind of behavior discourages people from getting tested and seeking treatment in case they test positive for HIV (Steinberg, 22-24).
Besides the nature of the society, testing positive for HIV is a source of weakness and vulnerability. For individuals, who hold a respectable place in the society, HIV is the last problem they want to face.  From this perspective, those individuals would rather stay without knowing their status or even fail to seek treatment for fear that their weakness or vulnerability will be exposed. Most of the people who are aware of their status will keep it a secret because they are afraid of the negative consequences of exposure. For those who are not married this is especially a major problem because no one will be prepared to marry a sick person. Some people get into marriage without testing for the disease because of the fear of knowing that they are positive and risking rejection (Kelly and Birdsall, 1585).
Besides this, most people in the community view sickness as bewitchment or as a result of some evil forces. This is a major factor behind the lack of testing and treatment. Sickness is seen as evil powers sent to the individuals by the ancestors or other people wishing them ill. As a result, the knowledge that one is sick from such an evil disease is something to be afraid of. This is especially a major problem given the fact that it interferes with man’s ability to procreate. Procreation in the African community is one of the most important aspects of the society. Any attack on this ability is viewed negatively and is normally a source of shame. This is especially a great problem in poverty stricken areas where their hope rests in the ability to reproduce (Kelly and Birdsall, 1587).
Iwelunmor and Airhihenbuwa (2012) posit that The kind of life that exists in the African continent strengthens stigma and shame associated with HIV/AIDS. Most of the communities in Africa live a communal life. This is an important element of the society because of the social support especially in care for the sick. However, as far as AIDS is concerned, this has played negatively especially in the efforts to fight the scourge. Stigma is used by communities and individuals in this setting, as well as in cultures were communal life exists. Stigmatization forms part of a conservative re-assertion of power associations, poverty, or moral power that rests on the capacity to control sexuality. Due to the fact that the community labels people living with AIDS as the “other”, individuals in the community seeks to secure the social structures solidarity and safety by casting out reprobates or re-affirming societal values. People living with AIDS are regarded as outcasts whoa are no longer able to contribute to the development and wellbeing of the community. For example, surveys have showed that some women fail to disclose their HIV status as they are afraid of not being able to participate in the socio-cultural element of food preparation because food is considered an element of support and acceptance. The society has seen people refuse to buy or eat food from women who are diagnosed with the virus (Mbonu, van den Borne and De Vries, 10-11).
Studies have also shown stigmatization of family members of an individual living with the disease or one that has died from AIDS. For this reason, people with the disease are discouraged by members of their families to remain silent about their condition to avoid shame or social rejection. In some cases getting assistance from the government too enhances a view of difference from the rest of the community given the assumption that there are only people living with AIDS who are assisted by the government in a community that is poor and in need for support (Mbonu, van den Borne and De Vries, 13).  
Stigma is a major hindrance to efforts to address the issue of HIV/AIDS. This is because it supports denial and secrecy, important factors in catalyzing transmission of the virus. Regardless of the argument that response to people living with the disease varies, with some individuals being able to receive adequate support, the stigma or shame associated with the disease affects seeking testing, receiving care once diagnosed, quality of care provided to those with the virus, and lastly the negative perception and treatment of people living with the disease by their families and communities, including partners. It also isolates those who are sick from their communities and become detrimental to their wellbeing.  Research into HIV-related stigma in Africa has been going on for a long time, which is informing policies and intervention programs. However, it has been recognized that effective treatment and care interventions necessitate a clear understanding of the cultural context within which stigma exists (Mbonu, van den Borne and De Vries, 14).

Work cited:
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Funding And Governance Mechanisms On The Development Of Civil-Society Responses To HIV/AIDS In East And Southern Africa." AIDS Care 22.(2010): 1580-1587
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