Effect of Stigma in the Management of HIV/AIDS Among HIV/AIDS Patients Receiving Care in General Hospital; Obi Local Government Area of Nasarawa State
Chapter One
Purpose of the study
The purpose of the study was to establish the impact of stigma and discrimination on the Management of HIV/AID in Obi Local Government Area, Nasarawa State, Nigeria.
Objectives of the study
The study was guided by the following objectives;
- To establish the level at which social rejection impact on the Management of HIV/AID in Obi Division, Nasarawa State,
- To assess the extent to which prejudiced attitudes impacts on the Management of HIV/AID in Obi Division, Nasarawa State,
- To assess how disclosure concerns impacts on the uptake of HIV counseling and testing services in Obi Local Government Area, Nasarawa State,
- To establish the extent to which observed enacted stigma impacts on the Management of HIV/AID in Obi Local Government Area, Nasarawa State,
CHAPTER TWO
LITERATURE REVIEW
Introduction
This chapter highlights the major concepts of the literature reviewed in relation to the study based on the following thematic areas; an overview of stigma and discrimination and HIV/AIDS prevention, social rejection and its impact on the uptake of Management of HIV/AID, prejudiced attitudes and its impact on VCT service uptake, disclosure concerns and its impact on VCT service uptake and finally the impact of observed enacted stigma on the uptake of Management of HIV/AID. The chapter also presents the theoretical and conceptual frameworks on which this study is based as well as a summary of the literature reviewed.
Stigma and Discrimination and Voluntary Counseling and Testing
HIV Voluntary counseling and testing (VCT) services are a key component of national aids programmes in sub-Saharan Africa. In terms of HIV prevention, post- test counseling sessions are an opportunity to provide education, and to promote strategies for reducing the risk of HIV transmission or acquisition among sexually active adults (WHO, 2004). Moreover, with the current expansion of antiretroviral therapy (ART) programmes, VCT sites are now acting as a gateway for HIV-infected persons to receive medical care beyond treatment for opportunistic infections (WHO, 2003). Indeed maximizing VCT use among HIV infected adults will be the first step to ensuring that they have the best chances of starting ART in a timely fashion, and that treatment coverage is as fair as possible. However, since the onset of the disease in the early 1980s, HIV and AIDS have triggered responses of fear, denial, stigma and discrimination, often targeted at those groups seen as the most affected for instance the drug users, sex workers among others. People living with HIV/AIDS have been rejected by their loved ones and their communities, unfairly treated in the workplace and denied access to education and health services. Fear of discrimination often discourages people from disclosing their HIV status, which make prevention and management of the disease very difficult.
HIV-related stigma and discrimination(S&D) has accompanied the epidemic from the start. Fear of and actual experience with stigma and discrimination reduce an individual’s willingness to practice prevention, seek HIV testing, disclose his or her HIV status to others , ask for( or give) care and support, and begin and adhere to treatment (USAID, 2006).
Stigma is described as an attribute that is deeply discrediting and results in the reduction of a person or group from a whole and usual person to a tainted, discounted one (Goffman, 1963), thus the ultimate effect of stigma as noted by Goffman is the reduction of the live chances of the stigmatized through discriminatory actions. Discrimination on the other hand is the negative acts that results from stigma and that serve to devalue and reduce the life chances of the stigmatized (Goffman, 1963). Stigma has its origin deep within the social structure of the society as a whole and in the norms and values that govern everyday life (Nylblade et al., 2003). Stigma and discrimination related to HIV/AIDS have been linked to misconceptions about the disease, fear of the disease due to its manifestations and fatality and to the association of HIV/AIDS with the stigmatized individuals in the community (Herek and Glunt, 1988; Boer and Emmons, 2004).
Social rejection and Management of HIV/AID uptake
Consequences of stigma can be viewed along a continuum from mild reactions for instance silence and denial, to ostracism. Many studies have found a close association between social rejection and uptake of Management of HIV/AID. The logic behind it is, having experienced rejection or observed others being rejected because of HIV and AIDS, few people if not none, will want their status to be revealed for fear of same rejection and would therefore rather not seek HIV testing. The pervasive perception that HIV can be relatively easily transmitted leads to behaviors that may be experienced as stigmatizing. This can include isolation of HIV patients in hospitals, isolation within families and avoidance by neighbors and the community more generally. The fear of being rejected in the family and the community has made people to decline using the Management of HIV/AID should they be found with the disease.
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
This section describes the methodology that was used in the study. It describes the research designs, target population, sample size and sample selection, the research instruments used, their reliability and validity and procedure for data collections. It also entails techniques for data analysis and finally ethical considerations in research.
Research Design
The research design employed in this study was descriptive survey which involved quantitative approaches. This design, at a glance, makes the researcher to identify what is in the whole population considering the nature of data needed and the resources that are available, being always limited, this design was the best for this study. Descriptive survey design enabled the researcher to describe the population with respect to a given outcome and to collect information on many variables from a large number of respondents and hence it was an efficient way of collecting information for this particular study since it involved a large population. Descriptive survey was also suitable as they are flexible in the sense that a wide range of information such as perceptions, attitudes, values, beliefs and past behaviors can be collected, which is the case for this study. Given the nature of this study, a lot of information was solicited ranging from the socio-economic profile to measures of stigma and discrimination, therefore survey was most appropriate for this study.
Target population
Target population is a set of individuals, items and objects with some common observable characteristics (Mugenda and Mugenda, 1999). The study was conducted in Obi, one of the Divisions in Nasarawa State. Obi Local Government Area is situated in the south west of Nasarawa town and covers a total area of 194.6 square kilometers with an estimated population density of 205 per square kilometers. The area has 6 locations and 13 sub-locations with a total population of 45,879 and 9,946 households (Census Report, 2009) as shown in Table 3.1. The area is predominantly inhabited by the kipsigis and Ogiek sub-tribes of kalenjins, with the main economic activities being subsistence farming, tea farming and livestock rearing.
This study targeted persons between 15-64 years of age which was calculated as a proportion of total number of people between ages 15-64 years in the whole State. The total population of Nasarawa State was estimated to be 1,621,802 by 2010 (Nasarawa district Strategic Plan, 2005-2010) as shown in Appendix III. Those between the ages of 15-64 years, which the study intended to use, was a total of 867,483 and therefore the proportion of the target population for the entire State was calculated as 867,483/1,621,802 which is equivalent to 0.5348884 or 53.48884%. The obtained proportion was then used to estimate the target population in Obi Local Government Area with a total population of 45,879 as 45,879 x 0.5348884; this gave 24,540 as the target population to be used to obtain the desired sample size.
CHAPTER FOUR
DATA ANALYSIS, PRESENTATION, INTERPRETATION AND DISCUSSIONS
Introduction
This chapter presents research findings of the study which have been discussed under thematic sub-sections in line with the study objectives. The thematic areas include demographic characteristics of respondents, uptake of Management of HIV/AID among the respondents, social rejection and uptake of Management of HIV/AID, prejudiced attitudes and uptake of Management of HIV/AID, disclosure concerns and uptake of Management of HIV/AID and finally observed enacted stigma and uptake of Management of HIV/AID. Hypothesis testing is also done on each of the main objectives of the study. This chapter also presents a logistic regression analysis on uptake of Management of HIV/AID while controlling for demographic factors and indicators of stigma and discrimination.
CHAPTER FIVE
SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS
Introduction
This chapter summarizes the major findings, conclusions, recommendations of the study, contributions to knowledge and suggestion for future research.
Summary of findings
From the data analysis, interpretation and discussion in chapter four, the study came up with a number of findings which are discussed thematically in this section based on the themes as was discussed in chapter four.
From the demographic data, it was found that majority of men (64.3%) and women (61.6%) were aged 35 years and below and that most of them were married (65.8%). Looking at the level of education, it was established that more than 70% of the respondents had at least acquired a secondary education. The main source of livelihood for these respondents came out clearly to be farming/animal raising (43.6%) and trade/business (27.5%). On the religious affiliation, majority of the respondents were protestants (63.9%) followed by Catholics (18.3%).
On the level of HIV testing uptake, findings from the study revealed that most respondents (66.1%) have had an HIV test which was equally distributed across gender, although a significant number (33.9%) had not tested for HIV. It was established that the major motivators for testing were personal decision and were expected to have sought testing themselves in VCT. Most notably, health care workers had played a major role in convincing people to carry out an HIV test. It was also revealed that a good number of people had been tested as part of treatment.
The study also highlighted reasons for not being tested for HIV by the respondents. Among the untested female and male respondents, the most commonly cited reason for not being tested was perceived no risk due to age or religion (42.6%) followed by lack of testing points or testing points too far from them (30.3%). However, some respondents reported that they had not tested because of fear of stigma and discrimination (19.7%).
On the impact of social rejection on uptake of Management of HIV/AID, the study established that the main social rejection contributor to stigma and discrimination which negatively impacts on uptake of Management of HIV/AID is the belief that it is not safe for someone to buy food from a vendor who is HIV positive and who is visibly sick where a total of 219 (60.8%) would not buy food from HIV positive people who are visibly sick. The study also revealed that having social rejection stigma reduces the odds of going for an HIV test by 2.214 (p<0.001). It is worth noting that majority of the respondents have knowledge on HIV transmissions, a factor always known to be instrumental in escalating social rejection stigma. For instance, a higher percentage disagreed with the statements which measured the level of social rejection: “I could become infected with HIV if I share a cup with a person living with HIV/AIDS” (81.7%), “your child could become infected if he/she interacts with a child who has HIV/AIDS” (76.7%) and “you could become infected if you live with a person living with HIV/AIDS” (78.1%). Majority of these respondents were more likely to have gone for an HIV test also. There was an association between uptake of Management of HIV/AID and social rejection where social rejection stigma reduces the chances of testing.
On objective two that investigated the impact of prejudiced attitudes on uptake of Management of HIV/AID, it was established that the major contributor of prejudiced attitude stigma is the belief that HIV is a punishment from God followed by the belief that HIV positive individuals are promiscuous. A significant number (47.3%) reported that they would feel ashamed if they were infected with HIV/AIDS. Majority of the respondents did not have any reason to be ashamed if someone in their family had HIV and AIDS. Many were also of the contrary opinion when they were asked whether they think HIV infected people should be ashamed of themselves. Although bivariate analysis did not show any significant difference between uptake of Management of HIV/AID and prejudiced attitudes (p<0.058), multivariate analysis showed presence of association between the two variables, where having prejudiced attitudes increased the odds of going for testing by almost 0.5 (p<0.001). On average, those who had prejudiced attitudes were more likely to have tested compared to those who did not have.
Conclusions
From the summary of findings, the study came up with some conclusions. The study concluded that religion and age category, among the demographic variables, had a significant impact on Management of HIV/AID uptake in Obi Local Government Area, Nasarawa State. However, it was noted that marital status, gender, level of education and source of livelihood did not have any significant influence on the uptake of Management of HIV/AID.
The study concluded that social rejection stigma impacts negatively on the uptake of Management of HIV/AID. Even though majority of respondents did not have social rejection stigma, those who reported having this stigma were less likely to have gone to VCT for testing. It was also concluded that respondents had adequate knowledge on the modes of HIV transmission which usually culminates into stigma and thus most of them were less likely to have social rejection stigma. On the same objective, the study found out that the main social rejection contributor to stigma is the belief that it is not safe to buy food from a person living with HIV/AIDS who is visibly sick.
On objective two, the study concluded that the belief that HIV is a punishment from God, that HIV belongs to people who are promiscuous was most prevalent among the respondents and were more likely to influence negatively on the uptake of Management of HIV/AID. However, having prejudiced attitudes were more likely to increase the chances of going to a VCT for testing, and therefore, prejudiced attitudes was positively associated with uptake of Management of HIV/AID. This was so because those who agreed to the statements that gauged whether respondents had these attitudes were almost equally distributed between those who had tested and those who had not tested. The study also concluded that many people would feel ashamed if they test HIV positive and this was thought to influence negatively on the uptake of Management of HIV/AID.
On objective three, the study concluded that disclosure concerns had a negative impact on the uptake of Management of HIV/AID. Those who had disclosure concerns were less likely to have ever tested. The most prevalent disclosure concern was public disclosure of HIV positive status. Majority of respondents did not know of someone who had disclosed his/her status publicly and also majority of them were not ready to disclose their status if they were tested HIV positive. This was found to have adverse impact on the uptake of Management of HIV/AID. The study also concluded that the main ways of knowing one’s HIV positive status in the community was through gossiping and when an HIV positive person is physically ill. This was found to discourage others from seeking to know their status.
Lastly, the study concluded that having observed someone being stigmatized and discriminated against were more likely to motivate one to go for testing, however, having observed someone being gossiped about shunned away many others from knowing their status. Majority of the respondents who had observed others being gossiped about because of their HIV positive status were less likely to have ever tested. This clearly is an indication that people fear being gossiped about and thus would prefer to remain untested. Generally the logistic regression output revealed that having observed stigma were likely to increase the chances of having ever tested.
Recommendations
The following recommendations should be implemented with a view of improving access to Management of HIV/AID, reducing stigma and discrimination and thus contributing to better health seeking behavior among the people.
- The association between acceptance of HIV testing and religion calls for a close working relationship between the church and the National AIDS Control Council in promoting Management of HIV/AID and community discussions and social mobilization around HIV/AIDS.
- The study also established that there is need to call for aggressive mobilization in the community and promotion of HIV testing services and, especially which will enable the common man in the villages to go for an HIV This recommendation is based on the research finding that people have not tested because of lack of testing points or testing points too far from them.
- The study also recommends the need to promote accepting attitudes towards people living with This includes educational, advocacy and community mobilization interventions to help reduce AIDS stigma by sensitizing the public to accept people living with HIV/AIDS as they are.
- The study also recommends the need to develop programmes that aim to combat stigma and discrimination and funds be allocated to such programmes so as to help in sensitizing the public about HIV and AIDS and its related stigma and Such programmes will be instrumental in educating people on the importance of HIV positive status disclosure, demystifying myths about HIV/AIDS and modes of transmission and infection and also in ensuring positive attitudes are accorded to those who are infected. This will ensure reduced stigma on HIV/AIDS.
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