GULU UNIVERSITY MEDICAL JOURNAL

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Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. HIV/AIDS stigmatization amongst the youths in Gulu, Northern Uganda. 1D.L Kitara, 2E, Odongo-Aginya, 2 SO Balmoi 1Dr. Kitara David Lagoro (PhD Fellow) (MBCHB, MMED, MPH, FCS (ECSA), PGD (PPM) Gulu University, Faculty of Medicine, Department of Surgery, P.O Box 166, Gulu, Uganda. 2Dr. Emmanuel Odongo-Aginya (PhD) Associate Professor of Parasitology & Immunology, Faculty of Medicine, Gulu University. 2Mr. Odong Stephen Balmoi (Dip. In Clinical medicine) Background Right from the beginning, the HIV/AIDs epidemic has been accompanied by an epidemic of fear, ignorance, and denial leading to stigmatization of and the decriminalization against people with HIV/AIDs and their family members (International center for Research on women, 2002). HIV/AIDs related stigma and the resulting discriminatory acts create circumstances that fuel the spread of HIV. The fear of being identified with HIV prevents people from learning their sero-status, changing unsafe behaviours and caring for the people living with HIV/AIDs. A study in Botswana and Zambia found that stigma against HIV positive people and fear of mistreatment prevented people from participating in voluntary counseling and testing and programs to prevent the mother to child transmission. The author argued that stigma and its resulting discrimination also intensifies the pain and the suffering of both people living with HIV/AIDs and their families. People living with HIV/AIDs are unfairly treated and or discriminated against because of their actual or suspected HIV status (Aggleton, Busza 1999), International center for Research on women 2002, Gilmore and Someville, 1994, Goldin 1994). Discrimination against people living with HIV/AIDs, apart from denying them their basic rights, and is also an ineffective public health measure. The London declaration on AIDs prevention following the world summit of ministers of health on programs for the HIV prevention in January of 1988 was the first international statement to recognize that “Discrimination against and stigmatization of HIV infected people and people living with AIDs and the population groups undermine public health and must be avoided.” Methodology This was a descriptive cross sectional study where both qualitative and quantitative data were obtained from amongst the youths in pece division in Gulu district. A structured questionnaire was administered to the youths of age ranging from 18 to 30 years in the Pece Vanguard parish in Gulu Municipality. Data was cleaned and analyzed manually. A total of 100 respondents were interviewed from a random selection of the respondents. The level of knowledge, attitude and practices regarding HIV stigma was assessed. Findings summarized in to tables, charts and graphs. Results The results showed that 52% of the respondents were male and 48% females, 51% of the youths did not know about HIV stigma, of those who knew and understood stigma, 74% of the them received the information from the radios, 10% from friends, 5% from the youth clinic. 97% of the youths knew the location of the youth friendly clinic. 43% of the youths did not test for HIV/AIDs because of fear of stigma. Only 4% of the youths would carryout stigmatization to their family members while 90% of the youths have practiced stigma on other people and are still willing to continue doing it as a method of HIV prevention. 56% of the respondents believe that stigmatization to HIV/AIDs is the only and sure way of reducing HIV infection. Conclusion There is sufficient knowledge (49%) about HIV stigmatization; however there is a poor attitude of the youths towards HIV stigma. 56% of the youths in this region believe that HIV stigma is the way forward in reducing the spread of HIV/AIDs. There is a poor Gulu University Medical Students’ Association (GUMSA) Passion for life 42
Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. practice where (90%) admitted to have practiced stigma on those they suspected of being infected with HIV/AIDs. Recommendations The ministries of health, Ministry of Education should help introduce HIV related stigma issues in the syllabus in the secondary and primary schools in order to reduce it amongst the youths. Prevention and mitigation of stigmatization on HIV person should be made in to policy, adopted and spread among the youths by the ministry of health. Introduction HIV/AIDs related stigma and discrimination has been called an epidemic in its own right (Mann 1987) and the single greatest obstacle to effective national response to HIV/AIDs. The concept and practice of stigma originated in the ancient Greece with the use of bodily marking to identify socially deviant or inferior members of the society (Varas Diaz et al). In the context of the HIV/AIDs epidemic, HIV related stigma is described as a process of devaluation of people either living with or associated with HIV and AIDs discrimination following stigma and is the unfair and unjust treatment of an individual based on his or her real or perceived HIV status (UNAIDs 2003). HIV/AIDs stigmatization & culture (HASD) HASD has been identified and described all over the world in both national population and ethnic subgroups with the most negative impact on a variety of issues ranging from HIV prevention and testing (Brooks et al 2005) access to treatment and care (Aggleton 2000), identity (Flowers et al 2006), (Hernandez and Torres 2005) disclosure of status (Liu et al, Clark et al 2005), there is greater stigmatization of particular groups due to preexisting prejudices against particular sexual lifestyle. In this study, the majority of the youths agreed that they could place stigma on their sister who were prostituting in order to discourage others from joining the group. Norman and Carr 2005, Norman et al 2006 found generally high levels of stigmatization among University students in Jamaica and significantly less sympathy for those considered “sex/gender transgressors”. Women were found more under HASD than men because of the presumption of promiscuityculturally unacceptable behaviours for women (Hong et al 2004) persons living with HIV/AIDs were able to evade much HASD through what Anderson (2007) calls “stigma avoidance strategies” the most important of these are limited to disclosure, deception and engaging in casual and doomed relationships or in no relationships at all, secrecy is then the key part of living with HIV. Norman et al 2006 found that most of the students they interviewed claimed that they would not place stigma on an HIV- positive family member or a friend, this non avoidance was associated with sympathy, HIV knowledge, education and awareness. This argument is also reflected in this research where 90% of the respondents admitted to have ever practiced stigmatization and that only 8.9% of them have ever placed it on their friend and only 4.5% of them have ostracized a family member as a result of sympathy they have for some of their family members they hold so dear compared to the 73.3% placed on someone known to them but 13.3% on strangers. The impact of stigmatization on the fight against HIV/AIDs: Stigmatization has exacerbated the problems faced by children orphaned by AIDs. Orphans encounter hostility from their extended families and communities and may be rejected, denied access to schooling and health care and left to fend for themselves. The wide spread of stigmatization is held accountable for the relatively low uptake of prevention of mother to child transmission (PMTCT) programs in countries where treatment is free. In Botswana for example, despite the fact that antenatal services is available and free in every antenatal clinic in the country, only 26% of the pregnant women availed themselves for the opportunity to protect their unborn children. Over half refused to take tests and nearly half of those who tested positive did not accept treatment. Despite the relatively cheap institutional support for HIV/AIDs, patients still shy away from the services (Mildmay center Mugisha Kemirembe et al 2000). At HIV clinic, patients seeking HIV/AIDs care and treatment were closely observed with regard to their social and psychological behaviours and the nature of the complaints they presented with or their relatives’ complaints. It was noticed that stigma was a major problem to the patients and their caregivers. Majority of the patients presented in stage III of the disease progression, with multiple opportunistic infections and would always be forced to the clinics by the relatives. Gulu University Medical Students’ Association (GUMSA) Passion for life 43
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