‘We are Not Fresh’: HIV-Positive Women Talk of Their Experience of Living with Their ‘Spoiled Identity’

Women have been identified as being at greater risk than men in South Africa's growing HIV epidemic. Stigma contributes to the epidemic, as it makes HIV-positive individuals reluctant to become identified and seek appropriate care. The purpose of this study is to begin to explore how women experience and deal with AIDS stigma under conditions where they have little formal support. In-depth, narrative interviews were conducted with ten HIV-positive women, living in a poor, black township in Cape Town. The study used both social constructionist and psychoanalytic theory to understand the impact that their ‘spoiled identity’ had on the emotional lives of these women. The study elicited women's narratives as they talked about their experience of living with a ‘spoiled identity’. The analysis suggested that the women drew on negative social discourses around HIV, which were then internalised, to become part of the self. However, the narratives also indicated the women's resistance to their stigmatised identity. The narratives illustrated their attempts to fend off the ‘spoiled identity’ by splitting off these bad representations and projecting them outside of themselves.

Women living with HIV/AIDS (WLHA), battling stigma, discrimination and denial and the role of support groups as a coping strategy: a review of literature

BACKGROUND AND OBJECTIVES

Women living with HIV/AIDS, in particular, have been positioned as a latent source of infection, and have captivated culpability and blame leading to a highly stigmatised and discriminated life. Despite the situation, women and their particular concerns have largely been ignored in HIV/AIDS research literature. This review aims to examine and analyze the feelings, experiences and perceptions of Women living with HIV/AIDS (WLHA) and will also access the role of support group as a coping strategy on the basis of 7 primary researches conducted in or on different parts of the world.

METHODOLOGY

A systematic literature search was carried out on major data bases ASSIA, CINAHL, Science Direct, Web of Knowledge, Wiley Inter Science, AMED, Pub Med/Bio Med Central, MEDLINE and Cochrane Library. The articles included for review purpose were gauged against the pre-defined inclusion/exclusion criteria and quality assessment checklist resulting in a final 7 papers.

FINDINGS/RESULTS

The findings were compiled into five thematic areas: (1) Disclosure as a sensitive issue; (2) Stigma and Discrimination associated with HIV/AIDS and the multidimensional effects on women's health and wellbeing; (3) Internalised Stigma; (4) Women living with HIV/AIDS experiences of being rejected, shunned and treated differently by physicians, family and close friends; (5) Support Group as among the best available interventions for stigma and discrimination.

CONCLUSION

Support groups should be offered as a fundamental part of HIV/AIDS services and should be advocated as an effective and useful intervention. Further research is needed to examine the effect of support groups for women living with HIV/AIDS. A community based randomised controlled trial with support group as an intervention and a control group could provide further evidence of the value of support groups.

Balancing between normality and social death: Black, rural, South African women coping with HIV/AIDS

The millions of people living with HIV/AIDS are in urgent need of effective care and support interventions. Such interventions should take people's reported needs, coping strategies, and context into account. Usually, active problem-focused coping strategies have been encouraged because they are considered to be more beneficial than passive emotion-focused strategies. However, this may not be the case in the South African context. This study was based on in-depth interviews with Black, rural, South African women about their coping strategies. The overriding aim of coping was to solve the tasks of physical, psychological, and social survival. Strategies involving avoidance of, escaping from, or minimizing HIV/AIDS and its accompanying emotional distress were predominant. We argue that such strategies could be adaptive in a society with scarce resources and marked by gender inequalities. Our findings suggest that care and support interventions should be sensitive to culture and context, should be holistic and participatory, and should include income generation and child care services.

HIV/AIDS and 'othering' in South Africa: the blame goes on

In order to explore the relevance of social concepts such as stigma and denial to the transmission of HIV, this qualitative study sought to examine cultural and racial contexts of behaviour relevant to the risk of HIV infection among South Africans. A cultural model was used to analyse transcripts from 39 focus group discussions and 28 key informant interviews. Results reveal how cultural and racial positionings mediate perceptions of the groups considered to be responsible and thus vulnerable to HIV infection and AIDS. An othering of blame for HIV and AIDS is central to these positionings, with blame being refracted through the multiple prisms of race, culture, homophobia and xenophobia. The study's findings raise important questions concerning social life in South Africa and the limitation of approaches that do not take into account critical contextual factors in the prevention of HIV and care for persons living with AIDS.

Sex, Sexuality and Sickness: Discourses of Gender and HIV/AIDS among Kwazulu-Natal Women

Current HIV-prevention work indicates that simply providing HIV-related information plays a limited role in changing sexual practices, and instead stresses the need to address the social and cultural forces shaping individual behaviour. The aim of this study was thus to explore the social influences that shape women's sexual behaviour with specific attention given to discourses of gender and HIV/AIDS. Material was generated through seven focus group discussions with black women living in a peri-urban area in Durban, and was interpreted using discourse analysis. The study clarified the ways in which women are not necessarily in a position to make purely rational, individual decisions about safe sex, since these decisions are intimately linked to social constructions of sexuality and the power relations that operate in cultures. It identified specific cultural practices linked to the organisation of gender roles and how these influence safe sex practices. The analysis then examined the implications of these findings for future HIV/AIDS education interventions.

Three educational and moral questions regarding AIDS among South African education students

Two objectives were explored: the extent to which undergraduates supported the admission to school of children with HIV, whether HIV sufferers were to blame for their illness, and AIDS was direct punishment from God. While 93 of 164 respondents did not think AIDS was punishment from God and 105 did not support exclusion of school children with AIDS, 75 and 49 held the opposite views, respectively. There was no conclusive support for whether HIV carriers were to blame for their disease: 70 responded yes, 75 no, and 12 I don't know.

Stigma and rejection: living with AIDS in villages in southern Thailand

The problems that face HIV/AIDS patients are now fairly well documented. These include experiences of guilt, anger, grief, fear of abandonment, and potential economic hardship and marginalization due to others' fear of infection and associated stigma. However, limited attention has been paid to the effects of AIDS-related stigma on access to, and the provision of, health services. Understanding how the stigma of AIDS affects the processes and experiences of diagnosis, treatment, prevention, and care is critical to effective public health policy and the delivery of health care programs and medical services. In this article, we examine stigma as experienced by people with HIV and AIDS, and by their families, in village Thailand. We also identify areas for improvement pertaining to people with HIV/AIDS and other stigmatizing diseases.

Dirty, diseased and undeserving: the positioning of HIV positive women

The discursive construction of HIV/AIDS associates deviance and disease. Women living with HIV/AIDS, in particular, have been positioned as a source or potential source of infection, and have attracted guilt and blame: in becoming 'disease' they have failed in their appropriate roles as carers and nurturers, responsible for the next generation. Based on in-depth interviews with 27 women living with HIV/AIDS this paper focuses on three ways of positioning HIV positive women: through discrimination on the part of medical professionals; through internalisation of stigmatisation; and through multiple stigmatisation of women who are or have been illicit drug users or sex workers. The implications of stigmatisation are discussed in relation to accessing health care and support.