Journal Article

Stigma, Structural Vulnerability, and “What Matters Most” Among Women Living With HIV in Botswana, 2017

Eisenberg, Marlene M., Link, Bruce G., Mehta, Haitisha T., Opondo, Philip R., Yang, Lyla S., Arscott-Mills, Tonya, Poku, Ohemaa B., Becker, Timothy D., Blank, Lilo I., Misra, Supriya, Rampa, Shathani, Entaile, Patlo, Dai Cao, Thi Xuan, Yang, Lawrence H., Blank, Michael B., Ho-Foster, Ari R.

2021

Overview

Objectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from “what matters most” in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners’. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner’s status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as “promiscuous” and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies.

• Publisher: American Public Health Association
• Subject: Acquired immune deficiency syndrome / Adult / AIDS / Blame / Botswana / Codes / Cultural groups / Cultural identity / Culture / Female / Focus groups / Gender / Gender inequality / Gossip / Health care / Health care policy / Health policy / Health services / HIV / HIV Infections - diagnosis / HIV Infections - epidemiology / HIV Infections - psychology / Human immunodeficiency virus / Humans / Inequality / Interviews as Topic / Local culture / Male / Medical tests / Men / Methods / Middle Aged / Mothers / Personhood / Pregnancy / Pregnancy Complications, Infectious - diagnosis / Pregnancy Complications, Infectious - epidemiology / Pregnancy Complications, Infectious - psychology / Prenatal care / Prenatal Care - organization & administration / Public health / Qualitative Research / Research & Analysis / Social Stigma / Socioeconomic Factors / Stigma / Tests / Vulnerability / Womanhood / Women / Womens health