Stigma and the social context of ART in KwaZulu-Natal, South Africa

• Main Author: Fitzgerald, Molly Louise
• Published: London School of Hygiene and Tropical Medicine (University of London) 2008
• Subjects: 362.196979209684
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.499998

The thesis presents findings from a qualitative study about the social context of Anti- retroviral therapy (ART) in rural South Africa. The study involved in-depth interviews with People living with HIV/AIDS (PLHA) at enrolment into ART (n=30) and at four months of treatment (n=26); caregivers (n=9) identified by the ART participants; health care providers (n=5) associated with the hospital-based ART clinic, and traditional healers (n=S). The research aimed to: 1) identify what forms and expressions of stigma exist in the social care context of participants enrolled in treatment; 2) explore how stigma influences social interactions over the course of ART therapy; and 3) understand the consequences of social interactions for treatment and health of ART initiators. Stigma was examined and disentangled from other key factors that potentially interfere with optimal treatment and health outcomes. The study explores the interplay of stigma and power through disclosure of HIV status and the event of initiating ART. The data is organised using Joffe's (1999) framework, which emphasizes that individuals establish both group identities as well as shared representations of risk within the historical and present day culturally situated contexts (Joffe 1999). The emphasis on maintaining a positive notion of identity remains consistent with an interpretation of Goffman's concept of stigma as a process of spoiling identity. Underlying study aims was the broader intention to improve the understanding of linkages between individual and contextual factors related to HIV / AIDS stigma. Social roles, including Parsons' (1982) "sick role" are used to understand expectations and obligations associated with identities, including PLHA. I examine the process of social discrediting identity by looking at the effect of language and by examining roles.