nursing and midwifery - text



Stigma is often a response to things that people fear. In the past, HIV stigma was cultivated because HIV was perceived as a life threatening infectious condition associated with sexual behaviour. As such, attaching stigma to the condition created an ‘us’ and ‘them’ and produced ‘innocent’ and ‘blameworthy’ sufferers. In this process, while the ‘us’ feel safe and protected, the ‘them’ feel vulnerable and devalued. 

Stigma can be defined as, either, received (or felt) stigma or internal (or anticipated) stigma. It is important for health care professionals to understand how internalized stigma means that people affected by HIV can come to expect negative reactions, fear them before they occur, and, even experience them when they don’t occur. For example, some of the women participating in our research recounted times when conversations or things that other people said about HIV had led them to be careful about disclosing their status, in order to protect themselves and their family from any unfavourable reactions. Stigmatising actions and behaviour have no place in health care where the primary goal is to maintain compassion, dignity and respect.

Internal or anticipated stigma is demonstrated in the following story, where Lisa anticipates what people might think about her when they know she is HIV positive.....



Internalised stigma can leave a person feeling isolated and unsupported at a time when they most need that support. Sue describes how she would have loved to talk about her HIV and compares it to other diseases...



Stigma can lead to discrimination

Stigma has been described as an attitude while discrimination has been described as behaviour. Discrimination is when we subject someone to some kind of less favourable treatment because they are associated with a particular group. HIV related stigma and discrimination refers to prejudice, negative attitudes, abuse and maltreatment directed at people living with HIV. The consequences of stigma and discrimination are wide-ranging. Examples of HIV discrimination are: 

  • Placing an ‘Out of Order’ sign on a toilet and asking that the HIV positive person only uses that toilet
  • Refusing fertility advice because one partner is HIV positive

It is illegal to discriminate in areas like healthcare and employment due to HIV and the Equality Act (2010) and the Disability Discrimination Act (2005) provide some protection against discrimination for people living with HIV.

HIV related stigma and discrimination affect the person psychologically, socially and impact on health and wellbeing.  Some people with HIV may experience double stigma e.g. from also being African, gay or mentally ill, thereby deepening the impact on their health.

Rachel describes how she felt stigmatised by the use of hazard stickers and also how one midwife with knowledge of HIV associated stigma took on board the significance of this and her distress that this might be a 'sign' to her visitors....