Cost of stigma, here and abroad

AIDS came home for my family when my mother, a nurse practitioner who cared for HIV-positive patients in the late 1980s, had a needle-stick accident. After injecting medication into a patient, she had pricked herself with the same needle, potentially exposing herself to the virus. She dodged the bullet, but many of her patients, well-loved members of our community, did not.

For this reason, I read with interest a recent feature article in the journal Science. It detailed how AIDS has shifted over 31 years from a disease of white, economically secure gay men on the coasts to one of poor African Americans – gay and straight – in the South, home to 43 percent of the country’s HIV-infected people. The virus has followed a trail of poverty south.

In an interview following publication of the article, Michael S. Saag, M.D., director of the UAB Center for AIDS Research, talked about how one contributor to the spread of HIV in the Deep South is fear. AIDS symptoms are ignored or hidden more in the African-American community due to cultural differences with respect to tolerance of homosexuality, says Saag. Being gay is taboo in both African-American and white communities, he says, but is especially so among African Americans, and even more so among African-American churchgoers.

Saag also recently recommended that I cover a study published this week in the journal PLOS Medicine by his colleague, Janet Turan, Ph.D., associate professor in the Department of Health Care Organization and Policy at the UAB School of Public Health. Her study found that fear, this time of being labeled HIV-positive, was contributing to the spread of HIV in Kenya.

Fear of stigma was strong enough to keep mothers in one Kenyan province from having babies in health-care facilities because their communities had come to see such places as mostly for HIV-positive women, according to Turan’s study. Specifically, her team found a close link between HIV-related stigma and the fact that just 44.2 percent of mothers in Nyanza Province deliver their babies in facilities with skilled caregivers.

Professional help greatly increases the chances that any mother, HIV-positive or not, will survive childbirth, which takes the lives of more than 250,000 women in developing nations each year. In Nyanza, a region where one in five pregnant women is HIV-positive, skilled care during pregnancy and birth also increases the likelihood that those infected will receive antiretroviral drugs that prevent the passing of HIV from mother to child. Sadly, past studies in the region have reported that being labeled HIV-positive links women with promiscuity in the eyes of their families, often causing them to be abused by male partners, who are less likely to visit clinics or be tested for HIV themselves.

Many Kenyans think the region’s clinics are the best place to give birth for women with pregnancy complications, but women who do choose to use the clinics—over home births with traditional attendants—run the risk of being labeled HIV-positive. The stigma is so strong that many people have adopted a low opinion of anyone living with HIV, and not without cost. The study found that women with such opinions were about half as likely to deliver their baby in a health facility as those without them.

Government campaigns seeking to halt mother-to-child transmission of HIV may actually be part of the problem, Turan says. By urging HIV-positive mothers to give birth at clinics, the campaigns may be inadvertently promoting the idea that childbirth there is mainly for women who are HIV-positive. Public health messages need to be changed to stress that skilled care is a lifesaver for all women, says Turan.

For more information about the AIDS epidemic today at home or in Africa, or about UAB’s related efforts, see the sites for the UAB Center for AIDS Research, UAB’s 1917 Clinic for patients with HIV/AIDS, or the United Nation’s 2015 Millennium Development Goals, which include lowering the maternal death rate in developing countries by 75 percent.

About the Blogger

Greg Williams @gregscience @themixuab is research editor within Media Relations at the University of Alabama at Birmingham.