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Stigma: A Health Barrier for Women with HIV/AIDS

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The stigma experienced by women with HIV/AIDS is much like that of Hester Prynne in The Scarlet Letter. At the time of diagnosis with HIV/AIDS, women already are aware of the stigma associated with the disease. They immediately see themselves differently and believe others do also. The purpose of this article is to explore the multidimensional effect of stigma on women’s efforts to promote, maintain, and enhance their health. The experiences of the women in this study tell of rejection by family members, friends, health care providers, employers, and church members. This rejection caused by stigma affects access to health care, medication adherence, social interaction, and social support. Interventions are needed to decrease the impact of stigma on women with HIV/AIDS so they can achieve a higher level of wellness, increase their life span, continue in the workforce, and improve their quality of life.

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Method

An ethnographic methodology with repeated interviews and observation participation was used to gather data. A purposive sample of 9 European American women with HIV/AIDS was recruited using volunteer and networking sampling techniques. The sample was limited to European American women because health beliefs and practices vary between cultures (Leininger, 2002), and ignoring these differences results in cultural blindness (Clark, 1984) and complicates data interpretation (Morse, 1995). In-depth

Stigma Leads to the Redefinition

Stigma associated with HIV/AIDS has multidimensional effects on women's health and well-being. The stigma was so overwhelming for the women in this study that after diagnosis, they never perceived themselves in the same way. They may have been mothers, sisters, wives, teachers, secretaries, or designers prior to diagnosis, but afterwards they were simply women with HIV/AIDS. The diagnosis overshadowed everything they had been, everything they had accomplished, and totally redefined who they

The Many Faces of Stigma

At the time of diagnosis, the participants were already aware of the stigma associated with HIV/ AIDS. They personally faced the harsh reality almost immediately on diagnosis. Physicians who told them of their HIV-positive status warned them to tell no one because they would be shunned and rejected. As one young woman related about her diagnosing physician,

The first words out of his mouth after he told me it's the worst were, “Keep your mouth shut. Find you a good doctor and keep your

Honesty or Isolation?

The stigmatization associated with HIV/AIDS has been referred to as a second epidemic because of the considerable impact it has on the lives of the individuals (Chesney & Smith, 1999). When women are diagnosed with HIV/AIDS, the psychosocial implications, rather than the physiological impact, become the focus. The women in this study immediately adopted the stigma (Goffman, 1963) they associated with having HIV/AIDS. In essence, they became what they feared. In adopting the stigma, they had to

Secrecy Becomes a Health Barrier

The consequences of nondisclosure produce challenges related to the ability of women to promote, maintain, and maximize their health. The participants in this study were hesitant to tell anyone for fear of rejection. This was not limited to family members and friends but also included health care providers and employers. This hesitancy presented a barrier to their seeking health care and both formal and informal support. Taking medications and maintaining employment while not disclosing their

Nursing Implications

The results of this study and the literature recognize that the stigma of HIV/AIDS is a phenomenon that has a negative affect on many aspects of women's lives. The participants altered their self-perceptions (perceptions of self) on diagnosis of HIV/AIDS secondary to stigma. They spent endless hours and untold amounts of energy guarding their secret to avoid condemnation, rejection, and pain. The women delayed seeking health care, they avoided their family members and friends, and they

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    Copyright © 2004 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.