The moral stigma attached to AIDS

From IRIN, a story on how the social stigma of having AIDS in Kenya stands in the way of receiving treatment.

Many Kenyans see HIV as a punishment for immoral behaviour, which tends to perpetuate stigma against people infected with the virus, according to a report by ActionAid International, an anti-poverty agency, and Women fighting AIDS in Kenya, a local NGO.

The study, Extent and Impact of Stigma and Discrimination on Women and Children Infected and Affected by HIV and AIDS, found that 74 percent of respondents in 430 households in three districts of western Kenya felt people with HIV deserved their positive status as a punishment for morally unacceptable conduct, while 70 percent thought people with HIV were promiscuous.

"When you still have many people who view HIV infection as a punishment for immoral behaviour, it is a clear indication that they would stigmatize those living with the disease," said Ruth Laibon Masha, a national coordinator at ActionAid International's Kenya office. "Further, they have low risk perception because they feel they are not immoral, and would therefore not contract HIV."

Tina Mlambo, who lives in the informal settlement of Kariadudu in the capital, Nairobi, told IRIN/PlusNews: "AIDS came for people who are sleeping with many people. If you are a good person who only sleeps with one person, or don't sleep with anybody, where do you get AIDS?"

Yet according to the latest Kenya AIDS Indicator Survey, HIV is spreading fastest in stable, long-term relationships.

High stigma levels

More than half the survey participants were unwilling to share a meal with an HIV-positive person, or allow them to cook for functions or serve meals to guests. They were even unwilling to allow HIV-positive people to share household utensils.

Mlambo said she would not use the same basin as somebody who had HIV to bathe or wash her clothes. "I just feel ... that they can do something to also make me get it."

ActionAid researchers found that HIV-positive people often travelled far to obtain HIV testing and counselling or life-prolonging antiretroviral drugs. "About 60 percent of people we interviewed in the study say they travel long distances to seek HIV-related services just to conceal their status to the immediate community, for fear of stigma," Masha said.

People living with HIV are described in a variety of disapproving terms: Ochoyo ruoth (disgracing God); Ocham ma ok cham (has eaten the forbidden one); ikhwena yakhomba (licked by the crocodile).

Women bear the brunt of the stigma: about 70 percent of respondents believed that female sex workers spread HIV in the community, while 33 percent of HIV-positive married women interviewed had been abandoned by their husbands after testing positive.

Lillian Muthee, who has been living with HIV for six years, said religious institutions had much to do with creating a link between HIV and immorality, so they should be at the forefront of efforts to change the public perception of people living with HIV. "You simply keep quiet because you do not want to reveal your status and in essence reveal the fact that you were 'immoral'," she said.

Risk perception

Dr Nicholas Muraguri, head of the National AIDS and Sexually Transmitted Infections Control Programme, said although knowledge of HIV was nearly universal in Kenya, there was a need to raise people's awareness.

"If you know that you are also at risk, then you can't stigmatize another person - we are designing strategies to ensure that people appreciate the fact that they are not immune," he said. "We are determined to increase public education to reduce stigma."

The study suggested that the strategies aimed at reducing stigma be revised, and stressed the need to make people and communities appreciate their own risks and vulnerabilities. It also called on key institutions and opinion-makers to take the lead in reducing stigma.

"Use positive images of people living with HIV to reduce negative imagery," the authors recommended. "This will reduce fear-based assumptions made about people living with HIV, such as the belief that HIV results in immediate death, and that people living with HIV are a danger to society."