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Published on: March 30, 2014
Stigma, Structural Vulnerability, and "What Matters Most" Among Women Living With HIV in Botswana, 2017
Lawrence H Yang1, Ohemaa B Poku1, Supriya Misra1
1Lawrence H. Yang is with the Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY. Ohemaa B. Poku is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Supriya Misra is with San Francisco State University, San Francisco, CA. Haitisha T. Mehta is with the Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY. Shathani Rampa is with the Department of Psychology, University of Botswana, Gaborone, Botswana. Marlene M. Eisenberg and Michael B. Blank are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Lyla S. Yang is with the Columbia School of Social Work, Columbia University. Thi Xuan Dai Cao is with the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada. Lilo I. Blank is with the College of Arts and Sciences, University of Rochester, Rochester, NY. Timothy D. Becker is with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Bruce G. Link is with the Department of Sociology, University of California Riverside. Patlo Entaile is with the Botswana‒UPenn Partnership, Gaborone. Philip R. Opondo is with the Department of Psychiatry, University of Botswana. Tonya Arscott-Mills is with the Perelman School of Medicine, University of Pennsylvania. Ari R. Ho-Foster is with the Faculty of Medicine, University of Botswana.
Abstract:
Objectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from "what matters most" in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners'. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner's status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as "promiscuous" and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies.
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