7. Thematic analysis

A number of themes recur throughout both of the studies.

FIRST, it is important to recognize that HIV/AIDS-related stigmatization, discrimination and denial can appear in a variety of forms, at a variety of levels and in a variety of contexts. Mapping these forms is the first step towards being able to identify their determinants. It may be important theoretically as well as practically to differentiate between individual, family-level, community and institutional determinants.

SECOND, pre-existing local cultural practices and beliefs are both determinants and legitimators for HIV/AIDS-related stigmatization, discrimination and denial. These beliefs frequently establish categories of person or types of behaviour that are likely to be stigmatized (e.g. sexually “promiscuous” individuals, sex workers, drug users and homosexuals). The advent of HIV/AIDS frequently reinforces these already existing types of stigma, imbuing them with new and potent legitimacy.

THIRD, there is an important distinction to be made between “felt” and “enacted” stigma. Felt stigma arises from the real or imagined stigmatizing responses of others. It has an important role to play in “policing” the behaviour of people living with HIV/AIDS, causing some to deny their serostatus, others to conceal it, and all to experience anxiety about telling others and seeking care. The consequences of both felt and enacted stigma undermine efforts to challenge HIV/AIDS-related stigmatization, discrimination and denial. Both prevent people living with HIV/AIDS publicly acknowledging their serostatus and playing their full and proper role in prevention and care.

FOURTH, socioeconomic status and relative financial (and productive) security can influence the stigmatizing process. By enabling some families to “conceal” HIV/AIDS-affected members either within the home or in private medical facilities, some individuals are able to avoid being overtly stigmatized. At the same time, however, it may be especially shameful for wealthy individuals and their families to acknowledge being affected. More generally, socioeconomic status and wealth allow people to better manage the flow of information relating to HIV/AIDS and its impact upon family and household members.

FINALLY, it is clear that there is a strong gender bias in HIV/AIDS-related stigmatization, discrimination and denial. Women and men are not dealt with in the same way when they are infected – or believed to be affected – by HIV/AIDS. There is evidence that men are more likely to be accepted by family and community. Women, on the other hand, are more likely to be blamed, even when they have been infected by their husbands in what for them have been monogamous relationships. This double standard exacts a terrible toll on women as mothers, as daughters, as care-givers and as people living with HIV/AIDS. HIV/AIDS-related stigma, and the discrimination to which it leads, therefore plays a key role in intensifying gender inequalities.