文章基本信息

标题：“We, the AIDS people. . .”: How Antiretroviral Therapy Enables Zimbabweans Living With HIV/AIDS to Cope With Stigma
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作者：Catherine Campbell ; Morten Skovdal ; Claudius Madanhire 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：6
页码：1004-1010
DOI：10.2105/AJPH.2010.202838
语种：English
出版社：American Public Health Association
摘要：We studied the impact of antiretroviral treatment availability on HIV/AIDS stigma through interviews with 118 antiretroviral treatment users, HIV/AIDS caregivers, and nurses in Zimbabwe. Treatment enables positive social and economic participation through which users can begin to reconstruct their shattered sense of social value. However, stigma remains strong, and antiretroviral treatment users remain mired in conflictual symbolic relationships between the HIV/AIDS people and the untested. To date, the restoration of users' own sense of self-worth through treatment has not reduced fear and sexual embarrassment in framing community responses to people living with HIV/AIDS. Much remains to be learned about the complex interaction of economic and psychosocial dimensions of poverty, treatment availability, and conservative sexual moralities in driving HIV/AIDS stigma in specific settings. How does antiretroviral treatment (ART) affect the ability of ART users to cope with HIV/AIDS stigma? Stigma is a key driver of the HIV/AIDS epidemic, particularly in low-income settings.^{1 , 2} Psychologists have dominated discussions of its causes, foregrounding individual-level explanations, which include unrealistic fears of contagion and social embarrassment of the sexual nature of HIV transmission.³ The greatest challenge to this dominance comes from Castro and Farmer. In their classic 2005 article, they argue that stigma is determined more by lack of effective health services and treatment than by psychological factors, particularly in resource-poor settings where the sick and dying drain scarce community resources.⁴ They argue that access to ART enables people living with HIV/AIDS to regain potential value as economically and socially competent citizens and that as ART becomes universally accessible, stigma will gradually disappear. Since this 2005 article, ART has been slowly rolled out,⁵ transforming HIV/AIDS from a tortuous death sentence to a manageable chronic illness and providing researchers an opportunity to explore Castro and Farmer's arguments in specific contexts. We investigated the impact of ART on users in rural Zimbabwe to explore how treatment availability affects stigma in this setting. Goffman emphasizes the need to use the “language of social relationships rather than the language of attributes”⁶ to understand stigma. Viewing stigma as negative social representations of HIV-infected people, we examined the processes through which people living with HIV/AIDS internalize or resist it, leading to positive or negative social identities. We understand social identity in terms of Cooley's notion of the looking glass self⁷ and Mead's observation that social identities are heavily determined by how others view us.⁸ A vital precondition for human well-being and agency is the recognition of people as having value by those around them.⁹ Stigma arises when people are denied such recognition. We examine the extent to which the availability of ART opens up new modes of positive social recognition for treatment users. At the time of our late 2009 study 34% (2010 WHO guidelines) of those needing antiretroviral drugs in Zimbabwe were receiving them (compared with an average of 37% across sub-Saharan Africa).^{5 , 10} Many people living with HIV/AIDS remain visibly ill and dying, health services battle with the complex demands of ART rollout, and the long-term future of heavily donor-sponsored ART services remains uncertain. Although it is too early to offer definitive comment on Castro and Farmer's claims at this early stage, our study provides useful preliminary insights into potential pathways between ART use and stigma.