Introduction
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) remain a global concern to date (Taylor, 2001). Although HIV is believed to have originated from developed nations, its spread across the world was rapid. Currently, the highest number of patients infected with HIV is found in developing countries. Sub-Saharan Africa bears the greatest burden of the disease (Yeboah, 2007). Over 50 percent of people living with HIV are found in Sub-Saharan Africa (Holzemer, 2008).
The prevalence of HIV and AIDS has various implications. First, HIV infection rates have increased dramatically in Sub-Saharan Africa and many new cases of HIV have been recorded in Sub-Saharan Africa over the years. Second, the number of people affected by the AIDS epidemic has increased exponentially. The dependants and families of those infected with HIV and AIDS are the major victims.
The paper describes the historical and current role of stigma in the provision and care of people living with HIV and AIDS in the context of Ghana. Further, the paper discusses some of the main developments and current issues as well as the possible ways how to address the issues.
The historical and current role of stigma in the provision of HIV and AIDS care
In Ghana, the HIV and AIDS pandemic is not very different from that in Sub-Saharan Africa. Ghana is one of the Sub-Saharan countries located in the Western part of Africa. However, Ghana differs from other Sub-Saharan countries in terms of HIV and AIDS prevalence. The country has considerably low rates of HIV and AIDS. The implication is that new cases of HIV infections are decreasing. In addition, the statistics show that Ghana has improved slightly in managing HIV and AIDS. The improvement is attributed to the government’s efforts in combating the disease. The government of Ghana focuses on the prevention and management of HIV and AIDS, which has resulted in impressive statistics. For instance, the government enhanced public awareness campaigns on the disease, which created public understanding of the prevention and management of HIV and AIDS. Additionally, the government emphasized the provision of VCT (Voluntary Counseling and Testing) services to the population in the urban and rural areas.
Apart from the government’s efforts, the international community and Non-Governmental Organizations (NGOs) have played significant roles in the management of HIV and AIDS in Ghana.
Despite the decrease in new infections in Ghana, there have been various challenges. Like many other countries, Ghana has experienced diverse shortcomings in the management of HIV and AIDS. Initially, people infected with HIV and AIDS lacked options. In essence, the government failed to offer adequate facilities such as voluntary counseling and testing services, as well as access to widely distributed antiretroviral medications for people living with HIV and AIDS. People living with HIV and AIDS were initially ignored, which increased the risk of transmission. Even after the government started providing HIV and AIDS support services and facilities, the services were unfairly disseminated across the country. The rural areas experienced the greatest challenges in accessing such facilities and services. Actually, the rural areas faced a deficiency of health facilities. On the other hand, the urban centers had well-equipped health facilities. In principle, communities living in urban areas emerged better off in the prevention and management of HIV and AIDS compared to the rural residents.
Apart from poor infrastructure and healthcare services, stigmatization remains the other main challenge in the prevention and management of HIV and AIDS in Ghana. Stigmatization refers to the negative reactions towards those who are infected or affected by HIV and AIDS. Stigmatization of HIV and AIDS is not unique to Ghana and is experienced across the world (Whetten et al., 2008). However, the level and nature of stigmatization in different parts of the world differ based on the cultural, religious, and social systems. In Ghana, religion, and culture play significant roles in HIV and AIDS stigmatization (Parker & Aggleton, 2003). The rate of HIV and AIDS stigmatization has changed over time. In the past, the prevalence of stigmatization registered soaring rates across the whole country. However, stigmatization has reduced over time given the growing awareness of the disease.
Ghana is a country that is based on morals that are strongly influenced by Christianity and Islam. Every individual is expected to live according to the set of moral principles. In fact, those who go against these moral principles are seen as deviants and what follows is prejudice from the community. To begin with, some of the behaviors that attract prejudice from society include prostitution, drug abuse, childhood pregnancy, and homosexuality. Undeniably, these factors all play a role in HIV and AIDS stigmatization. In Ghana, people who engage in such behaviors are stigmatized and HIV is explained by supernatural causes. The relationship between HIV and AIDS occurs due to the close association of such behaviors with the risk of contracting HIV and AIDs. HIV and AIDS are contracted through sexual intercourse and other factors. Within Ghanaian society, sex is a subject that connotes morality. Sex is considered a preserve for those who are legally married. Therefore, sex outside marriage is considered immoral (USAID, Morrison & POLICY Project, 2006; Mill & Anarfi, 2002).
Based on the above reality, people infected with HIV were considered prostitutes, homosexuals, drug users, and adulterers (Ulasi et al., 2009). The implication of such consideration exposed people engaged in these behaviors to double stigmatization when they were infected with HIV and AIDS. HIV and AIDS stigmatization in Ghana is present in several ways (Mawar et al., 2005). Prejudice, abuse, violence, and discrimination are some of the ways through which stigmatization is presented. In the past, the stigmatization of HIV and AIDS was so intense that it affected the entire family and friends of the infected individuals. Society thought that HIV and AIDS were contracted through close contact with the infected persons. In essence, the HIV and AIDS patients were secluded from the general society. For instance, in the workplace, the person infected with HIV and AIDS was fired given the fear that they would affect other employees. Further, at the family level, spouses infected with the disease were kicked out of the marriage. Generally, the family rejected such people.
The main developments and current issues
However, through public awareness campaigns and education, the level of stigmatization has changed. Today, the stigmatization of the people living with HIV and AIDS has reduced. In essence, society has realized that people living with HIV and AIDS are normal humans who need love and care instead of ridicule or discrimination (Oduro and Otsin, 2013). The level of family and social support has increased for HIV and AIDS patients. Based on this shift in HIV and AIDS stigmatization in Ghana, the effects of stigmatization have also changed. Generally, the adverse effects of stigmatization have been reduced. Nevertheless, the nature of the effects of HIV and AIDS stigmatization remains the same.
One of the earliest effects of HIV and AIDS stigmatization in Ghana was denial. The level of stigmatization was so high that the thought of contracting HIV and AIDS was self-defeating. Therefore, whenever an individual tested HIV positive, the initial reaction was denial (Ulasi et al., 2009). The individual would not believe that they actually contracted the disease. As a result, they lived in states of denial, believing that they were not infected. Further, the thought of HIV and AIDs as a disease for the perverts such as prostitutes and homosexuals made the situation worse (Ulasi et al., 2009). Thus, individuals who never engaged in such socially disregarded behaviors renounced that they had HIV and AIDS. The denial extended to the family and society. In reality, society failed to acknowledge that people of honor could get HIV and AIDS. For instance, society doubted the possibility of pastors or fathers getting the disease (Holzemer et al, 2009).
The state of denial resulted in an increase in HIV and AIDS infections in the country. In the past, the rate of new HIV and AIDS infections in the country was alarming. In this regard, the government undertook actions to address the problem. Conversely, the state of denial also affected the government. Initially, the government never acted upon the epidemic. Instead, the government remained reluctant about the rapid spread of HIV and AIDS in the country. Consequently, more people were infected with the disease given the state of denial. For example, HIV-positive pastors infected many people with the disease since society never imagined pastors could be infected with HIV and AIDS (Kielmann & Cataldo, 2010). Additionally, respectable people in society easily infected many people with the disease due to societal denial.
Yeboah (2007) states that today, the state of denial of HIV and AIDS has declined. Through public awareness campaigns and education, the people of Ghana have realized that no one is immune to HIV and AIDS. In addition, society has realized that anyone can be infected with HIV and AIDS (Mill, 2003). Moreover, the fundamental shifts in the state of the society were the realization that HIV and AIDS is not a disease of perverts. Therefore, the level of stigmatization of people with HIV and AIDS declined over the years. Moreover, society has come to comprehend that HIV and AIDS are not only contracted through irresponsible sexual behaviors but also using infected needles, sharing of needles as well as mother-to-child transmissions (Yeboah, 2007). Further, individuals may be infected with HIV and AIDS by their own spouses unsuspectingly.
The state of denial in the provision of HIV and AIDS care was worse in the past. Actually, many people realized that they were infected with the disease but never sought health care and treatment (UNAIDS 2012). The state of denial made them avoid treatment and care with the belief that seeking such services would confirm their statuses. Therefore, many people were infected and lived without treatment and care. The result was the deterioration of health statuses due to the transformation of HIV into AIDS. Even when this happened, many people opted to stay indoors. In turn, the victims ended up dying. Today, the number of people seeking treatment and care for HIV and AIDS has increased considerably. However, some nurses stigmatize people living with HIV and AIDS seeking care and treatment thereby leaving PLHAs without any trustworthy person to seek help from (Mill et al., 2013).
Apart from denial, HIV and AIDS stigmatization caused secrecy. In essence, the information concerning HIV status remained a secret of the infected. People fear stigmatization and discrimination to avoid ridicule as well as neglect due to their HIV status. As a result, people would keep their HIV statuses in the hope that it would not be noticed (Taylor, 2001). The need for secrecy also prevented individuals from seeking treatment and care. For instance, people would not seek VCT services for fear that society would know their statuses. Moreover, given the level of stigmatization, society always perceives those visiting VCT centers to be HIV positive. The effect is that people avoid accessing VCT centers (Holzemer & Uys, 2005). Apart from people living with HIV, caregivers are also forced to hide their patients’ HIV and AIDS statuses for fear of stigmatization. Because of this, HIV and AIDS care reduced and denied people living with HIV the chance of benefiting from social and family support (Mwinituo & Mill, 2006; Holzemer et al., 2007; Holzemer et al., 2009).
Today, more Ghanaians visit VCT centers to know their HIV statuses. Moreover, the level of stigmatization has dropped significantly such that visiting VCT centers no longer signals that people are infected. Instead, through public awareness campaigns and education, people have realized that visiting VCT centers is critical. Unlike in the past when people considered visiting VCT centers as an indication of being infected, people consider it as a way of organizing the lives of individuals (Morolake, Stephens & Welbourn, 2009). For instance, people who tested HIV positive plan to live positively and commence taking anti-retroviral medication. Similarly, people who tested HIV negative avoid risky behaviors that may result in HIV infection. For married couples, visiting the VCT centers is now considered as a way of planning their lives (Mwinituo & Mill, 2006).
Stigmatization of HIV and AIDS patients was also espoused through families. In other words, the families abandoned those who tested positive. In most cases, such people ended up living isolated life without family support. In the treatment and care of HIV and AIDS, family support is important. A person infected with the disease needs family support in terms of love, care, material support, and help in the management of the disease. For instance, people losing their jobs due to HIV infection need family support in terms of basic needs. Moreover, family support is a major factor for acceptance of one’s status and taking medication (UNICEF, 2011).
In the past, family support was missing in Ghana. In fact, the family sidelined the individuals infected with the disease. As a result, the victims’ conditions worsened. Without family support, they were unable to provide for basic needs such as food, which is crucial in HIV and AIDS management. Moreover, the rejected victims feel useless. Such feelings discouraged accessibility, treatment, and care. As a result, the victims lose optimism in life and hope for death (Mill, 2003; Harris & Larsen, 2008).
The effect of the growing public awareness of the disease is that there is an increase in family support. In fact, today patients are encouraged by their families to live positively and take medications. Through family support, patients feel accepted and loved. The victims feel the need to continue with treatment in order to lengthen feeling the love and care from their families. The result is the reduction of family discrimination. In providing HIV and AIDS treatment and care, health professionals are incorporating families and society into care, treatment, and prevention (Tabi & Frimpong, 2003). The impact is enhanced effectiveness of care and prevention in HIV and AIDS in Ghana.
Regarding mother-to-child infections, HIV and AIDS stigmatization has had various effects. In the past, the level of stigmatization prevented many mothers from accessing healthcare that would prevent mother-to-child infections. As a result, many cases of mother-to-child infections were recorded. Many women bear the greatest burden of HIV and AIDS stigmatization given the patriarchal cultures in Sub-Saharan Africa. Therefore, pregnant women avoided seeking health care for fear of stigmatization (Theilgaard et al., 2011). However, this has changed over the years. Education of women and the general society has reduced mother-to-child infection as more women access health care during pregnancy (Oduro & Otsin, 2013).
Possible ways to address the issues
One of the strategies for addressing the problem of HIV and AIDS stigmatization in Ghana is public education on the disease (Aggleton, Yankah & Crewe, 2011), often with the active assistance of donor countries and multilateral institutions. The approach has been made a national priority to mitigate the effects of the disease on the economy. According to Tenkorang and Owusu (2013), studies have shown that educated people experience less stigma or show less stigma towards people living with HIV (PLHA) and AIDS compared to the non-educated. Further, this is founded on the fact that HIV and AIDS education helps in disqualifying the underlying myths about the disease that causes stigmatization. For instance, through HIV and AIDS education, people understand that the disease is not a curse (Barnett, 2008). In order to enhance the outcomes of HIV and AIDS education, it is important to use PLHAs as teachers or tutors. When a PLHA acts as a tutor, the learners are able to connect with the teachings given that the tutor talks from a practical point of view (Solomon, Guenter & Stinson, 2005). By extension, peer counseling should also be encouraged (Harris & Larsen, 2007).
Additionally, the stigmatization of HIV and AIDS victims can be addressed through the involvement of PLHAs. The involvement entails engaging PLHAs across the entire continuum from planning to the implementation of such plans. When PLHAs are involved through collaboration with other PLHAs or HIV-negative individuals, they feel a sense of belonging. Therefore, they experience less stigmatization (Stephens, 2004; Morolake, Stephens & Welbourn, 2009; Kielmann & Cataldo, 2010). Therefore, the PLHAs in Ghana should be engaged in policy formulations and implementations as a strategy for reducing stigma.
Finally, healthcare workers have a role to play in ending HIV and AIDS stigmatization and its effects on the provision of care. Instead of stigmatizing PLHAs, healthcare providers should give hope to PLHAs through counseling and connecting them with support groups. The support groups will be a source of hope given the sense of belonging it provides. Moreover, healthcare providers should help in transforming cultural and social biases against PLHAs by counseling the families and communities of those infected and affected by HIV and AIDS (Akinsola, 2001; Cutcliffe, 1995).
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