This fear of discrimination breaks down confidence to seek help and medical care.22 Self-stigma and fear of a negative community reaction can hinder efforts to address the HIV epidemic by continuing the wall of silence and shame surrounding the virus.Negative self-judgement resulting in shame, worthlessness and blame represents an important but neglected aspect of living with HIV.
The HIV and AIDS Bible opens a new chapter in African religious discourse by placing the pandemic at the forefront of theological discussions. Dube examines the HIV/AIDS crisis in light of biblical and ethical teachings and argues for a strong theological presence alongside current economic, social, and political efforts to quell this devastating disease.
The HIV and AIDS Bible will be helpful for teachers, clergy, social workers, health care providers, and anyone else seeking creative ways to integrate their religious beliefs with their efforts to alleviate the suffering caused by the HIV/AIDS pandemic.
As of 2015, more than 70 countries were using the HIV Stigma Index, more than 1,400 people living with HIV had been trained as interviewers, and over 70,000 people with HIV have been interviewed.6 Findings from 50 countries, indicate that roughly one in every eight people living with HIV is being denied health services because of stigma and discrimination.7 Whenever AIDS has won, stigma, shame, distrust, discrimination and apathy was on its side.
Every time AIDS has been defeated, it has been because of trust, openness, dialogue between individuals and communities, family support, human solidarity, and the human perseverance to find new paths and solutions.
This makes treatment less effective, increasing the likelihood of transmitting HIV to others, and causing early death.
For example, in the United Kingdom (UK), many people who are diagnosed with HIV are diagnosed at a late stage of infection, defined as a CD4 count under 350 within three months of diagnosis.
Self-stigma affected a person's ability to live positively, limits meaningful self agency, quality of life, adherence to treatment and access to health services.23 In Zimbabwe, Trócaire and ZNNP designed, implemented and evaluated a 12-week pilot programme to support people living with HIV to work through self-stigmatising beliefs.
After the 12 weeks, participants reported profound shifts in their lives.
The majority of participants (61%) reported a reduction in self-stigma, depression (78%) and fears around disclosure (52%), and increased feelings of satisfaction (52%) and daily activity (70%).24 Evidence suggests people from key affected populations are also disproportionally affected by self-stigma.
For example, a study of men in China who have sex with men found that depression experienced by participants due to feelings of self stigma around homosexuality directly affected HIV testing uptake.25 Similarly, a study of men in Tijuana, Mexico who have sex with men found that self-stigma was strongly associated with never having tested for HIV, while testing for HIV was associated with identifying as being homosexual or gay and being more ‘out’ about having sex with men.26 In countries that are hostile to men who have sex with men and other key populations, innovative strategies are needed to engage individuals in HIV testing and care programmes without exacerbating experiences of stigma and discrimination. 27 A country’s discriminatory laws, rules and policies regarding HIV can alienate and exclude people living with HIV, reinforcing the stigma surrounding HIV and AIDS.