Open AccessStigma, Structural Vulnerability, and “What Matters Most” Among Women Living With HIV in Botswana, 2017
Author(s) -
Lawrence H. Yang,
Ohemaa Poku,
Supriya Misra,
Haitisha Mehta,
Shathani Rampa,
Marlene M. Eisenberg,
Lyla Sunyoung Yang,
Thi Xuan Dai Cao,
Lilo Blank,
Ted Becker,
Bruce G. Link,
Patlo Entaile,
Philip Opondo,
Tonya Arscott-Mills,
Ari Ho-Foster,
Michael B. Blank
Publication year - 2021
Publication title -
american journal of public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.284
H-Index - 264
eISSN - 1541-0048
pISSN - 0090-0036
DOI - 10.2105/ajph.2021.306274
Subject(s) - stigma (botany) , blame , focus group , psychological intervention , context (archaeology) , medicine , vulnerability (computing) , structural violence , environmental health , social psychology , psychology , psychiatry , sociology , political science , geography , politics , computer security , archaeology , anthropology , computer science , law
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.