Skinner D, Mfecane S
Human Sciecnces Rcscarch Council, Private Bag X9182, Cap Town 80001, South Africa.
SAHARA J. 2004 Nov;1(3):157-64. doi: 10.1080/17290376.2004.9724838.
Stigma and discrimination play significant roles in the development and maintenance of the HIV epidemic. It is well documented that people living with HIV and AIDS experience stigma and discrimination on an ongoing basis. This impact goes beyond individuals infected with HIV to reach broadly into society, both disrupting the functioning of communities and complicating prevention and treatment of HIV. This paper reviews the available scientific literature on HIV/AIDS and stigma in South Africa, as well as press reports on the same subject over a period of 3 years. Analysis of this material indicates that stigma drives HIV out of the public sight, so reducing the pressure for behaviour change. Stigma also introduces a desire not to know one's own status, thus delaying testing and accessing treatment. At an individual level stigma undermines the person's identity and capacity to cope with the disease. Fear of discrimination limits the possibility of disclosure even to potential important sources of support such as family and friends. Finally, stigma impacts on behaviour change as it limits the possibility of using certain safer sexual practices. Behaviour such as wanting to use condoms could be seen as a marker of HIV, leading to rejection and stigma. All interventions need to address stigma as part of their focus. However, the difficulty of the task should not be underestimated, as has been shown by the persistence of discrimination based on factors such as race, gender and sexual orientation.
耻辱感和歧视在艾滋病流行的发展与持续存在过程中发挥着重要作用。有充分的文献记载，艾滋病毒感染者和艾滋病患者长期遭受耻辱感和歧视。这种影响不仅限于艾滋病毒感染者个体，还广泛波及整个社会，既扰乱了社区的正常运转，又使艾滋病毒的预防和治疗变得复杂。本文回顾了南非关于艾滋病毒/艾滋病和耻辱感的现有科学文献，以及三年内关于同一主题的新闻报道。对这些资料的分析表明，耻辱感使艾滋病毒问题淡出公众视野，从而降低了行为改变的压力。耻辱感还导致人们不愿了解自己的感染状况，进而延迟检测和治疗。在个人层面，耻辱感损害了感染者应对疾病的身份认同和能力。对歧视的恐惧限制了感染者向家人和朋友等潜在重要支持来源透露病情的可能性。最后，耻辱感影响行为改变，因为它限制了某些安全性行为的采用。诸如想要使用避孕套之类的行为可能被视为感染艾滋病毒的标志，从而导致他人的排斥和耻辱。所有干预措施都需要将消除耻辱感作为重点内容之一。然而，这项任务的难度不可低估，基于种族、性别和性取向等因素的歧视长期存在就说明了这一点。
