Department of Sociology and Anthropology, Baruch College, City University of New York, New York, NY, USA.
Glob Public Health. 2010;5(5):523-38. doi: 10.1080/17441690903207156.
With the world's highest antenatal HIV prevalence rate (39.2%), Swaziland has also been described as among the most stigmatising. Yet, only recently was an anti-HIV stigma and discrimination (S&D) platform included in the government's National Multisectoral HIV and AIDS Policy. This study draws on a medical anthropological project in rural Swaziland to examine experiences of stigma among people living with HIV/AIDS (PLWH). Qualitative methods included a semi-structured questionnaire and interviews (n=40) to identify patterns of stigma across three domains: verbal, physical and social. Key informant interviews (n=5) were conducted with health personnel and support group leaders. Descriptive statistics were situated within a thematic analysis of open-ended content. Among the findings, participants reported extensive HIV-related rumouring (36.4%) and pejorative name-calling (37.5%). Nearly one in five (18.2%) could no longer partake of family meals. Homesteads, which are an organising principle of Swazi life, were often markedly stigmatising environments. In contrast to documented discrimination in health care settings, the health centre emerged as a space where PLWH could share information and support. Given the UNAIDS call for national partners to 'know your epidemic' by tracking the prevalence of HIV-related S&D, results from this study suggested that unless 'knowing your epidemic' includes the lived experiences of HIV stigma that blister into discernible patterns, effectiveness of national initiatives is likely to be limited. Multidisciplinary and locale-specific studies are especially well suited in examining the cultural dynamics of HIV stigma and in providing grounded data that deepen the impact of comprehensive HIV/AIDS policies and programming.
斯威士兰的产前艾滋病毒感染率居世界之首（39.2%），同时该国也是受污名化影响最严重的国家之一。然而，直到最近，抗艾滋病毒污名和歧视（S&D）平台才被纳入政府的国家多部门艾滋病毒和艾滋病政策。本研究利用在斯威士兰农村进行的医学人类学项目，考察艾滋病毒/艾滋病感染者（PLWH）的污名经历。定性方法包括半结构式问卷和访谈（n=40），以确定三个领域（言语、身体和社会）中的污名模式。与卫生人员和支持团体领导人进行了关键人物访谈（n=5）。描述性统计数据置于对开放式内容的主题分析中。研究结果显示，参与者报告了广泛的与艾滋病毒相关的谣言（36.4%）和恶意辱骂（37.5%）。近五分之一（18.2%）的人不能再参加家庭聚餐。斯威士兰生活的组织原则是家园，但往往是明显污名化的环境。与医疗保健环境中记录的歧视形成鲜明对比的是，保健中心成为 PLWH 可以分享信息和支持的空间。鉴于联合国艾滋病规划署呼吁国家合作伙伴通过跟踪与艾滋病毒相关的 S&D 的流行情况来“了解你的疫情”，本研究结果表明，除非“了解你的疫情”包括可见的艾滋病毒污名化的生活经历，否则国家倡议的有效性可能有限。多学科和特定于当地的研究特别适合研究艾滋病毒污名的文化动态，并提供更深入了解全面艾滋病毒/艾滋病政策和规划的影响的基础数据。
