title: Effects of HIV-related stigma among an early sample of patients receiving antiretroviral therapy in Botswana.
abstract: Botswana, with its estimated HIV prevalence of 37%, instituted a policy of universal access to antiretroviral therapy (ART) in 2002. Initial enrolment lagged behind expectations, with a shortfall in voluntary testing that observers have attributed to HIV-related stigma - although there are no published data on stigma among HIV-positive individuals in Botswana. We interviewed 112 patients receiving ART in 2000, finding evidence of pervasive stigma in patterns of disclosure, social sequelae, and delays in HIV testing. Ninety-four percent of patients reported keeping their HIV status secret from their community, while 69% withheld this information even from their family. Twenty-seven percent of patients said that they feared loss of employment as a result of their HIV status. Forty percent of patients reported that they delayed getting tested for HIV; of these, 51% cited fear of a positive test result as the primary reason for delay in seeking treatment, which was often due to HIV-related stigma. These findings suggest that success of large-scale national ART programmes will require initiatives targeting stigma and its social, economic and political correlates.
authors.affiliation: Psychiatric Institute, University of California, San Francisco, CA 94143-0984, USA. wwollfe@lppi.ucsf.edu
authors.forename: W R
authors.initials: WR
authors.lastname: Wolfe
authors.forename: S D
authors.initials: SD
authors.lastname: Weiser
authors.forename: D R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: I
authors.initials: I
authors.lastname: Thior
authors.forename: J M
authors.initials: JM
authors.lastname: Makhema
authors.forename: D B
authors.initials: DB
authors.lastname: Dickinson
authors.forename: K F
authors.initials: KF
authors.lastname: Mompati
authors.forename: R G
authors.initials: RG
authors.lastname: Marlink
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001902:Botswana / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013240:Stereotyping
chemical_list: D019380:Anti-HIV Agents