title: Antiretroviral therapy and changing patterns of HIV stigmatisation in Entebbe, Uganda.
abstract: Antiretroviral therapy (ART) has the potential to change processes of HIV stigmatisation. In this article, changing processes of stigmatisation among a group of people living with HIV (PLWH) on ART in Wakiso District, Uganda, are analysed using qualitative data from a study of PLWH's self-management of HIV on ART. There were 38 respondents (20 women, 18 men) who had been taking ART for at least 1 year. They were purposefully selected from government and non-government ART providers. Two in-depth interviews were held with each participant. Processes of reduced self-stigmatisation were clearly evident, caused by the recovery of their physical appearance and support from health workers. However most participants continued to conceal their status because they anticipated stigma; for example, they feared gossip, rejection and their status being used against them. Anticipated stigma was gendered: women expressed greater fear of enacted forms of stigma such as rejection by their partner; in contrast men's fears focused on gossip, loss of dignity and self-stigmatisation. The evidence indicates that ART has not reduced underlying structural drivers of stigmatisation, notably gender identities and inequalities, and that interventions are still required to mitigate and tackle stigmatisation, such as counselling, peer-led education and support groups that can help PLWH reconstruct alternative and more positive identities. A video abstract of this article can be found at: https://youtu.be/WtIaZJQ3Y_8.
authors.affiliation: School of International Development, University of East Anglia, Norwich, Norfolk.
authors.forename: Steve
authors.initials: S
authors.lastname: Russell
authors.affiliation: Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Uganda.
authors.forename: Flavia
authors.initials: F
authors.lastname: Zalwango
authors.affiliation: Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Uganda.
authors.forename: Stella
authors.initials: S
authors.lastname: Namukwaya
authors.affiliation: Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Katongole
authors.affiliation: Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Uganda.
authors.forename: Richard
authors.initials: R
authors.lastname: Muhumuza
authors.affiliation: Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Uganda.
authors.forename: Ruth
authors.initials: R
authors.lastname: Nalugya
authors.affiliation: Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Uganda.
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology; D057545:Social Stigma; D013240:Stereotyping; D014454:Uganda; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; chronic illness; developing countries; doctor-patient communication/interaction; gender; stigma