Stigmatisation of the Body: The Social, Economic and Cultural impact of HIV/AIDS

 I first discussed this topic with a gentleman whilst I was in Kingston Jamaica. He was in his 60’s, and had caught the illness back in the late 1980’s, where sex, drugs and reggae set the tone for promiscuous activities. He has lived in silence ever since, although he was diagnosed in the 1990’s. The stigmatisation and labelling of an individual with HIV/AIDS by society, could have contributed to his reluctance to disclose his illness, even to his family.

Our conversation surrounded Jamaica Health Care System, that provides free medical treatment and medicine that is accessible to all patients, however he complained the effects of the infection does not allow him to work. His current socio-economic predicament impedes him from eating healthy to inoculate him from the symptoms.

We talked about his new found Christian lifestyle, I was intrigued by his life, so I enquired about his previous and current partners where he told me, some have already sadly died due the illness. He has an estimated fourteen adult children, and he now has a girlfriend who was pregnant but she has tragically lost the child. I immediately asked him, “why did you not use a condom”? He answered, I do not like them! I was appalled and disappointed, I could not understand his answer. I wanted to know why this lady’s life was not worthy to be protected.

It was found globally, women are more likely to be infected with HIV/AIDS than men, therefore preventative programs should empower women by creating an environment that promotes contraceptives, and laws that permits women rights in the process copulation.

Studies have shown the mortality rate of patients with lower economic status is higher than wealthier patients and a decrease in poverty correlates with a decrease in infection rates (Rubin, Colen & Link, 2010). Social welfare is therefore a core issue, as HIV/AIDS appears to increase impoverishment and decrease social mobility. Research indicates that unemployment rate among people living with HIV/AIDS can range from 45-65% (Dray-Spira, Guegen, & Lert, 2008).

The socioeconomic status (SES) of an individual suggests, even with free medical care and awareness programme, cultural attitudes and educational attainment, financial security, subjective perceptions of social status play an important role in the understanding, spread of the illness, and adherence to medical treatment and advice (Young et al., 2004) 

Domestically and internationally, HIV/AIDS is a disease that is embedded in social and economic inequity (Pelloski et al 2013) as it affects those of lower socioeconomic status, and impoverished neighbourhoods are at a disproportionately higher rate. Limited economic opportunities and periods of homelessness are associated with high risk sexual behaviour such as exchanging sex for money, housing, food, clothes, drugs and safety that increase the risk of HIV (Kalichman et al, 2011).

Ideals of masculinity in some parts of Jamaican culture and society at large, implies infidelity, risky and irresponsible, sometimes bullying sexual behaviour, which has created a setting for the illness to explode. It is an environment where “cocks roam freely”, whilst the vagina is coerced in to submission. This clearly shows, policies should focus on cultural attitudes, and how men and women view their social world, sexual relationship, and target those who behaviours are based historical gender norms.

It is important to teach people how to develop, loving and caring interactions and self values to be inculcated with behaviours that will allow them protection from infection. It is also evident equitable development -education, health, employment opportunities, social mobility and support are all important goals to aid the fight against the illness.

Responses to the disease are currently constructed on stigmatisation and a negative perception that perpetuates the epidemic. Prevention should be the key focus in any policy as the drivers of the epidemic are multifaceted and the complexity of our political, cultural and economic system still remains a barrier. 

International Preventative strategies focuses on the transmission of infected blood among drug users in Europe and sex workers in Thailand and Senegal. An editorial in Lancet 2004, reported governments in countries such as Uganda and Cambodia acknowledged the crisis by implementing intervention programmes to reduce infection rates. However, a UNDP report in 2004, suggests life expectancy in continents such as Africa and Eastern Europe, has already declined dramatically due to AIDS.

Treatment is not universally accessible as the key aspect of treatment are cost, sustainability and access. Countries such as, Mozambique has reported their Health Care System is under pressure as staff are being diverted to the HIV/AIDS epidemic. It was also found because of poor governance, drugs for treatment were being held back at ports due to unpaid duties.

Treatment for HIV/AIDS in poorer regions are funded by donors such as Global Fund and PEPFAR which has a limited lifespan, therefore patients are not guaranteed treatment for life and access to the drugs is complex. Rationing has been an issue debated in regards to access. Some commenters, view rationing as a morally neutral concept that describes the allocation of resources, of which there is not enough to go around. Living in poverty appears to determine a person’s ability or worthiness to access modern medical care.

The SES of an individual and cultural attitudes are core aspect in the HIV/AIDS debate. Governments policies should coordinate testing, treating and retaining with preventative measures such de-stigmatisation of the illness through education, promotion of/and free access to contraceptive and medication, and develop programmes to improve social welfare. Poverty is not a single factor in the HIV/AIDS discussion but rather it is characterised by multiple economic, cultural, social, physical and psychosocial stressors.

Author: Keithia Grant

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