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Comparing HIV-related symbolic stigma in six African countries: Social representations in young people’s narratives

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  • Winskell, Kate
  • Hill, Elizabeth
  • Obyerodhyambo, Oby

Abstract

HIV-related symbolic stigma arises from moralistic value judgements attached to people living with HIV and has negative consequences from both public health and human rights perspectives. Relatively little is known about cross-national variation in symbolic stigma. With the purpose of informing stigma reduction efforts within and across settings, we compared social representations of HIV in six African countries with estimated adult HIV prevalence rates ranging from 1 to 33%. Our study used a unique data source, namely a stratified random sample (n = 586, ∼5%) from 11,354 creative ideas contributed from six countries to a continent-wide HIV-related scriptwriting contest held between February and April 2005. The narratives were written by equal numbers of males and females aged 10–24 in urban and rural areas of Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso and Senegal. We combined three analytical approaches: descriptive statistics on certain quantifiable characteristics of the narratives, thematic data analysis, and a narrative-based approach. The association of HIV with outsiders (“othering”) and preoccupation with the circumstances of infection are more common in lower prevalence countries but vary substantially in tone depending on the sociocultural context. The highest proportion both of moralising narratives and of narratives with pessimistic outcomes come from South-East Nigeria and, to a lesser extent, from Kenya, countries with prevalence levels of 3.9 and 6.1% respectively, in which evangelical Christian movements, including Pentecostalism, have sizeable followings. The data provide a rare cross-cultural overview of symbolic stigma, identify country-specific needs, and point to strategies for future programming. Social representations from the highest prevalence countries, Swaziland and Namibia, and from lower prevalence Burkina Faso offer potential models for the framing of HIV in ways that serve to increase social proximity and counteract symbolic stigma.

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  • Winskell, Kate & Hill, Elizabeth & Obyerodhyambo, Oby, 2011. "Comparing HIV-related symbolic stigma in six African countries: Social representations in young people’s narratives," Social Science & Medicine, Elsevier, vol. 73(8), pages 1257-1265.
    • Handle: RePEc:eee:socmed:v:73:y:2011:i:8:p:1257-1265
    DOI: 10.1016/j.socscimed.2011.07.007
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    References listed on IDEAS

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    1. Winskell, Kate & Obyerodhyambo, Oby & Stephenson, Rob, 2011. "Making sense of condoms: Social representations in young people's HIV-related narratives from six African countries," Social Science & Medicine, Elsevier, vol. 72(6), pages 953-961, March.
    2. Hejoaka, Fabienne, 2009. "Care and secrecy: Being a mother of children living with HIV in Burkina Faso," Social Science & Medicine, Elsevier, vol. 69(6), pages 869-876, September.
    3. Maughan-Brown, Brendan, 2010. "Stigma rises despite antiretroviral roll-out: A longitudinal analysis in South Africa," Social Science & Medicine, Elsevier, vol. 70(3), pages 368-374, February.
    4. Campbell, Catherine & Skovdal, Morten & Mupambireyi, Zivai & Gregson, Simon, 2010. "Exploring children's stigmatisation of AIDS-affected children in Zimbabwe through drawings and stories," Social Science & Medicine, Elsevier, vol. 71(5), pages 975-985, September.
    5. Parker, Richard & Aggleton, Peter, 2003. "HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action," Social Science & Medicine, Elsevier, vol. 57(1), pages 13-24, July.
    6. Maman, Suzanne & Abler, Laurie & Parker, Lisa & Lane, Tim & Chirowodza, Admire & Ntogwisangu, Jacob & Srirak, Namtip & Modiba, Precious & Murima, Oliver & Fritz, Katherine, 2009. "A comparison of HIV stigma and discrimination in five international sites: The influence of care and treatment resources in high prevalence settings," Social Science & Medicine, Elsevier, vol. 68(12), pages 2271-2278, June.
    7. Genberg, Becky L. & Hlavka, Zdenek & Konda, Kelika A. & Maman, Suzanne & Chariyalertsak, Suwat & Chingono, Alfred & Mbwambo, Jessie & Modiba, Precious & Van Rooyen, Heidi & Celentano, David D., 2009. "A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS," Social Science & Medicine, Elsevier, vol. 68(12), pages 2279-2287, June.
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    1. Winskell, Kate & Sabben, Gaëlle, 2016. "Sexual stigma and symbolic violence experienced, enacted, and counteracted in young Africans’ writing about same-sex attraction," Social Science & Medicine, Elsevier, vol. 161(C), pages 143-150.
    2. Delavande, Adeline & Sampaio, Mafalda & Sood, Neeraj, 2014. "HIV-related social intolerance and risky sexual behavior in a high HIV prevalence environment," Social Science & Medicine, Elsevier, vol. 111(C), pages 84-93.
    3. Winskell, Kate & Kus, Landy & Sabben, Gaëlle & Mbakwem, Benjamin C. & Tiéndrébéogo, Georges & Singleton, Robyn, 2018. "Social representations of mother-to-child transmission of HIV and its prevention in narratives by young Africans from five countries, 1997–2014: Implications for communication," Social Science & Medicine, Elsevier, vol. 211(C), pages 234-242.
    4. Singleton, Robyn & Winskell, Kate & Nkambule-Vilakati, Siphiwe & Sabben, Gaëlle, 2018. "Young Africans' social representations of rape in their HIV-related creative narratives, 2005–2014: Rape myths and alternative narratives," Social Science & Medicine, Elsevier, vol. 198(C), pages 112-120.
    5. Denis-Ramirez, Elise & Sørensen, Katrine Holmegaard & Skovdal, Morten, 2017. "In the midst of a ‘perfect storm’: Unpacking the causes and consequences of Ebola-related stigma for children orphaned by Ebola in Sierra Leone," Children and Youth Services Review, Elsevier, vol. 73(C), pages 445-453.

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