HIV-related stigma: Adapting a theoretical framework for use in India

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HIV-related stigma: Adapting a theoretical framework for use in India

Wayne T. Steward, M. Herek, Jayashree Ramakrishna, Shalini

Bharat, Sara Chandy, Judith Wrubel and L. Ekstrand.

Social Science & Medicine, Volume 67, Issue 8, October 2008, Pages

1225-1235. doi:10.1016/j.socscimed.2008.05.032

Abstract

Stigma complicates the treatment of HIV worldwide. We examined

whether a multi-component framework, initially consisting of enacted,

felt normative, and internalized forms of individual stigma

experiences, could be used to understand HIV-related stigma in

Southern India. In Study 1, qualitative interviews with a convenience

sample of 16 people living with HIV revealed instances of all three

types of stigma. Experiences of discrimination (enacted stigma) were

reported relatively infrequently. Rather, perceptions of high levels

of stigma (felt normative stigma) motivated people to avoid

disclosing their HIV status.

These perceptions often were shaped by stories of discrimination against other

HIV-infected individuals, which we adapted as an additional component of our

framework (vicarious stigma).

Participants also varied in their acceptance of HIV stigma as legitimate

(internalized stigma). In Study 2, newly developed measures of the stigma

components were administered in a

survey to 229 people living with HIV.

Findings suggested that enacted and vicarious stigma influenced felt

normative stigma; that enacted, felt normative, and internalized

stigma were associated with higher levels of depression; and that the

associations of depression with felt normative and internalized forms

of stigma were mediated by the use of coping strategies designed to

avoid disclosure of one's HIV serostatus.