Abstract
Majority of African countries have high stigma index(HSI) and are mostly populated by rural dwellers with high levels of illiteracy/ignorance. Therefore, poor education and knowledge of human immune deficiency virus(HIV) infection might be key drivers of stigmatization. Eight countries with a stigma index(STI) >40%(Niger, Guinea, Ghana, Sierra Leone, Liberia, Mali, Togo, and Democratic Republic of Congo) of 32 African countries with listed STI by UNAIDS, and three (Rwanda, Zambia, and Namibia), with a low stigma index (LSI) of 20%, were descriptively analyzed. Four knowledge classes(≤25%-class one;>25%≤50%-class two; >50%≤75% class three; >75%-class four), and categories of stigmatisation score ( 1.5-class four - signifying little, medium, high and very high tendency to stigmatize, respectively), were created based on respondents 'answers to twelve questions assessing knowledge of HIV, and four questions assessing stigmatisation of HIV-positive people, respectively. Data were characterized and evaluated by frequency tables using IBM SPSS Software. Respondents in knowledge classes three and four, mainly comprised urban dwellers in both LSI (98.0%urban vs 96.5%rural), and HSI (80.3%urban vs 64.5%rural) countries. Females had higher educational attainment than males in countries with LSI (98.35%females vs 97.6%males) than his (79.8% females vs 81.6% males). However, males expressed positive views (< 0.5-class one) about having an HIV-positive teacher, continuing to teach (i.e. least tendency for social stigmatization), and would buy vegetables from an HIV-positive vendor (i.e. least tendency for physical stigmatization), than females. Meanwhile, 48% of respondents would not buy vegetables from an infected vendor, yet they knew that HIV will not be transmitted by sharing food with an infected person. Impact factors of positive attitudes towards HIV are urbanization, educational attainment, and knowledge about HIV. LSI countries are distinguished from HSI countries by higher female educational attainment and knowledge about HIV than male, which may impact HIV stigmatization, and could be of socio-cultural significance. Lesser tendency to stigmatize among males than females may suggest that socio-cultural factors which enable stigmatization may be gender-related. The greater tendency towards physical than social stigmatization may reflect respondents' perception that physical contact enables HIV transmission. The contradiction between knowledge and belief was evident hence almost half of those who knew the mode of transmission of HIV, had a negative attitude towards an infected vendor.
Highlights
The trends from the data suggest a negative association between educational attainment and stigmatization of people with HIV/AIDS, (Table 2)
The countries with the highest number of illiterates - i.e. those without any form of education – Niger (70.6%), Mali (70.3%), Guinea (60.5%), Sierra Leone (51.1%), Liberia (32%), Togo (29.3%), Ghana (21%) and Congo DR (13.5%) – in descending order), had high stigma index (>40%) unlike the three countries with the least number of illiterates, (Rwanda- 11.5%, Namibia-8.4% and Zambia-6.1%), who accounted for the highest number of those with the least tendency to stigmatize HIV-infected people –i.e. Rwanda (56.4%), Namibia (34.3%) and Zambia (24.1%)– in descending order
Further analysis showed a mixed result was observed among countries with the highest educational attainment in relation to a tendency to stigmatize
Summary
The HIV prevalence is approximately 2.2 % in Western and Central Africa, and 7.1 % in Eastern and Southern Africa. [1, 2, 3] In most cases, the rural populace accounts for the greatest burden of the disease. [4]for unknown reasons stigma and discrimination in connection with this disease are a frequently occurring problem in Africa.[3, 5] It was considered that over 70% of the African population are rural dwellers, [6, 7] who live in cultural communities with a high level of poverty, illiteracy, ignorance, and diseases [3, 8,9,10,11,12,13,14] due to poor health care and educational facilities. Incurable diseases have been perceived as a direct retribution from the “gods of the land” for acts of sacrilege/taboos [15] purportedly committed by the victims This often leads to outright stigmatization and isolation of victims from all forms of social interactions [3] including visitations, communal associations, community participation and even outright excommunication from the community as a way of assuaging the gods to contain the scourge. For the success of prevention campaigns und HIV-treatment, it is important to understand the drivers of HIV stigma and discrimination, especially in countries with high HIV-prevalence In this regard, it was considered that education and knowledge of HIV may play important roles in addressing HIV-related stigmatization
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