HIV-related Stigma in Rural and Tribal Communities of Maharashtra, India

Carol Vlassoff,Shobha Rao,Mitchell G Weiss,Firdaus Ali,Tracey Prentice

doi:10.3329/jhpn.v30i4.13291

Abstract

Stigma is a recognized barrier to early detection of HIV and causes great suffering for those affected. This paper examines HIV-related stigma in rural and tribal communities of Maharashtra, an area of relatively high HIV prevalence in India. The study used a mix of qualitative and quantitative methods to compare adult women and adolescents in a rural area, women in a rural area, and women in a tribal area. The respondents included 494 married women and 186 adolescents in a rural community and 49 married women in six tribal villages. HIV-related stigma was prevalent in all communities and was the highest among tribal and older respondents. High-risk behaviour was reported in both areas, accompanied with denial of personal risk. Our findings suggest that HIV may be spreading silently in these communities. To our knowledge, this is the first community-based study to make an in-depth assessment of HIV-related stigma in rural and tribal areas of India. By situating our findings within the broader discourse on stigma in the national and state-level data, this study helps explain the nature and persistence of stigma and how to address it more effectively among subcultural groups in India.

Highlights

An estimated 2.5 million people are living with HIV/AIDS in India [1], and many more are thought to be living with undiagnosed infection due to high levels of stigma and discrimination [2]
Several women in the rural community had been personally affected by HIV: some were HIV-positive, others had nursed HIV-affected relatives
Local primary health centre staff reported that an average of 10 sexually transmitted infections (STIs) cases from the village were detected each month, and one village doctor said he referred 8-10 clients a year for HIV testing

Summary

Introduction

An estimated 2.5 million people are living with HIV/AIDS in India [1], and many more are thought to be living with undiagnosed infection due to high levels of stigma and discrimination [2]. The reduction of stigma has been identified as a priority by India’s National AIDS Control Organization (NACO). India’s National Family Health Survey-3 (NFHS-3), conducted in 2005-2006, provides the most comprehensive picture of India’s HIV situation [1]. Four issues focused on HIV-related stigma: (i) caring for an HIVpositive relative; (ii) buying fresh vegetables from someone with HIV; (iii) allowing an HIV-positive female teacher, not visibly ill, to continue teaching; and (iv) willingness to reveal a family member’s positive HIV status. Over half of the respondents gave non-stigmatizing replies to individual questions but only 34% of females and 37% of males did so to all four questions

Objectives

Methods

Results

Discussion

Conclusion