Stigma toward people living with Human Immunodeficiency Virus: Insights from Anti-Retroviral Therapy clients in north-eastern Ghana

Abstract

Stigma toward People Living with Human Immunodeficiency Virus (PLHIV) remains a public health concern in Ghana and beyond. Whereas several studies have associated Anti-Retroviral Therapy (ART) services with stigma, the specific forms, and key drivers of stigma towards ART clients in poverty-stricken settings have not been exhaustively explored. Based on a case study of ART clients in the Upper East Region, this study explores the specific forms and the main drivers of stigma towards ART clients. We employed a qualitative research approach in the collection and analysis of the data. Purposive sampling was used to select the ART facilities and staff, and a convenient sampling procedure was employed to select the ART clients to participate in semi-structured key informant interviews. Barriers such as lack of knowledge, cultural norms, and a weak enabling environment were found to drive ‘public stigma’ and ‘self-stigma’ towards ART clients in the region. The former manifests in gossip, finger-pointing, insults, mockery, avoidance, and refusal of employment; while self-stigma was shown in a ‘feeling of guilt’, ‘self-isolation’, ‘excessive thinking’, ‘fear of insults’, and ‘fear of death’. These may lead to adverse health outcomes and loss of livelihoods. Therefore, we advocate the immediate and strict implementation of existing policies and legislation that aim to eliminate HIV-induced stigma in communities. Within this implementation framework, the Ghana Health Service, the Ghana AIDS Commission, the Christian Health Association of Ghana, and Non-Governmental Organizations (NGOs) in health are entreated to employ culturally appropriate education to increase awareness of the effectiveness of ART and promote the adoption of accepting attitudes towards ART clients in communities. We also recommend the conduct of a large-scale mixed methods research to identify specific forms of stigma encountered by ART clients in the country to inform the (re)design and implementation of ART anti-stigma policies and programmes.