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

• Type of Material: Article
• Authors: Kate Winskell Enger, Emory University; Elizabeth Hill, Emory University; Oby Obyerodhyambo, Emory University
• Language: English
• Date: 2011-10
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016%2Fj.socscimed.2011.07.007
• Title of Journal or Parent Work: Social Science and Medicine
• ISSN: 0277-9536
• Volume: 73
• Issue: 8
• Start Page: 1257
• End Page: 1265
• Grant/Funding Information: The research described here was supported by Grant Number 1R03 HD054323 01 A1 from the National Institute of Child Health and Human Development.; This research was also supported in part by the Emory Center for AIDS Research (P30 AI050409) and by Emory Global Health Institute.
• Keywords: Narratives; Youth; Social Representations; Namibia; Senegal; Stigma; Swaziland; Burkina Faso; South-East Nigeria; HIV; Kenya
• Research Categories: Sociology, General; Health Sciences, Public Health

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 April2005. 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.