Stigma

(image source)

This week our president made some of the first positive statements I have heard from the government regarding the AIDS epidemic in our country. Hopefully this will mark the end of the denial phase in the process of grieving for our country's slow death from HIV. I pray that now, as our country must inevitably move through the rest of the stages, that we will come to accept that AIDS is here to stay, and then move forward in developing strategies to fight it's rampant spread. This has been a long time coming.

You may ask what is fuelling this rampage? I have some ideas, and although they are not by any means a comprehensive list of all the factors, I suspect them to be some of the major role players. The stigma surrounding HIV, and denial of it's existence (supported by the government up until now) and the belief that "it will never happen to me" lie at the heart of it.

Why is it that a patient will come to hospital (or even bring their infant or child), and then not want to find out what is wrong with them and refuse treatment? Why seek help in the first place?
The prevailing attitude is: "If I dont test myself for HIV, I dont have it, and I dont have to make any lifestyle adjustments."

I am of the opinion that HIV is no different from other chronic or terminal illnesses. It's survival rate is comparable with that of ischaemic heart disease and diabetes (untreated, you may have HIV for 5 to10 years before developing any symptoms), and is better than most forms of cancer! The difference is that it is infectious, and you have to make adjustments to your lifestyle to avoid giving it to others (ie. stop sleeping around). This is the hard part, giving up the risky behaviour, and the topic for another post.

I am also of the opinion that the stigma is no different from syphilis, or TB. Why is it then that these are notifiable diseases, and HIV is not? I think that this is the first step to de-stigmatising the disease - make it notifiable, and bring it out into the open. Let clinics, employers, insurance companies etc. test people routinely. Changing the existing HIV testing policy (VCT) from an "opt-in" to an "opt-out" type process (as suggested recently by some Western Cape Health Department MP's) would be the first step. With the prevalence then revealed, it would be very difficult to discriminate against those infected with HIV, as I suspect the incidence would be much higher than expected. (The antenatal prevalence is 29% in our country, and I believe this reflects the working population). This is the best way to increase awareness of the seriousness of the disease, and get people to start thinking about the risks they are taking. Infected individuals would, with the knowledge of their status, be able to access treatment earlier, and therefore most likely live longer and healthier. Their partners would be able to take proper precautions too, and reduce their risk of infection.

Everybody wins.