The Art of Medicine: Women in Sub-Saharan Africa are so Afraid of the Stigma Associated with an HIV/AIDS Diagnosis That They Will Forgo Potentially Life-Saving HIV Testing and Treatment

The Fear Factor: Before a pregnant woman in sub-Saharan Africa will submit herself to testing and treatment for HIV she will often have to be convinced that an HIV-positive diagnosis will not drive her husband or her community away from her.

In 2009, the World Health Organization called for the “virtual elimination” of mother-to-child transmission (MTCT) of HIV by 2015. MTCT of HIV is how 90% of infants contract the disease, i.e. from their HIV-positive mother during pregnancy, childbirth or breastfeeding.

The WHO, emboldened by the promise of prenatal HIV testing and MTCT intervention programs, thus made the claim that in a mere 6 years, MTCT of HIV would be eliminated.

But that has not even come close to happening. In 2011, the last year for which figures are available, the WHO reports that “most” of the more than 3 million children living with HIV in sub-Saharan Africa acquired it from their HIV-infected mothers.

One reason MTCT of HIV continues is that medical care for these pregnant women hasn’t turned out to be as accessible as once thought. But researchers from the University of California discovered something else: that even when HIV testing and other prenatal care programs are available, pregnant women simply won’t avail themselves of those services.

Why? Because of the awful stigma that’s still associated with HIV in sub-Saharan Africa. Specifically, women fear being shunned, or worse, by their community, friends, family, their husbands, and even by health workers.

The woman’s biggest fear, according to the study, is of their male partner. She fears that she will be blamed for bringing the virus into the family, or worse, that her HIV/AIDS infection means that she has been promiscuous: a charge of promiscuity means being abandoned, beaten, or both.

A principal solution offered by the researchers was couple counseling that supports the woman and debunks the myths associated with the disease. However, both the problem of stigma and the offer of counseling reminds us that the practice of medicine is about more than just testing, treatment, and technology; that understanding the patient as a person, that their concerns in their immediate environment often need to come first before science can do its job.

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