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A study of nurses and HIV/AIDS patients in five African nations has found that stigma is decreasing, but burdens both HIV patients and their nurses.

The researchers say that this is limiting care options for HIV patients and strategies are needed to prevent stigma.

Researchers in Lesotho, Malawi, South Africa, Swaziland and Tanzania, along with researchers from the University of California in San Francisco, designed a system to assess the perceived stigma associated with HIV/AIDS.

They published their results in the March issue of the journal Qualitative Health Research.

The study used focus groups in urban and rural settings to monitor 1,444 people living with HIV and 1,388 nurses caring for HIV patients over one year. By measuring the degree of stigma associated with the disease at three points during the year, the researchers found that stigma is decreasing in all five countries — but at different rates and from different starting points.

Discrimination against people on antiretroviral drugs was more severe than against HIV patients who were not using the medication. This was because the infection was more obvious owing to frequent clinic visits.

Nurses treating people living with HIV were also stigmatised — for example, by not being given transport to visit HIV patients at home.

"AIDS-service nurses are not joined by other nurses in the canteen. The higher the level of stigmatisation experienced, the lower the level of job satisfaction for the nurses," Priscilla Dlamini, a principal investigator on the study and nursing lecturer at the University of Swaziland, told SciDev.Net.

The researchers argue that preventing such stigma is an essential part of medical treatment, and have found that bringing together nurses and people living with HIV decreases the negative impact of stigmatisation.

"Stigma is not just going to go away. It needs a strategic plan and needs to be addressed by the communities," says another principal investigator, Lucy Makoae from the National University of Lesotho. "Frequent contact between groups reduces fear, which gives rise to stigma," she added.

"There is no one single strategy that will work. A combination of strategies creates awareness of stigmatisation and helps people to move beyond it," adds Minrie Greef, of South Africa-based North-West University.

Link to abstract in Qualitative Health Research


Qualitative Health Research 18, 311 (2008)