Page 32 - Bophelo - Edition Two | March 2025

An Impact on Health exposure prophylaxis (PrEP) to prevent HIV infection due
From Awareness
to Action:
Confronting health stigma in a
modern society
Stigma is a well-documented barrier to health-seeking can prevent individuals from seeking help or continuing
behaviour, engagement in care, and adherence to treatment. This can lead to worsening symptoms and
treatment across a range of health conditions globally,
and is often overlooked. It can have profound effects on
an individual’s health, both mentally and physically. For
example, stigma surrounding mental health conditions
30 THE SOUTH AFRICAN MEDICAL RESEARCH COUNCIL
a lower quality of life. People may internalise negative
beliefs, leading to self-stigma, which can result in
feelings of shame and reduced self-esteem.
to the stigma attached to it. PrEP is perceived as HIV
This feeling of shame can also impact physical health. For treatment (ARVs), as one girl reported that she did not
example, individuals with stigmatised conditions like HIV want to take PrEP because in her understanding it is the
may avoid seeking medical care due to fear of judgment same as ARVs. A young female participant reported that
or discrimination, leading to untreated health issues and she had been concerned about PrEP stigma related to
poorer health outcomes. The guilt related to seeking help people mistaking it for ARVs, and also the assumption
can lead to social exclusion, where individuals are isolated that PrEP users are promiscuous. Other research among
from their communities, adding to feelings of loneliness, adolescents and young people in South Africa identified
depression, and anxiety, further exacerbating health these and other barriers to HIV treatment: stigmatising
problems. The stress of dealing with shame can have direct social norms lead to concerns about being identified as
physiological effects, such as increased blood pressure and living with HIV, challenges coping with an HIV diagnosis,
weakened immune response; while prolonged stress can anticipated stigma in the health facility, concerns about
lead to unhealthy coping mechanisms, such as substance confidentiality in the health facility, school absences,
abuse. Stigmatised individuals face barriers in accessing inflexible clinic scheduling, and fears that health workers
healthcare, education, and employment, further limiting will lack sensitivity and compassion.
their opportunities and resources, leading to poorer
health and socioeconomic outcomes. With regards to family planning, scientists in the HSRU
have found that fears of being seen at the clinic and
Stigma, amongst other factors, increases the risk of HIV and being judged by healthcare providers for engaging in
unintended pregnancy among adolescent girls and young sexual activities while still young continues to be one of
women (AGYW). Further, stigma significantly impacts the barriers in accessing family planning among AGYW.
access and use of sexual and reproductive health (SRH) General fear of being seen at the clinic for family planning
services, particularly family planning and HIV prevention and other privacy issues was also cited a number of times
of HIV infection compared to their male counterparts and AGYW to just visit the clinic for these services. This “clinic”
by AGYW, stating that it is difficult for them and other
services for AGYW. Consequently, AGYW has high rates
stigma, which can be attributed to AGYW’s perceptions
a high unmet need for family planning, leading to AGYW
of the attitudes and behaviours of both healthcare staff
having high rates of unintended pregnancies.
at the facility, has serious (unintended) consequences.
To alleviate the HIV burden among AGYW, the Global AGYW may not want to return to the facility for follow-
up appointments for their family planning, fearing being
Fund to Fight AIDS, TB, and Malaria has invested in a
scolded and stigmatised by nurses or other clinic staff,
combination HIV prevention intervention, now called
thus missing their next pregnancy prevention method
the My Journey Programme, for AGYW. This programme
was implemented in South Africa from 2016 through
pregnant, AGYW may not come to the clinic for antenatal
2024. Combination HIV prevention interventions, which dose and fall pregnant as a consequence. Further, if
merge effective biomedical, behavioural, and structural care on time or seek abortion care services due to fears
of being judged for falling pregnant while still young, or
interventions for combined delivery, are one of the
key strategies for reaching the 95-95-95 targets and being discriminated against for seeking abortion care.
achieving the SDG goal of ending the HIV epidemic by Both these negative outcomes have serious long-term
consequences for AGYW’s health and wellbeing, through
2030.
to adulthood.
Researchers from the Health Systems Research Unit
(HSRU) evaluated the above-mentioned combination Stigma also has a significant impact on men’s health,
HIV prevention intervention between 2018-19 (the particularly in the context of mental health. Men are less
HERStory 1 study), 2020-21 (the HERStory 2 study), and likely than women to seek help for mental health issues
2024 (The HERStory 3 study). Dr Kim Jonas led 2 of due to societal expectations of masculinity, which often
these evaluations (HERStory 2 and 3), which found that emphasise strength and self-reliance. Men may avoid
stigma consistently hinders access to HIV and pregnancy seeking medical care and withdraw from social interactions
prevention methods among AGYW. Specifically, the due to fear of judgment or discrimination, leading to
study found that AGYW do not access and/or use pre- poorer health outcomes. Societal views on masculinity
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