Page 33 - Bophelo - Edition Two | March 2025
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An Impact on Health                                   exposure prophylaxis (PrEP) to prevent HIV infection due
                                                                  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
 From Awareness   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 Action:   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
 Confronting health stigma in a   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.
 modern society  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
 Stigma is a well-documented barrier to health-seeking   can prevent individuals from seeking help or continuing   HERStory 1 study), 2020-21 (the HERStory 2 study), and   likely than women to seek help for mental health issues
 behaviour,  engagement  in  care,  and  adherence to   treatment. This can lead to worsening symptoms and   2024  (The  HERStory  3  study).  Dr  Kim  Jonas  led  2  of   due to societal expectations of masculinity, which often
 treatment across a range of health conditions globally,   a lower quality of life. People may internalise negative   these evaluations (HERStory 2 and 3), which found that   emphasise strength and self-reliance. Men may avoid
 and is often overlooked. It can have profound effects on   beliefs, leading to self-stigma, which can result in   stigma consistently hinders access to HIV and pregnancy   seeking medical care and withdraw from social interactions
 an individual’s health, both mentally and physically. For   feelings of shame and reduced self-esteem.   prevention  methods  among  AGYW.  Specifically,  the   due to fear of judgment or discrimination, leading to
 example, stigma surrounding mental health conditions   study found that AGYW do not access and/or use pre-  poorer health outcomes. Societal views on masculinity


 30  THE SOUTH AFRICAN MEDICAL RESEARCH COUNCIL                                     THE COMMUNITY ISSUE         31
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