**3. Results**

Demographic characteristics are presented in Table 1. Twenty four persons were female and 21 persons were married. An explanatory model was organized in a causal structure based on the combined responses of the interviewees (Figure 1). The model shows stigma by society as being affected by 10 different determining factors, all of which relate to processes and conditions that allow a manifestation of the stigma. These determining factors are degree of knowledge, association with promiscuity, blame, societal reaction to care givers, media, poverty, fear, religion, gender, and government role. Blame functions both as a determining factor that creates stigma, as well as manifestations of stigma. Other manifestations of stigma are abandonment, isolation, and harassment.

The views of both men and women are combined. The described findings and interpretations offer a general insight, illustrated with verbatim excerpts. In the following sections, the various determining factors are presented. Subsequently, we describe different manifestations of stigma. Thirdly, the conditions of care will be described, and finally, we discuss how these processes and condition interrelate in the explanatory model.

Societal Beliefs and Reactions About People Living with HIV/AIDS 211

Conditions for care e.g Close relative Religious sympathy Shift to HCPs

We distinguished many factors, such as degree of knowledge, association with promiscuity, blame, reactions to care givers, media, poverty, fear, religion, gender, and government role.

We found that inadequate knowledge about transmission and about HIV/AIDS can influence how people react to PLWHA. Although information on different ways of transmission of HIV may be increasing, still many people are not aware of accurate means of transmission of HIV virus. To some of the participants, people's lack of knowledge about HIV/AIDS infection and the routes of transmission contributes to reluctance to care for

*'Reaction depends on the education of the person involved, the mentality. Many people think if they* 

PLWHA are especially ostracized when they show signs and symptoms of AIDS. Many participants based a judgment about HIV status on appearance, rather than on information, and a person's looks may determine how negative the reaction he or she receives. For instance, if a person with HIV is heavy weighted, people around may not believe that the person has HIV. When the person has an appearance widely associated with HIV, people begin to react negatively to the person, even if they are wrong about the diagnosis. Participants in our study described the appearance of a HIV-positive person as slim with skin rashes. They frequently mentioned loss of weight and being sick for a long time, as

Fig. 1. shows determining factors, conditions of care And manifestations of stigma

Manifestations of stigma Abandonment Isolation Harassment Blame

Determining factors Degree of knowledge Association with promiscuity Blame Societal reaction to caregivers Media Poverty Fear Religion Gender Government role

**3.1 Determining factors** 

**3.1.1 Degree of knowledge** 

PLWHA, as the following quote illustrates:

elaborated on in the following quote:

*touch the HIV person they will get it.' (Male, single)* 


Table 1. shows the information about the participants

Fig. 1. shows determining factors, conditions of care And manifestations of stigma

#### **3.1 Determining factors**

210 Social and Psychological Aspects of HIV/AIDS and Their Ramifications

**Participant Gender Marital Status Types Of Work Tribe**  1 Female Single Company Worker Efik 2 Male Married Police Officer Kalabari 3 Female Married Legal Practitioner Efik 4 Female Married Legal Practitioner Ibo 5 Female Married Sales Woman Ibo 6 Female Married Teacher Yoruba 7 Female Married Teacher Ibo 8 Male Single Company Worker Yoruba 9 Female Single Motor Company Ibo 10 Male Married Manager Yoruba 11 Female Single Manager Efik 12 Male Married Supervisor Ibo 13 Male Single Manager Efik 14 Female Single Office Secretary Ibo 15 Female Single Hair Dresser Ibo 16 Male Single Company Worker Efik 17 Female Single Company Worker Efik 18 Female Single Company Worker Ibo 19 Female Single Company Worker Ibo 20 Male Single Company Worker Ibo 21 Female Married Company Worker Ibo 22 Male Married Police Officer Efik 23 Female Married Legal Practitioner Efik 24 Female Married Manager Yoruba 25 Female Married Teacher Ibibio 26 Male Married Businessman Ibo 27 Male Married Manager Yoruba 28 Female Single Computer Analyst Yoruba 29 Female Married Shop Owner Ibo 30 Male Married Government Worker Ibo 31 Male Married Company Worker Efik 32 Male Single Restaurant Worker Efik 33 Male Single Company Worker Ibo 34 Female Married Insurance Worker Ibo

35 Female Married Motor Company

Table 1. shows the information about the participants

36 Female Single Student Ibo 37 Female Single Student Efik 38 Male Single Student Efik 39 Male Single Student Ibo 40 Female Married Surveyor Yoruba

Worker

Ibo

We distinguished many factors, such as degree of knowledge, association with promiscuity, blame, reactions to care givers, media, poverty, fear, religion, gender, and government role.

#### **3.1.1 Degree of knowledge**

We found that inadequate knowledge about transmission and about HIV/AIDS can influence how people react to PLWHA. Although information on different ways of transmission of HIV may be increasing, still many people are not aware of accurate means of transmission of HIV virus. To some of the participants, people's lack of knowledge about HIV/AIDS infection and the routes of transmission contributes to reluctance to care for PLWHA, as the following quote illustrates:

*'Reaction depends on the education of the person involved, the mentality. Many people think if they touch the HIV person they will get it.' (Male, single)* 

PLWHA are especially ostracized when they show signs and symptoms of AIDS. Many participants based a judgment about HIV status on appearance, rather than on information, and a person's looks may determine how negative the reaction he or she receives. For instance, if a person with HIV is heavy weighted, people around may not believe that the person has HIV. When the person has an appearance widely associated with HIV, people begin to react negatively to the person, even if they are wrong about the diagnosis. Participants in our study described the appearance of a HIV-positive person as slim with skin rashes. They frequently mentioned loss of weight and being sick for a long time, as elaborated on in the following quote:

Societal Beliefs and Reactions About People Living with HIV/AIDS 213

concerned about the way other people will react to them when caring for a person with HIV/AIDS. A female participant described what happened when she went to hospital to learn the result of a HIV/AIDS test of a relative visiting her, which turned out to be positive.

*Laboratory worker: 'Oh madam, how long has this HIV person been staying with you in your house?* 

*Laboratory worker: You have to bring all your children for a HIV test. No, No, infact any help you want to give her let it be from a distance. She should be sent packing [sic] (sent away) from your* 

This exchange indicates the extent of stigmatizing reactions even from health care professionals. In some cases, people fear that neighbors might spread the word that a family is caring for a person with HIV/AIDS, thereby affecting the possibilities of family marriage. One of the common procedures in marriage is that the family of the groom asks around for information about a potential bride before going into marriage. This implies that neighbors' judgments can be significant. Some participants felt that their desire for marriage and to have children overrides caring for a person with HIV/AIDS. This concern was shown

*'Of course, caring for a person with HIV matters to me, because people around me can know about it or how else do people get husbands? They (potential suitors) can ask questions around about me where I live. I will not care for a person with HIV/AIDS even if she is my twin sister. Do you want me to get AIDS? I do mind as long as it is HIV/AIDS or do you want me to die young. You know it is a very serious disease that has no cure. You can see I am not married. I am a single girl. I do not* 

According to some participants, the media have created an image that HIV/AIDS is contracted by people who have sex with multiple partners, or who visit sex workers. One

*'People react to a person with HIV in the same way, no matter how you get it. The reason why it is like that is that the first awareness of HIV publicity said HIV was for people sleeping around. The media always said stick to one partner, use a condom. This made people feel that once people stick to one partner, they will not get HIV, not realizing that it is possible the one partner already has HIV.'* 

Participants said that the information people get from radio and television is that HIV/AIDS can be guarded against. This helps in fuelling the negative public reaction people give to PLWHA by shifting the responsibility to the individual. The next participant was concerned by the way media send HIV/AIDS messages to the public using words as for instance "obirinajocha" (means you end up in the white sand underground), which can contribute to

*'What is being chumed out in the media is also an issue. One begins to wonder whether they are out to create an undesired effect because we hear all over the media that this is an incurable disease and people should better not attempt by any means to pick it up. The media create an atmosphere of* 

Poverty is seen as an underlying factor in preventing care for people suffering from HIV/AIDS. Poor people are often looked down upon in the society. Thus, HIV/AIDS only

*helplessness for HIV positive people, as well as their care givers'. (Male, married)* 

She received this response in the hospital:

*Woman: She has been staying for three months* 

*house.' (Female, married)* 

**3.1.5 Media** 

*(Female, married)* 

**3.1.6 Poverty** 

vividly in the following comment:

participant had the following to say:

how people respond to HIV/AIDS:

*want anything that will stain my image.' (Female, single)* 

*'The hair of people with HIV starts falling out with boils all over the skin and they are slim.' (Female, single)* 

People felt confirmed in this judgment strategy, and looked for outward HIV/AIDS features. Some participants, without knowing the exact illness of a person, assume the HIV status of that person and feel they are right if they see prototypical HIV/AIDS features. For instance, in the words of one interviewee:

*'I know someone has HIV when someone is real lean and before you know it the person is sick. When they take the person to the hospital the doctor will examine and find out that the person is HIV positive.' (Male, single)* 
