**6. Limitations**

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

Our data showed that the discovery and disclosure of a positive HIV status may lead to family disharmony, generating a lot of suspicions. The findings show that concealment and disclosure remained an uphill task for PLWHA. The concealment affects their self-efficacy in seeking care in health institutions, which in turn can lead to non-utilization of health-care institutions because they will not want to be seen there. This study showed that some of the participants who disclosed, experienced negative consequences while others received support. Some of our participants had problems when they went on the radio programme as part of the PLWHA association activities because they revealed their positive HIV status and people who knew them recognized their voices. This shows the downside of PLWHA becoming active in HIV programs and has implication for support from their partners which is necessary to be able to utilize health care institutions. Furthermore, non-disclosure

Society can sometimes condemn PLWHA giving birth to children (Lekas et al., 2006; Valencia-Garcia et al., 2008), which affects their reproductive rights and self-efficacy of seeking early care. Our data shows that both unmarried and married participants did not plan to disclose their positive HIV status to their spouses but did want to have children. This is significant in Nigeria because high value is placed on children (Isiugo-Abanihe, 1994). Non-disclosure of positive HIV status to their spouses has implications for not seeking early treatment, as well as for the prevention of vertical transmission. Criminal prosecution for HIV transmission has already been applied in a few cases in the United Kingdom, where research showed that the majority of PLWHA in the study were against criminalization of reckless HIV transmission, while a few felt it might be justified if it changed the behavior of PLWHA (Dodds & Keogh, 2006). While the protection of individuals in society is important, the sexual rights, disclosure problems and further stigmatization of PLWHA remain a concern. Brown and colleagues noted that there are existing legislative tools to respond to actions that constitute criminally harmful behavior arguing that HIV-specific laws to punish PLWHA is unnecessary, counterproductive and jeopardizes the human rights of PLWHA (Brown et al., 2009). Furthermore, direct or indirect inclusion of criminalization of vertical transmission pose serious consequences for female PLWHA as well as undermine the success of vertical transmission programmes so far

The participants' coping strategies were highly determined by the anticipation of negative reactions from society and the link to non-monogamous heterosexual transmission. They utilized different coping strategies to hide their condition since they believed it would not be accepted in society. The ability to cope with HIV/AIDS further depended on their marital status. Discordant partners found it more challenging to cope, because some were abandoned by their partners due only to the suspicion of being HIV infected. Our data also showed that married people received support better. The route through which participants felt they contracted their HIV virus was related to their emotional reaction and the support they received. Literature has pointed out that many women living with HIV/AIDS consider themselves as innocent victims in order to escape moral judgment from society (Doyal,

Furthermore, our study showed that gender played a role in the knowledge of partner's HIV status, as some of the female participants did not know their partners were HIVpositive and could not seek care when they were infected with HIV/AIDS. Schur (1984), noted that the overall subordination of women can lead to a snowballing effect because of the difficulty for them to achieve desired goals, such as getting tested for HIV. Women are

contributes to the spread of HIV/AIDS when people have unprotected sex.

achieved (Csete et al., 2009).

2009).

Although the findings from this study are informative, they must be interpreted in the context of some methodological limitations. First, this is a small exploratory, qualitative study. Second, the findings were organized within the explanatory model which was based on literature review of HIV-related stigma in Sub-Saharan Africa and so it is subject to the limitation of the search criteria used. Third, the findings cannot be generalized to the larger population. Fourth, the study was conducted with people who were open about their positive HIV status and belonged to a patient association. Finally, some of the participants were also on ART and enjoyed government, as well as social and company support.
