Stigma, Structural Vulnerability, and What Matters Most Among Women Living With HIV in Botswana, 2017

Objectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from what matters most in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners'. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner's status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as promiscuous and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual-and structural-level interventions can address stigma unintentionally reinforced by health care policies. (Am J Public Health. 2021;111(7); 1309-1317. https://doi.org/10.2105/AJPH.2021.306274)

Automated summary

This study reveals that beneficial health care policies implemented in the context of gender inequality can inadvertently reinforce disadvantage among women with HIV, leading to stigma and blame towards these women. Cultural and structural interventions are needed to resist and address the unintended consequences of health care policies on stigma towards women with HIV.