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Perceived Stigma is Real Stigma

July 23, 2010

Cassandra Mickish

K4Health, JHU∙CCP | Comm. Specialist
On Thursday at the XVIII International AIDS Conference in Vienna, I was looking at the variety of posters and stumbled across one about research in Uganda that really struck me. 
 
Researchers G.J. Wagner, S. Linnemayr, C. Kityo, and P. Mugyenyi investigated perceived provider stigma amongst HIV-positive clients and its implications. They had three main objectives: determine the fertility intentions of male and female HIV-positive clients; assess patients’ perceived access to family planning support from the patients’ providers; and to explore the relationship between perceived access to family planning support from the provider and HIV treatment adherence.

The researchers interviewed adult patients who were in a committed relationship at two Ugandan HIV clinics. They found that nearly half of patients interviewed – 48% of women and 46% of men – wanted to conceive a child in the near future. However, 45% of women and 40% of men said that they were not fully comfortable talking to their provider about fertility desires. 
 
Analysis showed that patients who wanted children were actually less likely to feel comfortable talking to their provider about family planning and their fertility desires. Even more troubling, patients who did not perceive family planning support were less likely to adhere to their HIV treatment, arguably putting them at greater risk of both unintended pregnancies and a higher viral load with greater risk of vertical and horizontal transmission.
 
These findings reinforce the importance of not only reducing provider stigma, but encouraging active discussion of fertility and family planning between providers and patients. Patients should not have to initiate these important but sometimes difficult discussions. Providers need to ask their patients about their risk and desire for pregnancy, so they can provide the tools necessary to prevent unintended pregnancy and ensure safe motherhood. Information and communication are integral to health, and perceived stigma is real stigma until providers demonstrate support.
 
Cassandra Mickish is a program specialist at K4Health and manager of the Resources for HIV/AIDS & Sexual and Reproductive Health Integration website.

 

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