Stigma of HIV and AIDS

Background and justification of the study

 Human Immune Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)remain the major public health and persistent challenge globally. As such, the topic has aroused a lot of research projects. Majority of people infected with HIV/AIDS are reported to be from developed countries with an estimation of 66% living in Sub-Saharan Africa (1). Gayle described HIV AIDS epidemic in Sub Saharan Africa as a “global human tragedy” (2). Malawi is one of the least developed countries in sub-Saharan region with prevalence rate of HIV/AIDS estimated at 15.2% in adult population (1). Despite a lot of studies about HIV/AIDS, the World Health Organisation acknowledged the gaps in public health to effectively deal with this virus (3).

Stigma attached to HIV has been one of the main challenges faced by those infected. They are a lot of literatures related to HIV stigma, however the consistency related to implementation in tackling this, is not well documented (4). While they are also a lot of policies, and guidelines about HIV stigma, little is known if those policies are put in practice.  Studies have pointed out the need for global response to deal with this pandemic (6).

HIV has placed a big burden to Public Health Sector. The prevalence rate of adult population with HIV/AIDS, is shocking considering that it is also a productive age. Ross et al estimated the global cost of this virus reached up to 11.6 billion for medical expenditure alone in 2006 stressing that the financial cost and impacts of suffering are getting worse (7). As such, the researcher decided to do this study with hope of providing new information about the experience of HIV stigma and provide insight to implement the use of dominant policies of HIV stigma. A study conducted by one UCC student might not change everything, but it will change something, thereby contributing positively to Public Health industry.

Theoretical/conceptual framework

This study will draw on the HIV and stigma which analyses people’s relationships with others (8).  Stigma is one of the main concepts of HIV, yet efforts to deal with stigma are not consistent.  Gofman social theories suggest that stigmatisation has a ‘social construct’ that make other people feel down (8). This research will consider this theory throughout the study.

Review of the literature

This literature review will include current perspective from WHO websites, google scholar, UCC library database and some reports from Malawi about HIV/AIDS.

Global prospective of HIV and AIDS

The prevalence of HIV/AIDS is increasing worldwide, contributing to the burden on public health sector. In 2017, the World Health Organization estimated that 36.9 million people were infected with HIV globally (3). Over 940,000 people died worldwide due to illnesses related to AIDS in the same year (3).  Trustworthy studies have indicated that, even if this pandemic was to be eliminated today, the long-term impacts of what the world is facing today might last for the next 20years (9).

HIV/AIDS stigma

Studies have agreed that, since the discovery of HIV, fear has been one of the responses which at some extent attach stigma to it (7). Stigma can be perceived in different ways, however, Gofman the researcher of theories of stigma reported that people with HIV face stigma because the infection is still considered by others as a personal responsibility for contracting the virus (10).

Overview of Malawi country profile

Malawi is situated in the Southern part of sub-Saharan Africa. The country is divided into three main regions which are further subdivided into 28 districts (11). In terms of economy, Malawi is one of the least developed countries in the world with Gross Domestic Product (GDP) per capita of $195.77 (12). Donor assistance is reported to boost the countries resources (9). While agriculture contributes mainly to its economy, HIV and AIDS has been reported to bring down the countries efforts to reduce poverty as such, about 63.7% of Malawians populations live below poverty line (12). Recent statistics have reported that Malawi has a population of 19.16 million and highlighted a drop of life expectancy from 42years to 39years over the last 20years. HIV/AIDS pandemic was said to be the leading cause of the decline (13).

Overview of HIV/AIDS in Malawi

Malawi like many other countries in sub-Saharan region has been greatly affected by HIV/AIDS epidemic. Since the first case of AIDS was identified three decades ago figures of the epidemic continue to rise. 1n 2016 Malawi had 36,000 new HIV infection, 27,000 Aids related death and over 100,000 people were living with HIV (13). The high prevalence rate of HIV in adult’s population which is estimated at 14.4% has greatly affected the productive age group (14). As a result, not only the fight in epidemic has been a challenge, but also poverty reduction efforts have been affected (14).

 Study population, sample and size

The study population will be divided into two different categories. People with HIV, and people who directly or indirectly encounter with them.  In accordance to Malawi Ethical Review Board, the participants will be aged from 18 and above. Participants will come from different cultural grounds of rural area of Malawi. The other group will also comprise of participants who are 18 and above, encountering HIV people in different ways

RESEARCH QUESTIONS/ STUDY AIMS AND OBJECTIVES

AIM

• To analyse the effects of stigma on HIV/AIDS peoples in Malawi
• Objective of the study
• To identify barriers to effective relationships with HIV/AIDS people
• To explore the lived experience of HIV/AID and stigma
• To identify factors which can facilitate the effective use of existing HIV/AIDS stigma policies
• To bring recommendations on measures to improve HIV/AIDS stigma

Research methodology

Several literatures have indicated that, data collection methods are chosen taking in consideration of the topic of the study (15).  If the study requires the researcher to understand nature of reality, qualitative method is preferably (16). Considering the exploring study topic to be conducted, qualitative method is therefore more suitable for this research. Ethnographic method of data generation which explores data from ‘real world’ point of view and not under experimental settings will be used (17). Different studies have noted that in ethnographic studies the researcher immerse himself in a social setting, trying to observe behaviours or conducting interviews (18). Referring from these explanations, ethnography suits this study best. However, the main weakness of this study is that, it observes people over period, as such, generalisation of findings may be limited (17).

Sample selection and justification

Purposeful sampling will be used to identify participants. Voluntarily participation will be the only way to partake the study. 20 participants will be chosen. The objectives of the study will be explained to the chosen participants. For those who will volunteer to take part in study, date and time for interviews will be discussed. Considering the aim of this study and the financial limitation small sample is appropriate. Qualitative interviews will be used because they create real world meaning to understand the experiences (9). Above all, this study topic is sensitive, so the setting of the study will be more appropriate for audial and visual privacy.

Ethical considerations

Malawi national Health Sciences Research Ethics Committee will be asked for the consent to conduct the study. The ethical committee will then be briefed about the research topic. Written consent will be given to participants to sign after they gain a full understanding of the study. The consent form will be brief, but it will explain the purpose of the study, data collection techniques and confidentiality measures.  The researcher will seek permission from participants to record interviews.

Data collections methods

 Qualitative method will be used for this study. Creswell, a prominent researcher suggested qualitative methods are appropriate when trying to understand the context of health promotion (9).  In a different study, the same researcher analysed that qualitative research uses inductive data analysis to learn about the meaning of the participants issues and open-ended questions are mainly used (10). Using these references and looking at the topic and nature of this study, it is therefore right to use qualitative method, rather than quantitative which is deductive and may not explore the real meaning of stigma.

Dissemination of the results

The findings of the study will be submitted to UCC department of Public Health in fulfilment of the master’s award. The results are also hoped to be presented to the hospital where the study will be conducted and to Mistry of health in Malawi. However, the researcher will stress that the results findings are for academic purpose and are not conclusive findings.

Study limitation

The lengthy of the study is short.

Lack of finance support to conduct the study as this is self-sponsoring study.

Sampling method

Data source for this study is mainly from people not documents. Participants will be identified at Alinafe hospital in Malawi. Those who are HIV positive and are receiving care at this hospital will be considered, the participants should be above 18years of age and living in catchment area of Alinafe hospital which covers Benga area. Those below 18 with HIV and receiving care at this hospital will not be included.

Analysis

Since interviews will be recorded, tapes will be labelled to avoid mixing up of the recordings. The recorded tapes will be transcribed then written down. After that, the study objective will be tailored up with the interviews to come up with the themes.

Feasibility, timeline and logistics

This research will commence from early May 2019 till end June. The researcher is planning to conduct a table quiz in February to fundraise the money for the study. A review of the literature will be undertaken between February and March and topic plan will be prepared.  By end March, the application to UCC Social Ethical Committee will be done.

Since this study will involve recording interviews, the recording equipment will be purchased in advance and tested before the study. The plan on how to undertake the whole research process will be written down in March to avoid missing out important details. After receiving ethical approval, data collection will start from May to June. In July, the researcher will spend time analysing the study and submit the results to relevant bodies.

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