“People don’t know that I’m HIV positive”: self-stigma in the lives of sub-Saharan African migrant women in Belgium

Agnes Ebotabe Arrey¹*, Johan Bilsen¹, Patrick Lacor² and Reginald Deschepper¹

¹Mental Health and Wellbeing Research Group, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.

²Department of Internal Medicine and Infectious Diseases-AIDS Reference Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium

*Corresponding Author E-mail: aarrey@vub.ac.be

Accepted 13 March, 2015

Abstract

Antiretroviral treatment has significantly reduced AIDS-related deaths but the increased number of people living with HIV/AIDS and experiencing stigma remains a global health challenge. Self-stigma deeply affects the lives of people with HIV/AIDS and may thwart prevention efforts. This paper explores the drivers of self-stigma, experiences and the coping strategies common to HIV-positive sub-Saharan African (SSA) migrant women in Belgium. Qualitative study of 40 SSA migrant women was conducted between April 2013 and December 2014. Participants were recruited through purposive sampling and snowball techniques from AIDS Reference Centers and AIDS workshops in Belgium; if 18 years and older, French or English speaking, and diagnosed HIV-positive more than 3 months. We conducted semi-structured interviews with patients and did observations during consultations and support groups attendances. Follow-up interviews were conducted four to eight months later. Thematic analysis was used to identify themes, aided by NVivo 8 as they emerged from data. Self-stigma was ubiquitous in the lives of almost all participants, driven by: public endorsed negative feelings, chronic/incurable nature of disease, HIV transmission misconceptions. The most striking implications of HIV self-stigma include: reluctance to seek treatment/care, unwillingness to disclose HIV+ status. Participants reported that disclosure/non-disclosure, treatment adherence, faith in God, empathy and support help them cope HIV/AIDS self-stigma. Our findings highlight the complex and shifting nature of self-stigma experienced by SSA migrant women living with HIV/AIDS in Belgium. There is urgent need for innovative culturally-adapted self-stigma reduction programs that will improve personalized support services and optimize HIV prevention and treatment.

Keywords: HIV/AIDS, Self-stigma, Stigma drivers, African migrant women, Belgium.