HIV-related stigma experiences: Understanding gender disparities in Thailand

ABSTRACT

This paper assesses the relationship between gender and HIV-related stigma experiences among people living with HIV (PLHIV) – enacted and anticipated stigma – and PLHIV caregivers – courtesy stigma – in Northern Thailand, along with the underlying reasons for stigmatising attitudes towards PLHIV – instrumental and symbolic stigma – expressed in the general population. We used data from the Living With Antiretrovirals (LIWA) study conducted on all PLHIV receiving antiretroviral treatment in four district hospitals in Northern Thailand (n = 513) and on a community sample of adults from the general population (n = 500). Women living with HIV and female caregivers of PLHIV reported higher rates of HIV-related stigma experiences than men. Gender interacted with other predictors – the period of HIV diagnosis and age – to increase the level of stigma experienced. Among the general population, attitudes of contact avoidance were infrequent. However, stereotypes depicting PLHIV as blameworthy were highly pervasive, with women perceived as the “victims” of their spouse's irresponsible sexual behaviours. In this context, women were yet more often subjected to HIV-related stigma than men, in particular women diagnosed in the pre-antiretroviral therapy era and younger female caregivers. The role of gender in shaping disparities in HIV-related stigma experiences is discussed.

KEYWORDS:

• Stigma
• courtesy stigma
• gender
• care
• Thailand

Acknowledgements

The authors are grateful to all the people who participated in the surveys. The authors are grateful for useful suggestions from Dr Joseph Larmarange, Dr Elise Marsicano, an anonymous reviewer and to Catriona Dutreuilh for her editorial work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Julie Pannetier (PhD in Demography) is a Postdoctoral Research Fellow at the Center Population & Development (CEPED) in France. She wrote her PhD thesis on HIV-related secrecy and stigmatisation in Thailand and she is currently working on chronic illness secrecy among sub-Saharan migrants living in France.

Eva Lelièvre (PhD in Applied Mathematics) is a Senior Researcher at the French national Institute for Demographic Studies (INED) in France. Her main areas of expertise include the dynamics of individual trajectories, intergenerational relationships and family networks. She started in 2000 a long-term collaboration studying the impact of the HIV-Aids epidemic in Thailand on the lives of PLHIV.

Sophie Le Cœur (MD and PhD in Epidemiology) is a Senior Researcher at the French national Institute for Demographic Studies (INED) in France. She started working on HIV in women and children in the Republic of Congo in 1985. She moved to Thailand in 1996. She is the Principal Investigator of several studies, in particular on the impact of HIV on the lives of PLHIV.

Additional information

Funding

This work was supported by the Agence Nationale de Recherche sur le Sida et les Hépatites Virales (ANRS) [grant number 12141] and Oxfam GB. Julie Pannetier received a doctoral scholarship from the Institut National d'Etudes Démographiques.