HIV-related stigma in African and Afro-Caribbean communities in the Netherlands: Manifestations, consequences and coping

Abstract

HIV-related stigma in African and Afro-Caribbean diaspora communities in the Netherlands was investigated. Interviews with HIV-positive and HIV-negative community members demonstrated that HIV-related stigma manifests as social distance, physical distance, words and silence. The psychological consequences of HIV-related stigma among those diagnosed with HIV reported were emotional pain, sadness, loneliness, anger, frustration and internalised stigma. The social consequences included decreased social network size, limited social support and social isolation, and resulted from not only enacted stigma but also self-imposed social withdrawal. Also, poor treatment adherence was a health-related consequence. People living with HIV employed both problem-focused and emotion-focused coping strategies to mitigate the negative consequences of stigma. Problem-focused coping strategies included selective disclosure, disengagement, affiliating with similar others, seeking social support and, to a lesser extent, activism. Emotion-focused strategies included distraction, positive reappraisal, religious coping, external attributions, disidentification and acceptance. HIV-related stigma clearly permeates African and Afro-Caribbean communities in the Netherlands, and should be targeted for intervention.

Keywords:

• HIV/AIDS
• stigma
• consequences
• mental health
• coping

Acknowledgements

The authors thank the participants, the Dutch AIDS Fonds (grants 2006092, 7004), Abbott, the Dutch HIV Association, Humanitas, the Professional Organisation of HIV Consultants, the Community Health Services in Amsterdam, Groningen and Rotterdam and the following people: Evert van Veen, Fetzen de Groot, Gerjo Kok, Jan Prins, Jeannine Nellen, Juan Walter, Maartje Liebregts, Mariette Hamers, Nicole van Kesteren, Onno de Zwart, Ronald Brands, Stephan Cremer, Chantal Rumanzi, Dudly Tijn-a-Kwie, Elizabeth Njeru, Emmy Markelo, Erik Beune, Germain Ackermans, Indira Snip, Juan Walter, Mikel Haman, Mirte Wibaut, Nadia Mirjals, Pamela Matinde, Rubelto Baker, Urmy Macnack, Anne van Middelaar, Carolien van Wagenberg, Danielle Pool, Joyce van Leendert, Roy van Veldhuizen, Sanne van Lieshout and Simone Heijnen.