Community attitudes towards individuals living with HIV in rural KwaZulu-Natal, South Africa

Abstract

Antenatal sero-prevalence rates of 30% and more have been reported in KwaZulu-Natal since 1998 and over 50% of all adult deaths in 2000 were due to AIDS. Understanding the changing social and cultural attitudes to AIDS is important in providing contextual information to aid the design of interventions. This paper examines community attitudes towards individuals living with HIV. Eleven focus groups were conducted with men and women. Participants were asked to discuss how people living with HIV were treated within the family and community. The discussions were recorded and transcribed in isiZulu and then translated into English. These were coded using Nud*ist 6 software to identify key themes and sub-themes using content analysis. Gender and area differences were investigated. Generally participants expressed positive attitudes to the treatment of AIDS patients and felt that people living with HIV were being cared for within families. However, they reported more negative attitudes to those living with HIV by the general community and suggested these attitudes and acts of discrimination influenced disclosure. Discrimination included physical isolation and symbolism such as referring to them using a ‘three finger’ gesture. Participants also reported mixed responses to known HIV-positive individuals, ranging from sympathy to a lack of care, on the grounds that the person is certain to die. There are gender differences in terms of the attitudes towards people living with HIV. Compassion and hopelessness seem to be more common among women than men.

Acknowledgments

The Microbicide Feasibility Study in Preparation for Phase III Microbicide Trials in the Hlabisa Sub-district, South Africa, was conducted with a grant from UK DFID (Grant number G0100137) through the Medical Research Council, UK. The authors would like to thank the participants and the following for facilitating the focus group discussions: the late Bonisiwe Mfekayi, Matsemela Moloi, Thandile Shandu and Wandile Manqele. We also thank Susan Watkins for comments on an earlier draft of this paper and the anonymous reviewers.

Notes

1. The term used in describing an individual in Zulu is gender neutral but when translated into English the issue of specifying gender arises. Henceforth, gender specific terms he/she in the quotations are used to put across the point. Where reference to gender is made this is highlighted in the quotations.

2. The three fingers’ sign is used to symbolize HIV. Sometimes the Euphemism magama mathathu (three words) is used in referring to HIV. Thus instead of saying directly that an individual is suffering from HIV, either the three finger sign or the euphemism ‘three words’ is used.

3. Connotes that those who are HIV-positive are paying for their actions.

4. This is a direct translation from the Zulu term for medicine. However although the term gives the connotation of a herb, in actual fact, it denotes antiretrovirals.