University of Cape Town

Critical Health Humanities Portfolio Assignment

Cover sheet

Names of student: …AMMAARAH ISAACS…………………………………….

………………………………………………………………
Student registration number: ISCAMM002…………………………………………………………………………………….
Date of submission: …………18/10/2021……………………………………………………………………………………………..

Plagiarism statement:

1. I know that plagiarism is wrong. Plagiarism is to use another’s work and pretend that it
is one’s own. Plagiarism includes publishing or submitting one’s own work in more than
one context.
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Each contribution to, and quotation in, this essay/report/project/…ESSAY…………… from
the work(s) of other people has been attributed, and has been cited and referenced.
3. This essay/report/project/……ESSAY…………….. is my own work.
4. I have not allowed, and will not allow, anyone to copy our work with the
intention of passing it off as his or her own work.
5. I acknowledge that copying someone else’s assignment or essay, or part
of it is wrong, and declares that this is my own work.

Signature: ___________ _________________ Date: 18/10/21

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4.7 Define and critically discuss internalised stigma and explain how internalised stigma may
affect a patient’s response to their HIV illness and how a health professional may support
patients in working through this.  

Stigma is an attribute that is deeply discrediting. “A person marked by stigma struggles with

foreclosure, diminished self-esteem, discrimination and isolation” (Szcześniak et al., 2018).

Many HIV positive individuals are victims of stigma from their community, they thus

internalize this stigma and the stereotype which accompanies it. In this essay, I will define

and critically discuss internalised stigma regarding HIV, and how this affects the male and

female response in African culture, with reference to participants feedback and discussions

on studies conducted in this field. I will also discuss strategies healthcare workers may

implement to support HIV positive patients. 

Internalized stigma is essential to understanding patient narratives as it defines the actions

patients take concerning their health status. Internalized stigma as defined in the article by

Szcześniak according to Livingstone and Boyd is “a subjective process, embedded in the

sociocultural context, characterized by negative feelings (about the self), maladapted

behaviour, the transformation of identity or the application of stereotypes resulting from an

individual’s experiences, perceptions or anticipation of negative social reactions on the basis

of their illness.” Patients with a disease feel they have a lower social standing than those who

are healthier and stronger. They devalue their worth and believe they are not worthy of a

family or love. Internalized stigma is born from social and structural stigma and affects many

facets of the self. Due to this internalized stigma, individuals that test positive for HIV might

feel they do not belong in their community.

According to a study conducted by Simbayi, “internalized stigma accounted for 4.8% of the

variance in cognitive-affective depression scores” of patients who tested positive for

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HIV/AIDS. This could be the result of these patients feeling ‘dirty’, ashamed, feeling that it

was their fault for contracting HIV/AIDS, or feel they must have done something to deserve

their condition (Simbayi et al., 2007). For males in African culture, it could result in them

feeling unmasculine as it is perceived that those who have HIV/AIDS are weak and

vulnerable‌(Lynch, Brouard and Visser, 2010). 

This feeling of unmasculinity results in African men generally not seeking out treatment or

even testing for HIV/AIDS. African masculinity historically constitutes “assertive

heterosexuality, control of economic decisions within and outside the homes, political

authority, cultural ascendency and support for male promiscuity” (Lynch, Brouard and

Visser, 2010, p16). If they are found to be HIV positive, they will start to feel that their

community will not see them as men. The pinnacle of manhood in African culture is the

ability to financially provide for their family, make decisions in their household, and be

sexually active with many women. The ‘hydraulic model’ suggests that male sexuality is

dependent on many different sexual partners for men to attain adequate sexual release. This

societal pressure for men to be more knowledgeable about sex and prove their manhood

pushes men to have multiple sexual partners and be at an increased risk of contracting HIV.

The internalized stigma men hold towards safe sex is that they inherently feel using a condom

or any other sexual barrier is not masculine. According to the study conducted by Dageid et

al, men who waited until they were very ill, stated that a real man looks strong and healthy

while those associated with HIV were seen as walking coffins which contradicts words to

describe manhood (Dageid, Govender and Gordon, 2012). They also feel clinics are catered

towards women, this further solidifies the fact that testing and getting treatment for HIV is

not manly (Lynch, Brouard and Visser, 2010).

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Although women are more open to getting tested or expressing their HIV status, they too face

stigma with regards to HIV/AIDS. Iwelunmor et al says with regards to women and HIV

HIV is redefining their lives and conflicting with their previously defined identity; thus

creating a new identity.

Women’s identities as mothers particularly, are disrupted as they fear their children will not

accept them. They fear their children will blame them (the mothers) for contracting HIV and

that they would not want to be around them. Women weigh the personal costs and benefits to

disclosing their seropositive status but are more willing to get tested and receive treatment

over their male counterparts. 

In the study conducted by Dageid et al, of African men who decided to test for HIV and

tested positive, there were many challenges they had to face. They experienced a loss of

physical strength which resulted in them losing their jobs and subsequently loss of food and

housing. They could no longer play the role of providers in their families. For other men, the

diagnosis came as a relief as it put a name to their illness. These men then had to decide

whether or not to disclose their status to their families. Those who decided not to disclose

weighed the pros and cons of whether it would be beneficial for them or not. The main reason

they felt they could not disclose was due to perceived stigma related to HIV/AIDS. The

negative repercussions outweighed the positives in their mind. These men felt that they would

not be accepted back into the family because of their HIV status, or will be made to feel

vulnerable and incapable. Those that decided to disclose expressed acceptance of their HIV

status, but also stressed that the “time, context, potential confidants and levels of support had

to be deliberated and found suitable to avoid rejection and stigmatisation”. Some men felt

they were responsible and led healthier lives and were going to use condoms forever, while

others received negativity, where their partner expressed they do not ‘feel free with him’

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(Dageid, Govender and Gordon, 2012). According to Iwelunmor et al “At the individual

level, stigma undermines the person’s identity and capacity to cope with the disease.” As seen

in these scenarios, it can be concluded that self-acceptance of HIV status makes the

disclosure process easier, it is this relaxation of the perceived stigma of HIV that allows these

men to speak freely to their loved ones. Positive feedback from those they disclose their

status to results in the desire to open up even more. This decision for disclosure was also the

result of professional counselling in assisting them with choosing the most advantageous

strategy for disclosure (Dageid, Govender and Gordon, 2012). 

Amongst counselling, there were other strategies healthcare workers and the healthcare

system could implement to support those diagnosed with HIV/AIDS. These include educating

HIV positive individuals on how HIV causes immune suppression and how ARV’s work, and

setting up campaigns for these patients to educate others. This helps deconstruct societal

stigmas that push the narrative of HIV as a ‘death sentence’. The community can see that

people can live normal lives even when diagnosed with HIV. Ignorance is the main problem

that causes stigma with regards to HIV. In the study conducted by Dageid et al, it was seen

that these men wanted to be meaningfully involved in HIV-related activities, whether it be as

a community educator, participating in support groups, training or workshop activities. This

involvement provides them with a sense of fulfilment that also fills the narrative of men

wanting to lead and make decisions to feel manly. In these activities, they feel needed which

could also alleviate feelings of depression and vulnerability. Another strategy healthcare

workers can implement is allowing the patient autonomy over their decisions, whether it be

disclosing their HIV status to their family or agreeing to take ARV’s. The healthcare worker

should not push their narrative onto their patient, as this may make them feel they have less

control over their lives and might participate in destructive behaviour ie. Unprotected sex.

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Allowing the patient control over their decisions increases patient-provider trust, resulting in

seropositive individuals gradually accepting the idea of disclosing their status. 

In conclusion, it is seen that internalized stigma plays a crucial role in the decision for

individuals to get tested for HIV and disclose their HIV status. In general, men are less likely

to want to know their HIV status, as they feel this might make them less of a man, whereas

women are afraid of disrupting their identity. Disclosing your HIV status is never easy, but

with the assistance of an empathic healthcare provider, it may become easier to accept your

status and subsequently open up to those you love.  

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References:

Dageid, W., Govender, K. and Gordon, S.F. (2012). Masculinity and HIV disclosure among
heterosexual South African men: implications for HIV/AIDS intervention. Culture, Health &
Sexuality, 14(8), pp.925–940.

Iwelunmor, J., Nwaozuru, U., Sofolahan-Oladeinde, Y., Conserve, D. and O. Airhihenbuwa,

C. (2017). Disclosure Narratives of Women Living with HIV in South Africa.

Lynch, I., Brouard, P.W. and Visser, M.J. (2010). Constructions of masculinity among a
group of South African men living with HIV/AIDS: reflections on resistance and
change. Culture, Health & Sexuality, 12(1), pp.15–27.

Simbayi, L.C., Kalichman, S., Strebel, A., Cloete, A., Henda, N. and Mqeketo, A. (2007).
Internalized stigma, discrimination, and depression among men and women living with
HIV/AIDS in Cape Town, South Africa. Social Science & Medicine, [online] 64(9), pp.1823–
1831. Available at: https://www.sciencedirect.com/science/article/pii/S0277953607000184.

Szcześniak, D., Kobyłko, A., Wojciechowska, I., Kłapciński, M. and Rymaszewska, J.

(2018). Internalized stigma and its correlates among patients with severe mental
illness. Neuropsychiatric Disease and Treatment, Volume 14, pp.2599–2608.

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