On towards children Pessimistic thoughts Feelings of worthlessness AG-490 side effects Decreased self-esteem Calling PLHIV names Desertion by spouses on diagnosis No AG-490 site stigma from familyAssociated stigma Anticipated stigma Internal stigmaAbusing, Insulting Avoidance Positive family supportStigmatizing behaviourReduced desire to start relationships and have more childrenAgents for and against stigmaImprovement in self-image and desire to start new relationships or damage to selfimage with resultant reduced desire to have childrenInsults from community members Hostility from health workers Support from health workers HAART reducing physical symptoms and restoring vitality HAART reducing psychological stresses and negative thoughts around death Reduction in negative self image with HAART Told all relatives and friendsCommunity as enhancer of stigma Health workers are source of stigma Health workers as mitigators of stigma HAART reducing stigmatizing symptoms of AIDS HAART reducing internal stigmaDisclosureManagement of stigmaImproved self-esteem, improvement in shattered and damaged self-image, increased desire to start new relationships and have more childrenRemaining strong in face of stigma Ignoring verbal taunts and obvious stigmatizing behaviour Remaining normal despite disease Going about daily business despite illness Having more children despite disease Keeping to herself to avoid stigma Proposed to by fellow PLHIV Started new relationship with fellow PLHIV after being alone for 3 yearsaResilience Adjustment NormificationWithdrawal Sero-sortingReactions to stigmaReduced interaction with others Start new relationships and reassessment of ability to have childrenThemes adapted from the “Conceptual Model of HIV/AIDS Stigma” [23].Nattabi B et al. Journal of the International AIDS Society 2012, 15:17421 http://www.jiasociety.org/content/15/2/17421 | http://dx.doi.org/10.7448/IAS.15.2.were using very abusive language but some were good to us. Some were saying that we are always told about delivery, but we don’t listen, we are delivering like pigs. So how can they get time to help us yet we are told not to deliver. But some were good, telling us to take our medications properly. Some were saying HIV-positive persons should not conceive. There were also reports of insults towards children born to PLHIV; thus, children of PLHIV were exposed to associated stigma. This form of stigma may also influence PLHIV’s desires to have children in the future. When asked about community members’ responses to his wife’s pregnancy, one male participant said: Yes, they were saying we should wait and see how HIV-positive children will be born. But even some still call my child `HIV-positive child’. . . [They say] `Bring your HIV-positive child and I carry’. Another type of stigma which was not elaborated in Holzemer’s [23] framework, but was revealed through the interviews, was anticipated stigma. Anticipated stigma is defined as the degree to which PLHIV expect that they will experience prejudice in the future [39]. This form of stigma resulted in self-isolation and sero-sorting, as described in the next section. Some study participants excluded themselves from relationships or confined themselves to HIV seroconcordant relationships for fear of being stigmatized. This form of stigma reduced the desire to have more children in some PLHIV for fear that they would be stigmatized as well. When asked why he didn’t desire to have more children, one male participant said: . . .so wh.On towards children Pessimistic thoughts Feelings of worthlessness Decreased self-esteem Calling PLHIV names Desertion by spouses on diagnosis No stigma from familyAssociated stigma Anticipated stigma Internal stigmaAbusing, Insulting Avoidance Positive family supportStigmatizing behaviourReduced desire to start relationships and have more childrenAgents for and against stigmaImprovement in self-image and desire to start new relationships or damage to selfimage with resultant reduced desire to have childrenInsults from community members Hostility from health workers Support from health workers HAART reducing physical symptoms and restoring vitality HAART reducing psychological stresses and negative thoughts around death Reduction in negative self image with HAART Told all relatives and friendsCommunity as enhancer of stigma Health workers are source of stigma Health workers as mitigators of stigma HAART reducing stigmatizing symptoms of AIDS HAART reducing internal stigmaDisclosureManagement of stigmaImproved self-esteem, improvement in shattered and damaged self-image, increased desire to start new relationships and have more childrenRemaining strong in face of stigma Ignoring verbal taunts and obvious stigmatizing behaviour Remaining normal despite disease Going about daily business despite illness Having more children despite disease Keeping to herself to avoid stigma Proposed to by fellow PLHIV Started new relationship with fellow PLHIV after being alone for 3 yearsaResilience Adjustment NormificationWithdrawal Sero-sortingReactions to stigmaReduced interaction with others Start new relationships and reassessment of ability to have childrenThemes adapted from the “Conceptual Model of HIV/AIDS Stigma” [23].Nattabi B et al. Journal of the International AIDS Society 2012, 15:17421 http://www.jiasociety.org/content/15/2/17421 | http://dx.doi.org/10.7448/IAS.15.2.were using very abusive language but some were good to us. Some were saying that we are always told about delivery, but we don’t listen, we are delivering like pigs. So how can they get time to help us yet we are told not to deliver. But some were good, telling us to take our medications properly. Some were saying HIV-positive persons should not conceive. There were also reports of insults towards children born to PLHIV; thus, children of PLHIV were exposed to associated stigma. This form of stigma may also influence PLHIV’s desires to have children in the future. When asked about community members’ responses to his wife’s pregnancy, one male participant said: Yes, they were saying we should wait and see how HIV-positive children will be born. But even some still call my child `HIV-positive child’. . . [They say] `Bring your HIV-positive child and I carry’. Another type of stigma which was not elaborated in Holzemer’s [23] framework, but was revealed through the interviews, was anticipated stigma. Anticipated stigma is defined as the degree to which PLHIV expect that they will experience prejudice in the future [39]. This form of stigma resulted in self-isolation and sero-sorting, as described in the next section. Some study participants excluded themselves from relationships or confined themselves to HIV seroconcordant relationships for fear of being stigmatized. This form of stigma reduced the desire to have more children in some PLHIV for fear that they would be stigmatized as well. When asked why he didn’t desire to have more children, one male participant said: . . .so wh.
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