Stigma and illness
As a Health Extension Practitioner, you will be working in the rural areas where 80–85% of the population of Ethiopia lives. The healthcare practice in rural areas is different from that of urban centres. The closeness you create with individuals, families and the community may make it difficult to decide about any ethical conflicts (dilemmas) that may occur in your day-to-day practice.
One of the serious ethical issues that you may encounter is stigma. Stigma is defined as a negative perception that is assigned to an individual because of any feature that, in the view of others, discredits and diminishes them from other people. The stigmatised person becomes a person who is discounted. In rural healthcare settings, stigma takes on special importance because of the close relationships that exist in small communities. To be viewed negatively by others, to be avoided, and to be seen as less than a full member of the community is a major burden for a person in a rural community.
Case Study 8.5 HIV and stigma
Jemila, a Health Extension Practitioner who is working at one of the Health Posts in Gambella Regional State, attends Ato Ojul's family. When she visited Ato Ojul's family she found that W/ro Hawa, the wife of Ato Ojul, is very depressed and tearful. Jemila tried to reassure her but Hawa was not willing to tell her the reason why she was depressed and crying. Later in the course of their discussion, Hawa told Jemila that she is HIV positive and that she is worried what will happen to her because of the stigmatising effect of HIV. If people in the wider community find out that she is HIV positive she fears that she will be an outcast and treated badly.
This is a complicated situation for Jemila to cope with, but there are some ethical principles that she can use to help her. Firstly, Hawa is her patient and must not be harmed by anything that Jemila does now or in the future. She must reassure Hawa about total confidentiality and establish a situation of trust between the two of them. Hawa's status is safe with Jemila and she can get treatment for her HIV without anyone else being aware.
What steps could Jemila take to address a stigmatising illness such as the HIV that has infected Hawa?
In the short term it is important that trust is established and that Hawa knows that she can rely on Jemila to support her without her problem becoming widely known. In the longer term Jemila can put in place a series of community-based educational activities designed to reduce stigma about diseases such as HIV. When the correct facts about HIV are known by the community they should be able to accept Hawa and not fear or reject her.