HIV/AIDS-Related Stigma and Discrimination Toward Women Living with HIV/AIDS in Enugu, Nigeria

165 Pages·2017·1.16 MB·English

Walden University
ScholarWorks
Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2016
HIV/AIDS-Related Stigma and Discrimination
Toward Women Living with HIV/AIDS in Enugu,
Nigeria
Chinyere Fidelia Nnajiofor
Walden University
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Walden University

College of Health Sciences

This is to certify that the doctoral dissertation by

Chinyere Nnajiofor

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. John Oswald, Committee Chairperson, Health Services Faculty
Dr. Lawrence Fulton, Committee Member, Health Services Faculty
Dr. Magdeline Aagard, University Reviewer, Health Services Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2016
Abstract
HIV/AIDS-Related Stigma and Discrimination Toward
Women Living with HIV/AIDS in Enugu, Nigeria
by
Chinyere Fidelia Nnajiofor

MS, University of Texas Pan American at Edinburg, 2009
MEd, University of Texas Pan American at Edinburg, 2004
PGD, River State University of Science and Technology, Nigeria, 1998
BS, Abia State University, Nigeria, 1989

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Health Services

Walden University
July 2016
Abstract
HIV/AIDS-related stigma and discrimination (S&D), lack of social support, poverty, and
gender inequalities have been identified as factors in the increased prevalence rate of HIV
transmission in Enugu, Nigeria, especially among women ages 15 to 49 years. Despite
the funding of reduction programs, HIV/AIDS-related S&D remain a major driving force
in the increased rate of new HIV cases in Enugu. This study addressed a perceived need
for behavioral change intervention approaches that span all societal factors to reduce the
HIV infection rate in Enugu Nigeria. The study was guided by Goffman’s (1963) social
S&D theory. The sample was composed of 132 women living with HIV/AIDS WLWHA
ages 21 to 54 years, purposefully sampled from the 4 HIV and AIDS comprehensive
initiatives care centers in Enugu, Nigeria. Fifteen WLWHA were interviewed and 114
participated in an online survey. The descriptive statistics and a multiple linear regression
analysis and comparison revealed a convergent significant relationship between the S&D
determinants (social, political, psychological, environmental, and cultural) and
HIV/AIDS-related S&D towards WLWHA in Enugu F (4,109) = 45.09, p <.001). It
also revealed that the cultural determinant of S&D was a significant predictor of
HIV/AIDS-related S&D towards WLWHA in Enugu (β = 0.81, p < 0.001). The
implications for positive social change include providing public health professionals
evidence-based data to inform policy change, plan and to implement programs that will
change societal attitudes and mobilize broad-based community actions to eradicate
HIV/AIDS–related S&D toward WLWHA in Enugu, Nigeria, and in Sub-Saharan
African Countries.
HIV/AIDS-Related Stigma and Discrimination Toward
Women Living With HIV/AIDS in Enugu, Nigeria.
by
Chinyere Fidelia Nnajiofor

MS, University of Texas Pan American at Edinburg, 2009
MEd, University of Texas Pan American at Edinburg, 2004
PGD, River State University of Science and Technology, Nigeria, 1998
BS, Abia State University, Nigeria, 1989

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Health Services

Walden University
July 2016
Dedication
The completion of my doctor of philosophy in health care services-health care
administration would not have been possible without the love and support of my family
and my close friends, Rev. Fr. Andre Bakajika Kazadi and Rev. Fr. Rigobert Poulang
Mot. I am very grateful to my sons and daughters, Francis-Kingsley, Anthony, Victor-
Marius, Olivia, Linda, and Uzoma, who patiently stayed at my side throughout this
journey. I thank you all for your love and inspiration. To all of my brothers, sisters, son-
in-law, daughters-in-law, and my grandchildren, I say: Thank you for your support and
encouragement. To my lovely mother, Angela E. Mokwe, I say: You did it!
Acknowledgments
First, I want to acknowledge my mother, Angela Ejimnaka Mokwe, who taught
me at an early age that if I stay focused, have a positive attitude, and constantly strive to
give my best effort, eventually, I will overcome my immediate problems and surmount
greater challenges. Her strength and sense of dignity in labor have anchored me
throughout all of my life endeavors.
I will always be grateful to Dr. John Oswald, my committee chair, for his tough
love, support, and candid feedback. His encouragement, infinite patience, coaching, and
guidance brought to completion the daunting task of writing a dissertation. I extend
thanks to my dissertation committee members: Dr. Lawrence Fulton and Dr. Magdeline
Aagard. Their support and positive feedback ensured the quality and relevancy of my
intellectual work to existing knowledge.
My gratitude goes to Dr. and Mrs. Uchenna V. Okenwa of the Enugu Ministry of
Health and Dr. Brigadier Ogbe, for their support and guidance.
Finally, I extend my gratitude to the staff in the Department of Health Services at
Walden University and to the staff of the four HIV/AIDS comprehensive care centers for
their guidance and support during this research process.
Table of Contents
List of Tables ................................................................................................. vi
Chapter 1: Foundation of the Study ................................................................ 1
Introduction ................................................................................................................... 1
Problem Statement ........................................................................................................ 3
Purpose Statement ......................................................................................................... 3
Nature of the Study ....................................................................................................... 4
Research Questions ....................................................................................................... 6
Theoretical Framework ................................................................................................. 7
Definitions of Terms ..................................................................................................... 7
Assumptions, Limitations, and Delimitations ............................................................... 8
Assumptions ............................................................................................................ 8
Limitations .............................................................................................................. 9
Delimitations ........................................................................................................... 9
Significance of the Study .............................................................................................. 9
History of HIV ............................................................................................................ 13
HIV Statistics Trends in Africa ................................................................................... 15
HIV Rates in Nigeria .................................................................................................. 18
History of the Igbo People .......................................................................................... 19
Beliefs of the Ndi Igbo of Nigeria ........................................................................ 21
Women’s Place ..................................................................................................... 23
HIV/AIDS Among Igbo People in Enugu and Nigeria in General ............................. 24
i
HIV/AIDS Prevalence Among Igbo Women in Enugu and Nigeria in General .. 25
Stigma Against Igbo Women With HIV/AIDS in Enugu and Nigeria in General 30
Behavioral and Psychosocial Aspects of HIV ............................................................ 32
HIV Interventions ....................................................................................................... 34
HIV Risk Reduction Programs ............................................................................. 39
HIV Interventions in Africa .................................................................................. 41
Negative Effects of HIV/AIDS-Related Stigma and Discrimination ......................... 44
Transition and Summary ............................................................................................. 49
Chapter 3: Research Method ......................................................................... 52
Introduction ................................................................................................................. 52
Research Design and Rationale .................................................................................. 52
Role of the Researcher ................................................................................................ 56
Study Sample .............................................................................................................. 57
Instrumentation ........................................................................................................... 58
Qualitative Component ...................................................................................... 58
Quantitative Component ....................................................................................... 59
Procedures for Recruitment, Participation, and Data Collection ................................ 60
Qualitative Component ......................................................................................... 60
Quantitative Component ....................................................................................... 62
Data Analysis Plan ...................................................................................................... 63
Qualitative Component ......................................................................................... 63
Quantitative Component ....................................................................................... 65
ii
Threats to Validity ...................................................................................................... 66
Issues of Trustworthiness ............................................................................................ 67
Ethical Procedures ...................................................................................................... 68
Summary ..................................................................................................................... 68
Chapter 4: Results ......................................................................................... 69
Introduction ................................................................................................................. 69
Research Questions ..................................................................................................... 71
Pilot Study ................................................................................................................... 72
RQ1: Qualitative Results ............................................................................................ 73
Analytic Approach ................................................................................................ 73
Data Analysis ........................................................................................................ 73
Validity, Trustworthiness, and Reliability ............................................................ 77
Coding ................................................................................................................... 77
Research Findings ....................................................................................................... 78
Category 1: Employment-Based Discrimination .................................................. 78
Category 2: HIV Screening and Identification ..................................................... 79
Category 3: Disclosure of HIV Status .................................................................. 82
Category 4: Stigma Related to Social Contact and Interaction............................. 83
Category 5: Internal Stigma and Psychological Effects ....................................... 88
Category 6: Cultural Stigma ................................................................................. 90
Category 7: HIV Care Experiences....................................................................... 91
Category 8: Agency and Empowerment ............................................................... 93
iii