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  • Agnes Ebotabe Arrey (a1), Johan Bilsen (a1), Patrick Lacor (a2) and Reginald Deschepper (a1)

Stigma and discrimination within health care settings remain a public health challenge across diverse cultural environments and may have deleterious effects on mental and physical health. This study explores the causes, forms and consequences of HIV-related stigma and discrimination among migrant sub-Saharan African women living with HIV in Belgium. A qualitative study was conducted with 44 HIV-positive sub-Saharan African migrant women between April 2013 and December 2014 in health care settings in Belgium. Data were analysed using thematic content analysis. Twenty-five of the women reported overt stigma and discrimination and fifteen reported witnessing behaviours that they perceived to be stigmatizing and discriminatory in health care settings. The themes that emerged as to the causes of stigma and discrimination were: public perceptions of migrants and HIV, fear of contamination and institutional policies on HIV management. Reported forms of stigma and discrimination included: delayed or denied care, excessive precautions, blame and humiliation. The consequences of stigma and discrimination were: emotional stress, inconsistent health-care-seeking behaviour and non-disclosure to non-HIV treating personnel. Stigma and discrimination in health care settings towards people with HIV, and more specifically towards HIV-positive sub-Saharan African migrant women, impedes sustainable preventive measures. Specialized education and training programmes for non-HIV health care providers require in-depth investigation.

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Adhikari, B., Kaehler, N., Chapman, R. S., Raut, S. & Roche, P. (2014) Factors affecting perceived stigma in leprosy affected persons in western Nepal. PLoS Neglected Tropical Diseases 8(6), e2940.
Aggleton, P., Yankah, E. & Crewe, M. (2011) Education and HIV/AIDS-30 years on. AIDS Education and Prevention 23(6), 495507.
Alemu, T., Biadgilign, S., Deribe, K. & Escudero, H. R. (2013) Experience of stigma and discrimination and the implications for healthcare seeking behavior among people living with HIV/AIDS in resource-limited setting. SAHARA Journal 10(1), 17.
Barrett, H. R. & Mulugeta, B. (2010) Human Immunodeficiency Virus (HIV) and migrant ‘risk environments’: the case of the Ethiopian and Eritrean immigrant community in the West Midlands of the UK. Psychology, Health & Medicine 15(3), 357369.
Beldie, A., den Boer, J. A., Brain, C., Constant, E., Figueira, M. L., Filipcic, I. et al. (2012) Fighting stigma of mental illness in midsize European countries. Social Psychiatry and Psychiatric Epidemiology 47 (Supplement 1), 138.
Bernard, E. J. (2007) UK Report Highlights Role of Media and African Communities to Combat HIV-Related Stigma. The African HIV Policy Network (AHPN) and Panos, London.
Bertozzi, S. M., Laga, M., Bautista-Arredondo, S. & Coutinho, A. (2006) Making HIV prevention programmes work. The Lancet 372(9641), 831844.
Browne, J. L., Ventura, A., Mosely, K. & Speight, J. (2013) ‘I call it the blame and shame disease’: a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open 3(11), 110.
Canadian HIV/AIDS Legal Network (2014) Criminal Law and HIV Non-Disclosure in Canada. URL: (accessed 24th April 2015).
Chalmers, J. (2002) The criminalisation of HIV transmission. Journal of Medical Ethics 28(3), 160163.
Clumeck, N., Sonnet, J., Taelman, H., Cran, S. & Henrivaux, P. (1984) Acquired immune deficiency syndrome in Belgium and its relation to Central Africa. Annals of the New York Acadamy of Sciences 437, 264269.
Conn, C. (2013) Young African women must have empowering and receptive social environments for HIV prevention. AIDS Care 25(3), 273280.
Davtyan, M., Brown, B. & Folayan, M. O. (2014) Addressing Ebola-related stigma: lessons learned from HIV/AIDS. Global Health Action 7, 14.
De Cock, K. M., Jaffe, H. W. & Curran, J. W. (2011) Reflections on 30 years of AIDS. Emerging Infectious Disease 17(6), 10441048.
Del, A. J., Likatavicius, G., Perez-Cachafeiro, S., Hernando, V., Gonzalez, C., Jarrin, I. et al. (2011) The epidemiology of HIV and AIDS reports in migrants in the 27 European Union countries, Norway and Iceland: 1999–2006. European Journal of Public Health 21(5), 620626.
DeMarco, R. F., Kendricks, M., Dolmo, Y., Looby, S. E. & Rinne, K. (2009) The effect of prevention messages and self-efficacy skill building with inner-city women at risk for HIV infection. Journal of the Association of Nurses in AIDS Care 20(4), 283292.
ECDC (2012) Responses to HIV and Migration in Western Industrialized Countries: Current Challenges, Promising Practices, Future Directions. European Centre for Disease Control, Stockholm. URL: (accessed 11th February 2013).
Ekstrand, M. L., Ramakrishna, J., Bharat, S. & Heylen, E. (2013) Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions. Journal of the International AIDS Society 16(3) (Supplement 2), 18717.
Elford, J., Ibrahim, F., Bukutu, C. & Anderson, J. (2008) HIV-related discrimination reported by people living with HIV in London, UK. AIDS Behavior 12(2), 255264.
Erwin, J. & Peters, B. (1999) Treatment issues for HIV+ Africans in London. Social Science & Medicine 49(11), 15191528.
Fakoya, I., Reynolds, R., Caswell, G. & Shiripinda, I. (2008) Barriers to HIV testing for migrant black Africans in Western Europe. HIV Medicine 9 (Supplement 2), 2325.
Feyissa, G. T., Abebe, L., Girma, E. & Woldie, M. (2012) Validation of an HIV-related stigma scale among health care providers in a resource-poor Ethiopian setting. Journal of Multidisciplinary Healthcare 5, 97113.
Goffman, E. (1963) Stigma: Notes on the Management of Spoiled Identity. Simon & Schuster Inc., New York.
Grossman, C. I. & Stangl, A. L. (2013) Editorial: global action to reduce HIV stigma and discrimination. Journal of the International AIDS Society 16(3) (Supplement 2), 18881.
Hackl, K. L., Somlai, A. M., Kelly, J. A. & Kalichman, S. C. (1997) Women living with HIV/AIDS: the dual challenge of being a patient and caregiver. Health & Social Work 22(1), 5362.
Harrison-Chirimuuta, R. & Chirimuuta, R. (1997) AIDS and Africa: a case of racisim vs science? In Bond, G. C., Krensike, J., Susser, I. & Vincent, J. (eds) AIDS and Africa and the Carribbean. Westview Press.
Hatzenbuehler, M. L., Phelan, J. C. & Link, B. G. (2013) Stigma as a fundamental cause of population health inequalities. American Journal of Public Health 103(5), 813821.
Heijnders, M. & Van Der Meij, S. (2006) The fight against stigma: an overview of stigma-reduction strategies and interventions. Psychology, Health & Medicine 11(3), 353363.
Holzemer, W. L. & Uys, L. R. (2004) Managing AIDS stigma. SAHARA Journal 1(3), 165174.
Juniarti, N. & Evans, D. (2011) A qualitative review: the stigma of tuberculosis. Journal of Clinical Nursing 20(13–14), 19611970.
Kipp, A. M., Pungrassami, P., Nilmanat, K., Sengupta, S., Poole, C., Strauss, R. P. et al. (2011) Socio-demographic and AIDS-related factors associated with tuberculosis stigma in southern Thailand: a quantitative, cross-sectional study of stigma among patients with TB and healthy community members. BMC Public Health 11, 675.
Kippax, S. C., Aggleton, P., Moatti, J. P. & Delfraissy, J. F. (2007) Living with HIV: recent research from France and the French Caribbean (VESPA study), Australia, Canada and the United Kingdom. AIDS 21 (Supplement 1), S1S3.
Kralik, D., Koch, T. & Telford, K. (2001) Constructions of sexuality for midlife women living with chronic illness. Journal of Advances Nursing 35(2), 180187.
Lauderdale, D. S., Wen, M., Jacobs, E. A. & Kandula, N. R. (2006) Immigrant perceptions of discrimination in health care: the California Health Interview Survey 2003. Medical Care 44(10), 914920.
Letamo, G. (2005) The discriminatory attitudes of health workers against people living with HIV. PLoS Medicine 2(8), e261.
Liamputtong, P. (2013) Women, Motherhood and Living with HIV/AIDS: A Cross-Cultural Perspective. Springer, Bundoora, Australia, doi:10.1007/978-94-007-5887-2.
Lin, C., Li, L., Wan, D., Wu, Z. & Yan, Z. (2012) Empathy and avoidance in treating patients living with HIV/AIDS (PLWHA) among service providers in China. AIDS Care 24(11), 13411348.
Link, B. G. & Phelan, J. C. (2001) Conceptualizing Stigma. Annual Review of Sociology 27(1), 363385.
Link, B. G. & Phelan, J. C. (2006) Stigma and its public health implications. Lancet 367(9509), 528529.
Mahendra, V. S., Gilborn, L., Bharat, S., Mudoi, R., Gupta, I., George, B. et al. (2007) Understanding and measuring AIDS-related stigma in health care settings: a developing country perspective. SAHARA Journal 4(2), 616625.
Manfredi, R., Calza, L. & Chiodo, F. (2001) HIV disease among immigrants coming to Italy from outside of the European Union: a case-control study of epidemiological and clinical features. Epidemiology & Infection 127(3), 527533.
Marsicano, E., Dray-Spira, R., Lert, F., Aubriere, C., Spire, B. & Hamelin, C. (2014) Multiple discriminations experienced by people living with HIV in France: results from the ANRS-Vespa2 study. AIDS Care 26 (Supplement 1), S97S106.
Mays, N. & Pope, C. (1995) Qualitative research: observational methods in health care settings. British Medical Journal 311(6998), 182184.
Miles, M. J. & Huberman, A. M. (1994) Qualitative Data Analysis: An Expanded Source Book, 2nd edition. Sage Publications, CA.
Minichiello, V. (2006) Book reviews: qualitative research methods. Australian and New Zealand Journal of Public Health 30(2), 190196.
Moyer, E., Igonya, E. K., Both, R., Cherutich, P. & Hardon, A. (2013) The duty to disclose in Kenyan health facilities: a qualitative investigation of HIV disclosure in everyday practice. SAHARA Journal 10 (Supplement 1), S60S72.
Noble, H. & Smith, J. (2015) Issues of validity and reliability in qualitative research. Evidence Based Nursing 18(2), 3435.
Norman, I. J., Watson, R., Murrells, T., Calman, L. & Redfern, S. (2002) The validity and reliability of methods to assess the competence to practise of pre-registration nursing and midwifery students. International Journal of Nursing Studies 39(2), 133145.
Nyblade, L., Singh, S., Ashburn, K., Brady, L. & Olenja, J. (2011) ‘Once I begin to participate, people will run away from me’: understanding stigma as a barrier to HIV vaccine research participation in Kenya. Vaccine 29(48), 89248928.
Obermeyer, C. M., Baijal, P. & Pegurri, E. (2011) Facilitating HIV disclosure across diverse settings: a review. American Journal of Public Health 101(6), 10111023.
Okall, D. O., Ondenge, K., Nyambura, M., Otieno, F. O., Hardnett, F., Turner, K. et al. (2014) Men who have sex with men in Kisumu, Kenya: comfort in accessing health services and willingness to participate in HIV prevention studies. Journal of Homosexuality 61(12), 17121726.
Okoror, T. A., Belue, R., Zungu, N., Adam, A. M. & Airhihenbuwa, C. O. (2014) HIV positive women’s perceptions of stigma in health care settings in Western Cape, South Africa. Health Care Women International 35(1), 2749.
Parker, R. (2012) Stigma, prejudice and discrimination in global public health. Cadernos de Saúde Pública 28(1), 164169.
Parker, R. & Aggleton, P. (2003) HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Social Science & Medicine 57(1), 1324.
Peretti-Watel, P., Spire, B., Obadia, Y. & Moatti, J. P. (2007) Discrimination against HIV-infected people and the spread of HIV: some evidence from France. PLoS One 2(5), e411.
Pettigrew, S. F. (2000) Ethnography and grounded theory: a happy marriage? Advances in Consumer Research 27, 256260.
Pulerwitz, J., Michaelis, A., Weiss, E., Brown, L. & Mahendra, V. (2010) Reducing HIV-related stigma: lessons learned from Horizons research and programs. Public Health Reports 125(2), 272281.
Rance, J. & Treloar, C. (2014) ‘We are people too’: consumer participation and the potential transformation of therapeutic relations within drug treatment. International Journal of Drug Policy, doi: S0955-3959(14)00099-1.
Reis, C., Heisler, M., Amowitz, L. L., Moreland, R. S., Mafeni, J. O., Anyamele, C. et al. (2005) Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria. PLoS Medicine 2(8), e246.
Rolfe, G. (2006) Validity, trustworthiness and rigour: quality and the idea of qualitative research. Journal of Advanced Nursing 53(3), 304310.
Saleem, H. T., Surkan, P. J., Kerrigan, D. & Kennedy, C. E. (2015) Childbearing experiences following an HIV diagnosis in Iringa, Tanzania. Qualitative Health Research, doi:1049732315605273.
Sartorius, N. (2009) Illnesses of the health system. Psychiatria Danubina 21(4), 444445.
Sasse, A., Van Beckhoven, D. & Verbrugge, R. (2015) Epidemiology of AIDS and HIV infection in Belgium. Scientific Institute of Public Health, Brussels, Belgium. URL: (accessed 25th January 2016).
Seedat, F., Hargreaves, S. & Friedland, J. S. (2014) Engaging new migrants in infectious disease screening: a qualitative semi-structured interview study of UK migrant community health-care leads. PLoS One 9(10), e108261.
Shefer, G., Rose, D., Nellums, L., Thornicroft, G., Henderson, C. & Evans-Lacko, S. (2013) ‘Our community is the worst’: the influence of cultural beliefs on stigma, relationships with family and help-seeking in three ethnic communities in London. International Journal of Social Psychiatry 59(6), 535544.
Shiripinda, I. & Eerdewijk, A. H. J. M. V. (2008) Facing HIV in The Netherlands: Lived Experiences of Migrants Living with HIV. Pharos, Utrecht. URL:
Sidibe, M. & Goosby, E. P. (2013) Foreword: global action to reduce HIV stigma and discrimination. Journal of the International AIDS Society 16(3) (Supplement 2), 18893.
Simbayi, L. C., Kalichman, S., Strebel, A., Cloete, A., Henda, N. & Mqeketo, A. (2007) Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Social Science & Medicine 64(9), 18231831.
Skinner, D. & Mfecane, S. (2004) Stigma, discrimination and the implications for people living with HIV/AIDS in South Africa. SAHARA Journal 1(3), 157164.
Surkan, P. J., Mukherjee, J. S., Williams, D. R., Eustache, E., Louis, E., Jean-Paul, T. et al. (2010) Perceived discrimination and stigma toward children affected by HIV/AIDS and their HIV-positive caregivers in central Haiti. AIDS Care 22(7), 803815.
Surlis, S. & Hyde, A. (2001) HIV-positive patients’ experiences of stigma during hospitalization. Journal of the Association of Nurses in AIDS Care 12(6), 6877.
Taylor, D. C. (2013) Stigma and prejudice in the language of sickness. Epilepsy & Behavior 27(1), 204205.
Thomas, F., Aggleton, P. & Anderson, J. (2010) ‘Experts’, ‘partners’ and ‘fools’: exploring agency in HIV treatment seeking among African migrants in London. Social Science & Medicine 70(5), 736743.
Thomas, S. L., Hyde, J., Karunaratne, A., Herbert, D. & Komesaroff, P. A. (2008) Being ‘fat’ in today’s world: a qualitative study of the lived experiences of people with obesity in Australia. Health Expectations 11(4), 321330.
Weine, S. M. & Kashuba, A. B. (2012) Labor migration and HIV risk: a systematic review of the literature. AIDS Behavior 16(6), 16051621.
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Journal of Biosocial Science
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