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

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HIV/AIDS-Related Stigma and Discrimination Toward Women Living with HIV/AIDS in Enugu, Nigeria Chinyere Fidelia Nnajiofor Walden University 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 Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Health and Medical Administration Commons, and the Public Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. 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 .................................................................................
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