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The work is made available under the Creative Commons CC0 public domain dedication. Interviews and focus group discussions were audio-recorded, transcribed, translated to English, and analysed using a grounded theory approach.
However, HIV elicited feelings of guilt and shame as a sexually transmitted disease. Participants feared transmitting HIV to others and felt responsible for avoiding transmission. Many participants feared—or had previously experienced—rejection by partners due to their HIV status and reported hiding their medication, avoiding disclosure, or avoiding relationships altogether.
As Susan Sontag wrote, AIDS diagnosis became a metaphor for indulgence, deviance, and transgression, a stigma or a mark of personal failure [ 1 ]. In sub-Saharan Africa SSA , different metaphors emerged based on epidemiological and cultural contexts.
AIDS was linked to sex work, witchcraft, divine punishment for sinful acts, and attributed to immorality [ 2 — 7 ]. The negative social meaning associated with HIV was rooted in real fears of early death, leaving loved ones behind, and contagion. Stigma, however, has been profoundly injurious to the mental health of PLHIV and has discouraged HIV testing, status disclosure, and treatment and prevention uptake [ 8 — 14 ].
