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“It’s Better If I Die Because Even in the Hospital, There is a Stigma, People Still Gossip”: Gossip as a Culturally Shaped Labeling Process and Its Implications for HIV-Related Stigma in Botswana

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Abstract

This study qualitatively explores HIV-related gossip as both a manifestation and driver of HIV-related stigma, which is a known barrier to HIV testing and treatment in Botswana. Data were elicited from 5 focus group discussions and 46 semi-structured in-depth interviews with individuals living with HIV and community members with undisclosed serostatus in Gaborone, Botswana in 2017 (n = 84). Directed content analysis using the ‘What Matters Most’ theoretical framework identified culturally salient manifestations of HIV-related stigma; simultaneous use of Modified Labeling Theory allowed interpretation and stepwise organization of how the social phenomenon of gossip leads to adverse HIV outcomes. Results indicated that HIV-related gossip can diminish community standing through culturally influenced mechanisms, in turn precipitating poor psychosocial well-being and worsened HIV-related outcomes. These harms may be offset by protective factors, such as appearing healthy, accepting one’s HIV status, and community education about the harms of gossip.

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Acknowledgements

We wish to thank the staff of the Princess Marina Hospital Infectious Disease Care Clinic. This work would also not have been possible without Bophelo Calvin Gontse, Mpho Kepaletswe Thuto Salepito, Dr. Rogers Moeng, and Dr. Vincent Dipatane, Dr. Marlene Eisenberg, Ms. Lilo Blank, and Ms. Lyla Yang. This research was supported by a grant and core support services from the Penn Mental Health AIDS Research Center, a National Institutes of Health (NIH)–funded program (P30MH097488); a Fogarty International Center and National Institutes of Mental Health R21 Grant (TW011084-01; PI: L.H. Yang); and the Focus for Health Foundation. O. B. Poku was supported by the T32 Global Mental Health Training Program at the Bloomberg School of Public Health, Department of Mental Health (5T32MH1032). The study also benefited from core support services provided by the Penn Center for AIDS Research, an NIH-funded program (P30AI045008).

Funding

This research was supported by a grant and core support services from the Penn Mental Health AIDS Research Center, a National Institutes of Health (NIH)–funded program (P30MH097488); a Fogarty International Center and National Institutes of Mental Health R21 Grant (TW011084-01; PI: L.H. Yang); and the Focus for Health Foundation. O. B. Poku was supported by the T32 Global Mental Health Training Program at the Bloomberg School of Public Health, Department of Mental Health (5T32MH1032). The study also benefited from core support services provided by the Penn Center for AIDS Research, an NIH-funded program (P30AI045008).

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Author notes

  1. Lawrence H. Yang and Sarah M. Murray are co-senior authors.

Authors and Affiliations

  1. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Ohemaa B. Poku & Sarah M. Murray

  2. Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Evan L. Eschliman

  3. Botswana-UPenn Partnership, Gaborone, Botswana

    Patlo Entaile

  4. Department of Psychology, Queens College, City University of New York, New York, NY, USA

    Shathani Rampa

  5. Department of Clinical and Counselling Psychology, Teachers College, Columbia University, New York, NY, USA

    Haitisha Mehta, Danielle Tal, Lea Silvert & Tingyu Li

  6. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Timothy D. Becker

  7. Medical Research Council, South Africa, Cape Town, South Africa

    Darshini Govindasamy

  8. Department of Psychiatry, Vagelos College of Physicians and Surgeons Columbia University, New York, NY, USA

    Melissa A. Stockton

  9. New York State Psychiatric Institute, New York, NY, USA

    Melissa A. Stockton

  10. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA

    Adebola Adedimeji

  11. University of Botswana, Gaborone, Botswana

    Ari Ho-Foster

  12. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Michael B. Blank

  13. Johns Hopkins School of Nursing, Baltimore, MD, USA

    Derek T. Dangerfield II

  14. School of Global Public Health, New York University, New York, NY, USA

    Lawrence H. Yang

  15. Mailman School of Public Health, Columbia University, New York, NY, USA

    Lawrence H. Yang

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  1. Ohemaa B. Poku
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Contributions

Conceptualization: OBP, ELE, MBB, LHY; Investigation: OBP, PE, SR, AH-F, MBB, LHY; Methodology: OBP, ELE, PE, SR, TDB, MBB, LHY; Formal Analysis: OBP, ELE, HM, DT, LS, TL, TDB, DG, MAS; Data Curation: OBP, ELE; Writing—original draft preparation: OBP, ELE, HM, DT, LS, TL, TDB, AH-F, MBB, DTDII, LHY, SMM; Visualization: ELE, HM, DT, LS, TL, TDB; Writing—Review & Editing: OBP, ELE, PE, SR, HM, DT, LS, TL, TDB, DG, MAS, AA, AH-F, MBB, DTDII, LHY, SMM. Funding Acquisition: MBB, LHY; Resources: AH-F; Supervision: AH-F, DTDII, LHY, SMM; Project Administration: AH-F.

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Correspondence to Ohemaa B. Poku.

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Institutional Review Boards of the Botswana Ministry of Health and Wellness, University of Botswana, Princess Marina Hospital, University of Pennsylvania, Columbia University, and New York University.

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Poku, O.B., Eschliman, E.L., Entaile, P. et al. “It’s Better If I Die Because Even in the Hospital, There is a Stigma, People Still Gossip”: Gossip as a Culturally Shaped Labeling Process and Its Implications for HIV-Related Stigma in Botswana. AIDS Behav 27, 2535–2547 (2023). https://doi.org/10.1007/s10461-023-03980-x

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