AIDS and Behavior

, Volume 21, Issue 1, pp 217–226 | Cite as

Do Customers Flee From HIV? A Survey of HIV Stigma and Its Potential Economic Consequences on Small Businesses in Tshwane (Pretoria), South Africa

  • Li-Wei Chao
  • Helena Szrek
  • Rui Leite
  • Shandir Ramlagan
  • Karl Peltzer
Original Paper

Abstract

HIV stigma and discrimination affect care-seeking behavior and may also affect entrepreneurial activity. We interview 2382 individuals in Pretoria, South Africa, and show that respondents believe that businesses with known HIV+ workers may lose up to half of their customers, although the impact depends on the type of business. Survey respondents’ fear of getting HIV from consuming everyday products sold by the business—despite a real infection risk of zero—was a major factor driving perceived decline in customers, especially among food businesses. Respondents’ perceptions of the decline in overall life satisfaction when one gets sick from HIV and the respondent’s dislike of people with HIV were also important predictors of potential customer exit. We suggest policy mechanisms that could improve the earnings potential of HIV+ workers: reducing public health scare tactics that exacerbate irrational fear of HIV infection risk and enriching public health education about HIV and ARVs to improve perceptions about people with HIV.

Keywords

HIV stigma Infection risk Quality of life Consequences of stigma Small businesses 

Resumen

El efecto discriminatorio y estigma hacia el VIH puede afectar a la búsqueda de ayuda y a la actividad emprendedora. Entrevistamos a 2.382 personas en Pretoria, Sudáfrica. Los encuestados creen que los empresarios con trabajadores con VIH+ conocido pueden perder hasta la mitad de sus clientes, aunque el impacto depende del tipo de negocio. El que los encuestados teman adquirir VIH por el consumo diarios de productos de un negocio, a pesar del riesgo de infección ser nulo, es un factor importante para el declive en el número de clientes, especialmente en el sector alimentario. Otros de los factores que predicen la pérdida de clientes son la percepción de los encuestados de que la satisfacción general de la vida disminuye cuando uno se enferma a causa del VIH y la aversión a las personas con VIH. Sugerimos mecanismos políticos que puedan mejorar el potencial de ingresos de los trabajadores con VIH+: tácticas de reducción de alarma sanitaria que exacerba el miedo irracional de riesgo de infección de VIH y enriquecer la educación de la sociedad en salud sobre el VIH y los ARV para mejorar las percepciones sobre las personas con VIH.

References

  1. 1.
    Mann JM. Statement at an informal briefing on AIDS to the 42nd session of the United Nations General Assembly. J. R. Stat. Soc. 1988;151(1):131–6.CrossRefGoogle Scholar
  2. 2.
    Kalichman SC, Simbayi LC, Cain D, Jooste S, Skinner D, Cherry C. Generalizing a model of health behaviour change and AIDS stigma for use with sexually transmitted infection clinic patients in Cape Town. S. Afr. AIDS Care. 2006;18(3):178–82.CrossRefGoogle Scholar
  3. 3.
    Wolfe WR, Weiser SD, Bangsberg DR, Thior I, Makhema JM, Dickinson DB, Mompati KF, Marlink RG. Effects of HIV-related stigma among an early sample of patients receiving antiretroviral therapy in Botswana. AIDS Care. 2006;18(8):931–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F. Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care. 2007;19(1):28–33.PubMedCrossRefGoogle Scholar
  5. 5.
    Nyblade L, Carr D. Towards a stronger response to HIV and AIDS: Challenging stigma. Washington, DC: International Center for Research on Women; 2004.Google Scholar
  6. 6.
    Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the internalized AIDS-related stigma scale. AIDS Care. 2009;21(1):87–93.PubMedCrossRefGoogle Scholar
  7. 7.
    Peltzer K, Ramlagan S. Perceived stigma among patients receiving antiretroviral therapy: a prospective study in KwaZulu-Natal. S. Afr. AIDS Care. 2011;23(1):60–8.CrossRefGoogle Scholar
  8. 8.
    Gostin LO. The AIDS litigation project: a national review of court and human rights commission decisions, Part II: discrimination. J. Am. Med. Assoc. 1990;263(15):2086–93.CrossRefGoogle Scholar
  9. 9.
    Gostin LO, Feldblum C, Webber DW. Disability discrimination in America: HIV/AIDS and other health conditions. J. Am. Med. Assoc. 1999;281(8):745–52.CrossRefGoogle Scholar
  10. 10.
    Herek GM. AIDS and stigma. Am. Behav. Sci. 1999;42(7):1106–16.CrossRefGoogle Scholar
  11. 11.
    Richter M. Aiding intolerance and fear: the nature and extent of AIDS discrimination in South Africa. Law Democr. Dev. 2001;5(2):196–211.Google Scholar
  12. 12.
    GNP+, ILO. The PLHIV stigma index. evidence brief: stigma and discrimination at work. The Global Network of People Living with HIV (GNP+): Amsterdam; 2012.Google Scholar
  13. 13.
    Kurzban R, Leary MR. Evolutionary origins of stigmatization: the functions of social exclusion. Psychol. Bull. 2001;127(2):187–208.PubMedCrossRefGoogle Scholar
  14. 14.
    Oaten M, Stevenson RJ, Case TI. Disgust as a disease-avoidance mechanism. Psychol. Bull. 2009;135(2):303–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Oaten M, Stevenson RJ, Case TI. Disease avoidance as a functional basis for stigmatization. Philos. Trans. R. Soc. B. 2011;366(1583):3433–52.CrossRefGoogle Scholar
  16. 16.
    Rozin P, Markwith M, McCauley C. Sensitivity to indirect contacts with other persons: AIDS aversion as a composite of aversion to strangers, infection, moral taint, and misfortune. J. Abnorm. Psychol. 1994;103(3):495–504.PubMedCrossRefGoogle Scholar
  17. 17.
    Rozin P, Fallon AE. A perspective on disgust. Psychol. Rev. 1987;94(1):23–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Rozin P, Nemeroff C, Horowitz M, Gordon B, Voet W. The borders of the self: contamination sensitivity and potency of the body apertures and other body parts. J. Res. Personal. 1995;29(3):318–40.CrossRefGoogle Scholar
  19. 19.
    Quinn TC. Global burden of the HIV pandemic. Lancet. 1996;348(9020):99–106.PubMedCrossRefGoogle Scholar
  20. 20.
    Valdiserri RO. HIV/AIDS stigma: an impediment to public health. Am. J. Public Health. 2002;92(3):341–2.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Hogg RS, Heath KV, Yip B, Craib KJ, O’Shaughnessy MV, Schechter MT, Montaner JS. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. J. Am. Med. Assoc. 1998;279(6):450–4.CrossRefGoogle Scholar
  22. 22.
    Frank J, Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N. Engl. J. Med. 1998;338(13):853–60.CrossRefGoogle Scholar
  23. 23.
    Mannheimer SB, Matts J, Telzak E, Chesney M, Child C, Wu AW, Friedland G, Terry Beirn Community Programs for Clinical Research on AIDS. Quality of life in HIV-infected individuals receiving antiretroviral therapy is related to adherence. AIDS Care. 2005;17(1):10–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Burgoyne RW, Tan DH. Prolongation and quality of life for HIV-infected adults treated with highly active antiretroviral therapy (HAART): a balancing act. J. Antimicrob. Chemother. 2008;61(3):469–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Pryor JB, Reeder GD, Vinacco R, Kott TL. The instrumental and symbolic functions of attitudes toward persons with AIDS. J. Appl. Soc. Psychol. 1989;19(5):377–404.CrossRefGoogle Scholar
  26. 26.
    Herek GM. Illness, stigma, and AIDS. In: Costa Jr PT, VandenBos GR, editors. Psychological aspects of serious illness: chronic conditions, fatal diseases, and clinical care. Washington, DC: American Psychological Association; 1990. p. 107–50.Google Scholar
  27. 27.
    Parker R, Aggleton P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc. Sci. Med. 2003;57(1):13–24.PubMedCrossRefGoogle Scholar
  28. 28.
    Skinner D, Mfecane S. Stigma, discrimination and the implications for people living with HIV/AIDS in South Africa. J. Soc. Asp. HIV/AIDS. 2004;1(3):157–64.CrossRefGoogle Scholar
  29. 29.
    Winskell K, Hill E, Obyerodhyambo O. Comparing HIV-related symbolic stigma in six african countries: social representations in young people’s narratives. Soc. Sci. Med. 2011;73(8):1257–65.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Maughan-Brown BG. Attitudes towards people with HIV/AIDS: stigma and its determinants amongst young adults in Cape Town, South Africa. S. Afr. Rev. Sociol. 2006;37(2):165–88.CrossRefGoogle Scholar
  31. 31.
    Maughan-Brown B. Stigma rises despite antiretroviral roll-out: a longitudinal analysis in South Africa. Soc. Sci. Med. 2010;70(3):368–74.PubMedCrossRefGoogle Scholar
  32. 32.
    Genberg BL, Kawichai S, Chingono A, Sendah M, Chariyalertsak S, Konda KA, Celentano DD. Assessing HIV/AIDS stigma and discrimination in developing countries. AIDS Behav. 2008;12(5):772–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Genberg BL, Hlavka Z, Konda KA, Maman S, Chariyalertsak S, Chingono A, Mbwambo J, Modiba P, Van Rooyen H, Celentano DD. A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Soc. Sci. Med. 2009;68(12):2279–87.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Stephenson R. Community factors shaping HIV-related stigma among young people in three African countries. AIDS Care. 2009;21(4):403–10.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Chao L-W, Gow J, Akintola G, Pauly M. HIV/AIDS stigma attitudes among educators in KwaZulu-Natal, South Africa. J. Sch. Health. 2010;80(11):561–9.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Chao L-W, Szrek H, Peltzer K, Ramlagan S, Fleming P, Leite R, Magerman J, Ngwenya GB, Pereira NS, Behrman J. A comparison of EPI sampling, probability sampling, and compact segment sampling methods for micro and small enterprises. J. Dev. Econ. 2012;98(1):94–107.PubMedCrossRefGoogle Scholar
  37. 37.
    Chao L-W, Pauly M, Szrek H, Pereira NS, Bundred F, Cross C, Gow J. Poor health kills small business: illness and microenterprises in South Africa. Health Aff. 2007;26(2):474–82.CrossRefGoogle Scholar
  38. 38.
    Colvin M, Connolly C, Madurai L. The epidemiology of HIV in South African workplaces. AIDS. 2007;21:S13–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Gómez-Olivé FX, Angotti N, Houle B, Klipstein-Grobusch K, Kabudula C, Menken J, Williams J, Tollman S, Clark SJ. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care. 2013;25(9):1122–8.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Simbayi LC, Shisana O, Rehle T, Onoya D, Jooste S, Zungu N, Zuma K. South African national HIV prevalence incidence and behaviour survey. Pretoria: Human Sciences Research Council; 2014.Google Scholar
  41. 41.
    Fisher RJ. Social desirability bias and the validity of indirect questioning. J. Consum. Res. 1993;20(2):303–15.CrossRefGoogle Scholar
  42. 42.
    EuroQol Group. EuroQol - A new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.CrossRefGoogle Scholar
  43. 43.
    Erzo FP. Neighbors as negatives: relative earnings and well-being. Q. J. Econ. 2005;120(3):963–1002.Google Scholar
  44. 44.
    Kalichman SC, Simbayi LC, S Jooste, Toefy Y, Cain D, Cherry C, Kagee A. Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS Behav. 2005;9(2):135–43.PubMedCrossRefGoogle Scholar
  45. 45.
    Ware JE, Keller SD, Kosinski M. How to score the SF-12 physical and mental health summary scales. Boston: Health Institute, New England Medical Center; 1995.Google Scholar
  46. 46.
    Naveh-Benjamin M, Ayres TJ. Digit span, reading rate, and linguistic relativity. Q. J. Exp. Psychol. 1986;38(4):739–51.CrossRefGoogle Scholar
  47. 47.
    StataCorp. Test linear hypotheses after estimation. http://www.stata.com/manuals13/rtest.pdf, Accessed 18 March 2016.
  48. 48.
    UCLA Statistical Computing Group. Comparing regression coefficients across groups using suest. http://www.ats.ucla.edu/stat/stata/code/suest.htm, Accessed 18 March 2016.
  49. 49.
    Gershon RR, Vlahov D, Nelson KE. The risk of transmission of HIV-1 through non-percutaneous, non-sexual modes: a review. AIDS. 1990;4(7):645–50.PubMedCrossRefGoogle Scholar
  50. 50.
    Lee RM. Doing research on sensitive topics. London: SAGE Publications; 1993.Google Scholar
  51. 51.
    Ellsberg D. Risk, ambiguity, and the savage axioms. Q. J. Econ. 1961;75(4):643–69.CrossRefGoogle Scholar
  52. 52.
    Frisch D, Baron J. Ambiguity and rationality. J. Behav. Decis. Mak. 1988;1(3):149–57.CrossRefGoogle Scholar
  53. 53.
    Payne JW, Bettman JR, Johnson EJ. Behavioral decision research: a constructive processing perspective. Annu. Rev. Psychol. 1992;43(1):87–131.CrossRefGoogle Scholar
  54. 54.
    Carey MP, Schroder KE. Development and psychometric evaluation of the brief HIV knowledge questionnaire. AIDS Educ. Prev. 2002;14(2):172–82.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Herek GM, Capitanio JP. Conspiracies, contagion, and compassion: trust and public reactions to AIDS. AIDS Educ. Prev. 1994;6(4):365–75.PubMedGoogle Scholar
  56. 56.
    Maughan-Brown B. Measuring HIV/AIDS stigma. Cape Town: Centre for Social Science Research; 2004.Google Scholar
  57. 57.
    Chao L-W, Szrek H, Leite R, Peltzer K, Ramlagan S. Risks deter but pleasures allure: is pleasure more important? Judgm. Decis. Mak. 2015;10(23):204–18.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Population Studies CenterUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Porto Business SchoolUniversity of PortoPortoPortugal
  4. 4.HIV/AIDS, STIs and TB Research ProgrammeHuman Sciences Research CouncilPretoriaSouth Africa
  5. 5.Centre for Economics and FinanceUniversity of PortoPortoPortugal
  6. 6.Faculty of EconomicsUniversity of PortoPortoPortugal
  7. 7.Department of Research Innovation and DevelopmentUniversity of LimpopoPolokwaneSouth Africa
  8. 8.ASEAN Institute for Health DevelopmentMahidol UniversityBangkokThailand

Personalised recommendations