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


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.


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


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.



This project was supported by the U.S. National Institutes of Health R01- HD-051468 (Chao P.I.) and by the European Regional Development Fund through COMPETE 2020 - Programa Operacional Competitividade e Internacionalização (POCI) and by Portuguese public funds through FCT (Fundação para a Ciência e a Tecnologia) in the framework of the project POCI-01-0145-FEDER-006890. We would like to thank a number of people, including Mark Pauly, Jere Behrman, Peter Fleming, Erika Laranjeira, Jeffery Patterson, Lorna Madurai, Khangelani Zuma, Adlai Davids, Gina Weir-Smith, and Tholang Mokhele. We especially thank our team for their dedication and hard work in interviewing participants: Field Supervisors Vernon Kekana, Given Kgafel, and Godfrey Bongani Ngwenya; Field Researchers Gertrude Makomane, Josephine Mantsho, Mmule Mataboge, Vongani Mdaka, Sipho Mhlabane, Fhatuwani Mulangeni, Micah Nangambe, Patronella Ragedi, Nomti Kutlwano Segale, and Lerato M. Twala; Field Researchers and Field Nurses Mina Sebokeng Makgetloa and Daniel M Mpowana; Field Nurses, Martha Kedibone Dhlewayo, Charmaine Hlangwane, Debra Mosidi Molepo, Delina Nkoana, and Irene Ramodisha; and Office Staff Fikile Maseko, Sue Samuels, and Charles Kgaladi.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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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

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