Case study- Role of Church leaders who confront the HIV/AIDS stigma in Tanzania

Introduction 

The case study is a method of analysis that helps in the investigation of real-life examples by a thorough examination of people, practices and their relationships (Ebneyamini & Sadeghi Moghadam, 2018). The case study can be used for the analysis of the single person or group of people to get detailed data’s, interventions and complex issues. This assessment aims at highlighting the case study by Hartwig et al. 2006; Church leaders confront HIV/AIDS and stigma: a case study from Tanzania. This case study explicitly describes the role of church leaders who confront the HIV/AIDS stigma in Tanzania. Further, the theoretical perspective integrated with this case study is critical medical anthropology. The critical medical anthropology shows the construction of health and illness attributable to the unequal world (social relations, power relations etc.) and its shift to critical in terms of treatments and intervention (Gamlin et al., 2020). To discuss and characterise the concepts of public health issue HIV and stigma, definitions of the theoretical framework and interpretive explanation will be used.

Case study

The stigma of HIV/AIDS in African Countries appears to be a significant barrier to prevention and treatment interventions. Faith-based organisations (FBOs) have both been found to perpetuate the stigma of HIV and even mitigating it. Following several HIV/AIDS and women's healthcare training workshops, a case report of 15 females and males Tanzanian church leaders resulted from a participatory assessment session to determine their HIV health promotion practises (Hartwig et al., 2006). The workshop helped participants to recognise the core social factors of the inherent stigma of HIV and exposed the deficiency of a language to communicate about stigma (Hartwig et al., 2006). Several respondents in the consultations and structured observations have shifted from roles of silence and disapproval to HIV/AIDS teaching.

HIV is among the most severe public health problems in the world, the virus that triggers AIDS (Fauci et al., 2019). AIDS is a debilitating and destructive illness that affects people globally and it comes without indication, like all diseases. An unprecedented 1.8 million people have contracted HIV worldwide in 2019, reflecting a 25 per cent drop in new HIV outbreaks after 2012 (Giroir, 2020). Stigma and racism are continuing to be the main barriers, along with other socioeconomic inequality and exclusion (Turan et al., 2017). In support of this Merrill et al. (2020) states that Africa accounts for nearly three-quarters of the global population living with AIDS. The incidence of adult HIV in Tanzania is estimated to be 8.0 per cent (Hartwig et al., 2006). The incidence of the disease has not minimized its stigma because of the accumulated effects of numerous premature deaths and the psychological, economic and social implications for families and societies.

Theoretical framework

Critical Medical Anthropology (CMA) is a medical anthropology subset that incorporates critical health theory and ethnographic methods at the ground level in considering the political system of health and the impact of social injustice on the health of the individual as per the module teachings. This theory plays a huge role in public health issues such as HIV/AIDS (Singer & Baer, 2018). Medical anthropologists will contribute to significant governance and advocacy activities in important ways, as well as on-the-ground Tran’s disciplinary decision making, by highlighting the social dynamics, power structures, development culture, and conceptions that propel the global health sector (Panter-Brick & Eggerman, 2018). This incorporates political-economic perspectives with anthropological methods-based culturally appropriate study of human behaviour. It is distinguished by a highly applied outlook and a dedication to improving population wellbeing and fostering equality in health. The origin of the critical medical anthropology began in the 1970s when the political philosophy of health was created by the interdisciplinary movement (Singer & Baer, 2018). Today, critical medical anthropology has developed into one of the three primary frameworks used for health, disease and well-being in anthropological study. The idea that social systems such as racism, oppression and injustice inflict direct and indirect damage to persons is the primary viewpoint for understanding HIV/AIDS, according to this hypothesis (Molldrem & Smith, 2020).

Case study and the theoretical perspective

The case study shows that a lot of social inequalities results in challenges of fear and stigma among HIV patients. Such inequalities include low social status, low incomes, poverty, fear about the result of talking openly about HIV and stigma and such factors discourage the open discussion on HIV infection thereby discouraging proper knowledge about such infectious diseases (Hartwig et al, 2006). Similarly, as a theoretical approach for interpreting the HIV/AIDS outbreak, critical medical anthropology has been suggested by many anthropologists (Obrist & Van Eeuwijk¸2020). They say that cultures are formed by large-scale structural influences that are ingrained in economic and cultural structures, such as discrimination, patriarchy, political violence, inequality, and other social injustice. These powers "sculpt the delivery and outcomes of HIV/AIDS," that together characterise systemic brutality (Ibid.) (Obrist & Van Eeuwijk¸2020). As an example, Schoepf's findings show that a proliferation of various partner schemes was one result of the economic crash of the late nineties, as unemployment pressured women to trade sexual services for financial help (Bond, 2019). Such acts of social inequality and political economy raised the prevalence of HIV/AIDS. 

The notion of church leadership for mitigating stigma and creating positivity is the main focus of the case study and many participants of the case study believe that church leaders did help them in engaging in free conversations and open environment for talking about HIV/AIDS (Hartwig et al, 2006). Also, the study by critical medical anthropology shows that many researchers are trying to mine early success in lowering HIV incidence in Senegal and Uganda for insights about how to reduce the transmission of AIDS in other areas of Sub-Saharan Africa (SSA) (Karsenti, 2019). The early participation of church leaders in the initiatives of both countries to fight AIDS has been described by many researchers as an especially significant and observable factor in their progress (McLoughlin, 2020). Likewise, the theory also supports the significance of social powers in health outcomes such as by leaders as learnt in the course module. 

Next as per the module, the chosen theory identifies the external realities namely, healthcare systems, bodies, immunity and pathogens that cause illness. Moreover, the relation of diseases to power relationships and social inequalities cannot be ignored. Such that the case study shows power created by the role of the church, on one hand, gives an open environment to people (Hartwig et al, 2006). On the hand, it also discourages people as they believe that it is very difficult for the people to live with HIV after being rejected from church (Hartwig et al, 2006). Such ideologies are far different from the external realities but have a strong association with the social construct of inequality. 

Study shows reasons such as anxiety, ignorance of transmission techniques, lack of confidence that affected individuals will heal and inability to care for the ill while addressing what induces stigma (Kontomanolis et al., 2017). Obstacles were identified within the church, like 'religious beliefs that AIDS is a penalty for repenting,' the evidence that individuals believe it's disgraceful to speak about AIDS and Christian beliefs that they've fallen short of God's greatness and deserve no mercy (Hartwig et al., 2006). The proposed alternatives included recognising that AIDS is here and individuals must follow the teachings of the Church. Social hierarchy and its connection to leadership within the church and societies emerged as more aspects that propagated the overarching stigma of silence. These features include: leaders do not speak of AIDS as an issue; people are lacking leadership qualities, so they tend to remain still and silent and one might be stigmatised if they talk regarding AIDS (Pfadenhauer & Knoblauch, 2018). Although church leaders believe that the church leaders who had carried out home visits expressed that their plan to start visiting AIDS-affected families was strongly addressed within their groups. It also had a transformative influence on their perceptions regarding people living with HIV and helped them to overcome their concerns and biases (Hartwig et al., 2006). They believed that their leadership in their churches was starting to break down the taboo and this aligns with the theory of social constructivism and religion. 

Conclusion

It can be concluded that HIV/AIDS and stigma is a major public health issue and requires the integration of prevention measures to reduce their prevalence. The theory shows and the case study has many correlations. The theory suggests that social inequalities and political power relations affect the thinking and learning of perceptions of HIV. Also, the church leaders have the main role in promoting positivity and lowering the root causes of stigma but the bible dictates HIV as a sin for people living with these chronic diseases which affect the social construct and unable many people to speak about stigma. Faith-based organisations (FBOs) have both been found to perpetuate the stigma of HIV and even mitigating it. People even after knowing the reason for transmission and biological factors have fear regarding rejection from church and loneliness which justifies the chosen theory as such social inequalities have been constructed through power relations and notions.