SAN Mini-Conference, August 7, 2009

1. SAN Mini-Conference, August 7, 2009 Stigmatization of Women with HIV/AIDS in Arab Countries – The Case of Yemen Carrie E. Foote, PhD. Indiana-Purdue University Indianapolis AbdallahBadahdah, PhD. University of North Dakota

2. Overview of the Project • Central Purpose Develop a culturally specific scale designed to measure stigma attached to women with HIV/AIDS in Arab countries - Egypt, Yemen, Jordan, Qatar, and Kuwait (MENA Region).

3. Background – HIV & MENA region • HIV/AIDS prevalence rates remain relatively low; Yet, fastest growing infection rates in the world • Incidence rose over 300% from 2003-2007; 87K-380K reported HIV cases • Cultural values • Lower rates – non-marital sex, illicit drug use, and homosexuality are considered both sins and crimes • Rapid increase - Sex is a private matter; taboo topic for discussion; stigma • Arab females especially at risk • Gender inequality: Many Arab women remain uneducated; little choice over marriage partners; little control in sexual relations; largely dependent on men. • Nearly 80% of Arab women contract HIV from their husbands • Arab females 18-24 have HIV prevalence rates twice that of males in the same age category. Source: (UNAIDS 2007; Bibbo 2007; Ogden and Nyblade 2005; UNDP 2006; Hasnain 2005)

4. Background – HIV & MENA region • Stigma and Discrimination More Pronounced • Islamic doctrines about certain sex and drug related practices as sins and crimes + traditional Arab cultural values of honor and shame • Greater negative sanctions for illicit sexual conduct than drug use • Greater negative sanctions for women • Prevents those at risk from coming forward for counseling, testing and treatment, as this would involve disclosure of non-normative behaviors • This results in creating barriers to successful implementation of prevention and treatment strategies. Source: (Hasnain 2005; Feldner 2000)

5. Background – HIV & MENA region Source: (Nyblade 2006; Van Brakel 2006; Herek et al. 2002; Froman and Owens 2001; Genberg et al. 2007; Kalichman et al. 2005; Van Rie et al. 2008; O’Hea et al. 2001) One strategy to reduce AIDS stigma is to change negative beliefs towards afflicted groups Growing recognition for instruments tested in a variety of cultural settings Several AIDS stigma scales exist None developed and validated in the Arab region

6. Yemen - Challenges

7. Yemen - Progress Poster reads: “We all are supporters of AIDS patients.” Source: http://www.yementimes.com/article.shtml?i=1256&p=health&a=1

8. Methods • Self administered questionnaire (50 items) • 43 attitudinal items • 6 point-Likert scale – SD/SA • 7 background items: gender, age, marital status, children, income, willingness to take an HIV test, knew someone with HIV/AIDS • Convenience Sample • 612 college students, public University in Yemen • Men (305); Women (308) • Average Age: 21.5 SD 2.24 • Majority Single (511), no children (544), middle income (506) • Majority willing to take an HIV test (504), few knew someone with HIV/AIDS (30)

9. Results • Principle Axis Factor with Promax Procedure • 26 Items relevant to women and families; • women with AIDS got what they deserved • having a relative with AIDS would tarnish my own reputation • Two Factors Extracted • 12 items-items correlating to .40 or higher on one factor & .15 or less on the second factor were retained; • The factors accounted for 28% of the variance. • Cronbach’s alpha for the two factors were both .76, • Construct validity (r =.66)

10. Factor OneRestricting and Criminalizing HIV+ Women’s Reproductive Behaviors • Women with AIDS should be sterilized so they cannot have children. 0.54 • Pregnant women with AIDS should be required to have their babies tested for the AIDS virus. 0.49 • Women with AIDS who give birth to a child with AIDS should be prosecuted. 0.40 • Women with AIDS should not be allowed to get married. 0.46

11. Factor 2 Shaming & Blaming HIV+ Women • I would be ashamed if someone in my family got AIDS. 0.67 • Having a relative with mental illness is less harmful to my family’s reputation than having a relative with AIDS. 0.46 • Having a relative with AIDS would tarnish my reputation. 0.55 • It is more shameful for a family to have a female relative with AIDS than a male relative with AIDS. 0.52 • Women with AIDS got what they deserved. 0.59 • Young children should be removed from their homes if their mothers have AIDS 0.61 • Women with AIDS should be more ashamed of themselves than men with AIDS. 0.57 • People with AIDS should be allowed to adopt children 0.40

12. Discussion First attempt to develop an Arabic attitudes towards women with HIV/AIDS scale. Scale comprises 12 items Two factors covering critical manifestations of AIDS stigma: restriction and criminalization of women’s reproductive behaviors; and shaming and blaming HIV + women and relatives with HIV/AIDS The salience of motherhood in Arab society makes the first factor especially critical to measure and develop interventions to reduce stigma Second dimension not surprising given the taboo nature of sex and Arab societies being shame cultures. Similar to other scales which suggest the social context of AIDS stigma may not be much different in Arab societies and non-Arab societies Lends support to the idea that some of the AIDS stigma scales are useful in multiple cultural settings.

13. Thank you! شكرًا Abdallah.badahdah@und.edu foote@iupui.edu