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Introduction

A tendency towards secrecy and limited disclosure networks is frequently the outcome of the widespread stigma surrounding HIV among racial minorities, including young women in sub-Saharan Africa (Koch et al., 2021; Mackworth-Young et al., 2020). This stigma has a significant negative impact on these women's overall quality of life. According to Sciarotta et al. (2021), while health professionals may be supportive of sharing their HIV status, doing so can induce anxiety and have varying impacts on their self-perception and relationships, both positive and negative. In order to manage social relationships and maintain control over HIV disclosure, Mackworth-Young et al. (2020) emphasise that maintaining confidentiality is a deliberate decision rather than just a sign of shame or avoidance. The hypothesis that universal disclosure is always advantageous is contested by the study, particularly in situations where it could have negative effects. Owing to the study's focus, the results may not be as generalisable to other socioeconomic groups. As a result, a more thorough discussion of the possible policy implications and suggestions for healthcare practises in comparable situations is necessary (Mackworth-Young et al., 2020).

Ethnographic Insights

The study's ethnographic methodology provides insightful information about the real-world experiences of young women in Lusaka, Zambia, who are HIV positive (Mackworth-Young et al., 2020). The 12-month duration of the ethnography facilitated a thorough comprehension of their everyday routines, interpersonal connections, and the tactics they employ to manage their HIV status. One advantage of the extended interaction with participants is that it allows the researchers to record complex and changing experiences over time. The selection of participants was done by convenience and snowball sampling, which could have introduced bias into the sample (Mackworth-Young et al., 2020). Although this method might have restricted the range of viewpoints, it was suitable for the study's focus on young, middle-class women in urban Lusaka. It is imperative to recognise the findings, though, that there is a chance that the results cannot be applied to other groups or environments. A deeper understanding of the experiences associated with living with HIV was made possible by the comparative perspective offered by the interactive workshop involving young women who were either HIV-negative or whose status was unknown. The methodological decision made by Mackworth-Young et al. (2020) indicates the authors' attempt to place the experiences of young women living with HIV within a larger context of young womanhood in Lusaka. For data processing and analysis, thematic analysis and the application of codes constitute a strong methodological approach. In order to ensure accuracy and transparency in the interpretation of data, it enables the methodical organisation and identification of important themes. Furthermore, by admitting the possible impact of their viewpoints on the results, the researchers' reflexivity exhibited in reflective memos and team discussions, improves the study's credibility (Mackworth-Young et al., 2020).

Cultural Impact

Crawford (2022) asserts that cultural influences have a major impact on how individuals perceive health, illness causes, and suitable treatment options. It includes a broad range of elements such as socioeconomic status, language, religion, customs, and social norms. Mackworth-Young et al. (2020) stress how important culture is in influencing the choices and experiences of young Zambian women living with HIV. They draw attention to the ways that social norms and cultural beliefs about HIV affect disclosure behaviours and methods for managing one's status. One key idea is that these young women manage their HIV status through strategic practices known as "secrecy and silence" (Mackworth-Young et al., 2020). The authors show how maintaining silence and secrecy are proactive tactics to navigate social interactions and defend one's identity from stigma. This reinterpretation dispels the popular belief that confidentiality has a bad connotation. The article also makes use of Caputo's (2022) concept of "bounded agency," which recognises that although the study's young women exhibited agency in making decisions about disclosure, that agency was limited by the widespread social stigma associated with HIV and the possible consequences of disclosure (Mackworth-Young et al., 2020). It is consistent with studies by Madiba et al. (2021) and Singh et al. (2021), which found that relationships, disclosure decisions, and the use of silence and secrecy as coping mechanisms are all significantly influenced by cultural contexts and gender. The article also emphasises how important it is for healthcare providers to adopt culturally sensitive practices, especially when it comes to HIV. The article highlights that in order to provide effective care, healthcare providers need to be sensitive to the cultural beliefs and practices of their patients (Mackworth-Young et al., 2020). The article's findings provide important new perspectives for public health professionals and policymakers involved in HIV prevention and treatment by illuminating the intricate interactions among culture, stigma, and agency.

Public Health Implications

Mackworth-Young et al.'s (2020) research greatly advances our knowledge of public health and development initiatives in the context of HIV/AIDS, especially for young women in Zambia. It illuminates the nuanced and ever-changing tactics people use to deal with the difficulties of living with HIV in a stigmatised setting. The idea of silence and secrecy subverts conventional wisdom regarding disclosure and emphasises the agency these young women used to control their identities. Furthermore, acknowledging "bounded agency" provides an essential viewpoint on how stigma and social structures can limit personal choices, offering insightful knowledge for support groups and interventions (Caputo, 2022). The article highlights the significance of customising public health initiatives to particular sociocultural contexts by stressing the cultural context, recognising that universal approaches might not be efficacious. Additionally, the article by Mackworth-Young et al. (2020) provides wider ramifications for comparable situations worldwide. It urges legislators to take into account the various methods people use to manage their HIV status and to establish settings that aid rather than obstruct their efforts. The results of this study can offer significant insights for international public health initiatives such as PEPFAR, the United States President's Emergency Plan for AIDS Relief, which works in more than 50 countries to combat the global HIV epidemic. This will enable the development of more effective strategies in various cultural contexts around the world (Kim, 2022; CDC, 2023).

Complex Understandings

Therefore, the research conducted by Mackworth-Young et al. (2020) provides a more complex understanding of the experiences of young women living with HIV in Zambia. It challenges conventional narratives around disclosure by examining the significance of silence and secrecy as active strategies. The idea of "bounded agency" sheds more light on the difficulties in making decisions when facing stigma. The focus on culture draws attention to the necessity of using culturally competent methods in the medical field. Overall, this study adds to our understanding of public health and development initiatives by highlighting the significance of specialised assistance and interventions in settings where HIV-related stigma is prevalent. It is an invaluable tool for developing policies and programmes that work for similar populations around the world.

References

‌Caputo, V. (2022). Anthropology's silent ‘others’: A consideration of some conceptual and methodological issues for the study of youth and children's cultures. In Youth cultures. UK: Routledge.

Centers for Disease Control and Prevention (CDC). (2023). Eliminating HIV as Global Health Threat. https://www.cdc.gov/vitalsigns/global-hiv/index.html#:~:text=Since%202004%2C%20PEPFAR

Crawford, R. (2022). A cultural account of “health”: Control, release, and the social body. In Issues in the political economy of health care. UK: Routledge.

Kim, Y. (2022). The effectiveness of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in responding to HIV/AIDS in Four African Countries. The International Journal of Health Planning and Management, 37(5), 2585–2599. https://doi.org/10.1002/hpm.3484

Koch, A., Ritchwood, T. D., Bailey, D. E., Caiola, C. E., Adimora, A. A., Ramirez, C., Holt, L., Johnson, R., McGee, K., McMillian-Bohler, J. M., Randolph, S. D., & Relf, M. V. (2021). Exploring resilience among black women living with hiv in the southern United States: Findings from a qualitative study. Journal of the Association of Nurses in AIDS Care, 33(2), 224–234. https://doi.org/10.1097/jnc.0000000000000311

 Mackworth-Young, C. R. S., Bond, V., & Wringe, A. (2020). Secrets and Silence: Agency of young women managing HIV disclosure. Medical Anthropology, 39(8), 720–734. https://doi.org/10.1080/01459740.2020.1764551

Madiba, S., Ralebona, E., & Lowane, M. (2021). Perceived stigma as a contextual barrier to early uptake of HIV testing, treatment initiation, and disclosure; the case of patients admitted with AIDS-related illness in a rural hospital in South Africa. Healthcare, 9(8), 962. https://doi.org/10.3390/healthcare9080962

Sciarotta, D., Melo, E. A., Damião, J. de J., Filgueiras, S. L., Gouvêa, M. V., Baptista, J. G. B., Agostini, R., & Maksud, I. (2021). The 'secrecy' about the diagnosis of HIV/ Aids in Primary Health Care.Interface - Comunicação, Saúde, Educação, 25. https://doi.org/10.1590/interface.200878

Singh, S. K., Sharma, N., & Sharma, S. K. (2021). Dealing with dilemmas: Understanding the process and challenges of disclosing the HIV status of people living with HIV/AIDS through gender lens. Journal of Health Management, 23(3), 380–400. https://doi.org/10.1177/09720634211035227

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