abandoned me. I am disappointed! They certainly suspected that I had AIDS (Ministère de la Santé, 1992, cited in IRESCO, 1995:35).

Although the various dimensions and repercussions of stigmatization may be difficult to quantify, they are an extremely important aspect of the burden of AIDS in the region. Increasingly, counseling in preventing new infections and limiting the destructive forces of stigmatization and discrimination is being recognized as an essential part of caring for people with AIDS.2

Economic Hardship Due to HIV

Evidence about the magnitude of the economic impact of AIDS at the individual level is scarce and generally qualitative in nature (see below) (Ainsworth and Over, 1994a, 1994b). Certainly, people with AIDS face high medical bills and an uncertain economic future. As their health degenerates, illness results in the loss of income-earning potential, while at the same time many persons with AIDS spend their household savings in trying to treat various opportunistic infections or find a cure for AIDS itself.

Anecdotal reports of workplace discrimination have been documented in a number of African countries affected by the HIV/AIDS epidemic. For example, in some areas of sub-Saharan Africa, employers are reportedly subject to prison terms and fines if they hire HIV-infected people (Danziger, 1994). Government officials in another country have encouraged employers to test workers and dismiss those who are infected (Cohen and Wiseberg, 1990, cited in Danziger, 1994). The experience of AIDS-related discrimination can include social ostracism and exclusion from usual networks for accessing emergency resources. Ignorance of modes of transmission of the virus can result in abandonment of people with HIV/AIDS by their relatives and expulsion from the family safety net, leaving the infected completely destitute (Awusabo-Asare and Agyeman, 1993).

Care for People with AIDS

In those parts of Africa where the epidemic is already fairly advanced, AIDS has become a part of everyday life, and the need for care is most urgent. Extensive treatment protocols have been developed for people with AIDS in industrialized countries. However, these protocols are less relevant in Africa because of a shortage of manpower and resources for the treatment and care of people with AIDS and regional variations in the prevalence of certain opportunistic infections, such as tuberculosis and Pneumocystis carinii pneumonia (Schopper and


 See M'Pelé et al. (1994) for a recent review of the impact of counseling programs in Africa.

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