AIDS Research and Treatment clearance was obtained from the Human Sciences Research Council’s Research Ethics Council (REC 3/13/10/04). 3. Results and Discussion 3.1. Challenges for PLWHA. The main challenges faced by PLWHA, as identiﬁed by KIs and focus group participants, related to (i) HIV/AIDS-related stigma and “othering” (blaming and stigmatising the “other” whereas the “other” is deﬁned as someone with a diﬀerent religion, ethnic group to one’s own, and gay men) for the spread of HIV; (ii) disclosure of HIV status to others; (iii) risky behaviours for HIV infection; (iv) the importance of the socioeconomic context within which people with HIV live. 3.1.1. HIV/AIDS-Related Stigma and “Othering”. A domi- nant theme in this study was the extent to which stigma and discrimination remained a central concern for PLWHA: “To me stigma still exists a lot and it will never perish, because maybe if you can get sick and lose weight, people will point ﬁngers at you even if you are not HIV-positive, and they will say that you have AIDS.” (FGD—HIV-positive African women) “The problem that we are facing as a person living with this virus, there’s a stigma and a discrimination, because people, if you say ‘I am HIV-positive’, they are going to chase you away.” (FGD—HIV-positive African men and women) “When it comes to our [people of mixed race], you know it’s funny, our [people of mixed race] have a diﬀerent mentality in a way, because when it comes to the HIV thingy, our [people of mixed race] don’t want to get involved too much, or associated with HIV and AIDS, because there’s still very much stigma and ignorance.” (KI— Community AIDS counsellor) Reluctance and anxiety to disclose HIV-positive status, and fears of being rejected and discriminated against are evidence of the persistent nature of AIDS-related stigma in communities and households. AIDS-related stigma remains one of the barriers to curb the further spread of the disease amongst people who are aware of their HIV-positive status [21]. Thus, in the South African context, AIDS- related stigma poses a major challenge to the eﬃcacy of risk reduction interventions for PLWHA and other risk groups. Related to stigma was the extent of othering of the disease, with notions of the virus spread by being promiscuous (especially for women), gay or black: “My mother had AIDS and they said that she was sleeping around and she was drinking a lot . . . I think in the rural areas they still have that mentality that the person was sleeping around . . .She has AIDS, she has AIDS, she is a slut.” (FGD—HIV-positive African women) 3 “The idea that HIV and AIDS is a punishment from God I think runs through all religions, and that you’re being punished for leading a promiscuous life or immoral life or whatever, so that is also a dominant theme in the Muslim community.” (KI—Community Muslim AIDS support group) “It’s supposedly a black and a gay disease.” (FGD—HIV-positive African men and women) Perceptions of men who have sex with men (MSM), heterosexual women (as compared to men), other cultures and races other than one’s own being responsible for the spread of the HI virus all appeared to contribute towards the further stigmatisation of PLWHA. Blaming “the other” for the spread of the virus leads to a denial of one’s own vulnerability to HIV infection [22]. Denial of the vulnerability to HIV infection was also apparent among participants in this study: “I mean I know a lot of people like that, they never face any of the issues and they die because of, because they can’t get medical help because they don’t want to acknowledge they’ve got HIV you know.” (FGD—HIV-positive white gay men) “Every time when people die “No, he had TB, he or she”. No, I tell them, even my brother, he passed away, I saw him, I know the symptoms, and I went to his doctor to tell him I want to know his status because I’m also HIV-positive, and his doctor told me he was HIV-positive, but at home they denied that my brother was HIV-positive.” (KI—National PLWHA organisation) In addition, people tended to distance themselves from HIV, giving it other names. They also did not talk openly about HIV in the community and this fostered stigma: “What is “this thing”? They do not want to understand that I have HIV, they do not want to say it, “I have this thing” . . . because of the stigma that is attached to HIV in the townships it becomes so terrible, and it is making our work very diﬃcult.” (KI—National AIDS organisation) In line with these perceptions, reports of AIDS-related stigma in the Western Cape province of South Africa is such that HIV/AIDS is called “ulwazi” which means “that thing” [23]. “That thing” not only implies that there is no cure, but also suggests that it is a stigmatised illness that cannot be referred to by name [24]. Gender also plays a strong role in experiences of stigma. AIDS-related stigma for women is intensiﬁed because of their subordinate role in society [25, 26]. Interviews with KIs in this study revealed that AIDS-related stigma is a barrier for women accessing free voluntary counselling and testing (VCT) and prevention of mother-to-child transmission (PMTCT) services. For example, mothers who are HIV- positive ﬁnd it diﬃcult to comply with medical advice to