Language Circle: Journal of Language and Literature 14(2) April 2020 Available online at http://journal.unnes.ac.id/nju/index.php/LC P-ISSN 1858-0157 E-ISSN 2460-853X A Conceptual Analysis of Metaphors Engendering HIV and AIDS- Related Stigma and Discrimination in Kisii County, Kenya Geoffrey Mokua Maroko Department of Languages and Linguistics Machakos University, Machakos Email: gmaroko@mksu.ac.ke Gladys Nyamoita Mokua Department of Pharmacognosy, Pharmaceutical Chemistry & Pharmaceutics Kenyatta University, Nairobi Email: mokuag@yahoo.com Augustus Onchari Nyakundi Department of Communication Studies Chuka University, Chuka Email: augustusosoro@gmail.com Meshack Ondora Onyambu Department of Pharmacognosy, Pharmaceutical Chemistry & Pharmaceutics Kenyatta University, Nairobi Email: mesh10200@yahoo.com Abstract Metaphors are mapped across two conceptual domains where A is B. Metaphorical expressionsare defined by dimensions including novelty, conventionality, abstractness and concreteness. The AbaGusii of Western Kenya is a highly conservative community of Bantu speakers of Western part of Kenya. They view HIV and Aids as taboo that cannot be the subject of discussion in public. Hence, People Living with HIV (hereafter PLHIV) are stigmatized and discriminated. The purpose of this paper is to analyse the metaphorical words and concepts that engender HIV and Aids-related stigma and discrimination in Kisii County. Descriptive narratives were elicited from HIV support providers using focus group discussions and follow-up interviews. The narratives were ana- lysed in terms of five attributes of stigma and discrimination within the conceptual metaphor theory. Results revealed some culturally ingrained metaphors that evoke stigma and discrimination. The paper advocates for language management efforts using success stories in HIV and Aids management to construct positive messages to counter the negative metaphors. Keywords: Metaphor, Stigma, Discrimination, Conceptual domain, Mapping According to statistics in the Department of Health in Kisii County, the leading causes of morbidity and mortality are respiratory tract infections, HIV and Aids, perinatal conditions, Tuberculosis, malaria, skin conditions, accidents and diarrheal diseases. The western parts of the country including Kisii County are the most af- fected. The County ranks fifth among the most affected Counties after Homabay, Siaya, Kisumu and Migori respectively. The female gender is ap- parently more susceptible to HIV and Aids than their male counterparts. According to a report by the National Aids Control Council, access to anti-retroviral treatment is highest in UasinGishu County averaging at 144% but ranks lowly in Kisii County at only 48%. Accordingly, ART is being INTRODUCTION According to the MoH (2014), the number of new HIV infections remains high with close to 101,560 new infections reported annually. This trend has made HIV the third largest epidemic in Sub-Saharan Africa. It is estimated that 1.6 mil- lion people are living with HIV in Kenya. One of the major barriers identified in access to HIV testing and treatment, care and support services is stigma and discrimination. Stigma is viewed as the devaluation of people living with or are asso- ciated with HIV and Aids while discrimination is what happens when someone is treated in an un- just, unfair or prejudicial way, often on the basis of belonging to a particular group. Language Circle: Journal of Language and Literature 14(2) April 2020 138 AbaGusii belong to two of the 47 Counties in Kenya namely; Nyamira and Kisii. The esti- mated population in Kisii County by 2018 was 1,406,043 comprising of 674,901 males (48%) and 731,142 females (52%) (KNBS projection from 2009 census). With the population growth rate of 2.2% per annum, it is estimated that by the year 2022, the total population will be ≈ 1,533,977. AbaGusii believed in a supreme god called Engoro, whom was understood to have cre- ated the universe and was the source of all life. AbaGusii culture identifies four rites of passage namely Okoiborwa (Birth), Ogachia mache motwe (Initiation), Okonywoma (Marriage) and Ogokwa (Death). Each of these rites was tradi- tionally observed under very strict codes. Any violation of the codes was taboo and attracted serious repercussions including generational cur- ses and even death. Sex is a taboo subject among AbaGusii with anything associated with it being communicated euphemistically or metaphorical- ly. Sex before marriage or out of wedlock was considered taboo. It attracted a type of curse (amasangi) which led to the death of the perpet- rator, the victim or their close relatives such as spouses and children. The society allowed sex among traditionally wedded couples. AbaGusii traditions socialised men to marry many wives through metaphoric expressions in the male cir- cumcision song (esimboore). Widows were also allowed to engage in sexual relations with an officially anointed person closely related to the husband such as a brother or a cousin. This was traditionally referred to as ogosoa nyomba (‘ente- ring the house’). Death was considered an “unna- tural” event brought about by witchcraft (oborogi) or unhappy ancestors (chisokoro) for violating the norms and customs. AbaGusii believed in medicine men and women and also in the spirits of their ancestors. It is a common practice that a large population of PLHIV visit traditional health practitioners and use traditional medicine especially for the management of HIV/Aids. Some of the reasons for shunning conventional facilities for compre- hensive care include stigma and discrimination, traditional beliefs, cultural barriers, and lack of confidentiality. This therefore indicates a clear need to explore ways in which traditional medi- cine practitioners can be used more effectively to facilitate delivery of both western biomedical in- novations and traditional therapies. The MoH Report (2014, p.21) outlines a raft of recommendations to address the prob- lem of stigma and discrimination among them being the need to conduct regular studies to received by less adult individuals than expected in the top 5 counties (Homabay, Siaya, Kisumu, Migori, Kisii and Turkana) with high prevalen- ce rates. The number of those in ART dropped from 14509 in 2012 to 11467 in 2016 (Kisii Coun- ty, Health at a Glance Report at their Website). Partly, this can be attributed to entrenched stigma and discrimination surrounding HIV/Aids in Ki- sii County. According to UNAIDS (2017), stigma and discrimination is creating barriers to accessing HIV prevention, testing and treatment services and putting lives at risk. The report shows that people living with HIV who experience high le- vels of HIV-related stigma are more than twice as likely to delay enrolment into care as people who do not perceive HIV-related stigma. In Ki- sii County, people living with HIV avoid going to health facilities for support for fear of having their status disclosed or of suffering further stig- ma and discrimination based on their HIV status. A report by UNAIDS (2017) indicates that across 19 countries with available data, one in five peop- le living with HIV avoided going to a clinic or hospital because they feared stigma or discrimi- nation related to their HIV status. When people living with HIV wait until they are very ill before seeking help, they are less likely to respond well to antiretroviral therapy. The report asserts that in order to reach all people living with, or at risk of, HIV and to link them with HIV prevention and treatment services, the world must step forward and confront discrimination. The Kenya HIV and AIDS Prevention and Control Act (2006) safeguards the rights of People Living with HIV (PLHIV), promotes vo- luntary HIV testing, confidentiality and privacy, non-discrimination in employment and educa- tion, and unfettered access to quality healthcare services. It also calls for the integration of HIV programs in all sectors. Despite this, PLHIV are often confronted with the problem of stigma and discrimination. The Kisii people (also known as the Aba- Gusii tribe) form a Bantu ethnic group who oc- cupy the Kisii highlands in Nyanza, Western Ke- nya. AbaGusii constitute the sixth largest ethnic group in Kenya, comprising about seven percent of the national population. EkeGusii is the eth- nic language of AbaGusii. According to Guthrie (1964), EkeGusii is labeled zone E42 narrow East African Bantu language group in Kenya. The lan- guage has two dialects; Rogoro and Maate, but we used the Rogoro dialect which has more speakers and considered to be more prestigious (Bosire, 1993). Language Circle: Journal of Language and Literature 14(2) April 2020 139 measure,monitor the levels and underlying cau- ses ofHIV related stigma and discrimination and providelocalised evidence-based interventions to addressthe situation. This paper hypothesizes that stigma and discrimination are anchored in the linguistic metaphors that are used to depict HIV and Aids. Therefore, the aim of the paper is to establish the forms of HIV and Aids-related stigma and discrimination, identify the linguistic metaphors that entrench stigma and discrimina- tion, and finally to unpack their meanings and connotations with a view to highlighting how they instigatestigma and discrimination in PL- HIV. The paper recommends a shift from these metaphors occasioned by campaign mechanisms that demystify PLHIV. From the non-linguistic paradigm, Wamal- wa, Neyole, Poipoi & Bitok (2015) carried out a study to determine HIV prevention knowledge and knowledge gaps among PLHIVs in Kisii County, Western Kenya. A total 340 PLHIVs across 9 health facilities and 6 Key informants, mainly HIV managers and programmers were interviewed. We found high generalized know- ledge among PLHIVs on HIV prevention, as well as on condom use, abstinence and faithfulness to a partner as prevention methods. We however found low knowledge levels on emerging biome- dical prevention methods, including treatment as prevention. Similarly, despite high knowledge le- vels on Mother to Child Transmission (MTCT), few PLHIVs know exact phases in which MTCT can occur pregnancy, delivery and breast feeding –with males, those depending on kin as prima- ry income source and PLHIVs attending higher- level facilities least likely to have this knowledge. Media, health workers and HIV campaigns re- main the most important communication chan- nels for PLHIVs as regards HIV information, while peers are an important information source for males. Our observations highlight the need to further promote knowledge of various HIV pre- vention methodologies, especially emerging pre- vention methods, among specific PLHIVs socio- demographic groups that exhibit low knowledge levels. In another study, Wamalwa et al (2015) sought to establish condom use determinants and practices among people living with HIV (PLHIVs) in Kisii County, Kenya. They inter- viewed 340 PLHIVs and 6 health workers. Fin- dings revealed that although most PLHIVs had correct knowledge and approved condoms as effective for HIV prevention, consistent use and condom use at last sex were notably low especi- ally among PLHIVs aged 18 – 24, those who de- pended on remittances from kin as main source of income, as well as during sex with secondary and casual partners. This study notes that kno- wledge on various benefits of using condoms is associated with enhanced condom use practices. Non-disclosure of HIV status to secondary and casual partners remains a key barrier to condom use among PLHIVs. Our observations highlight the need to further promote condom use among specific PLHIVs socio-demographic groups who continue to exhibit low condom use rates. Feyissa, Abebe, Germa & Woldie (2012) investigated stigma and discrimination against PLHIV by healthcare providers in Jimma zone, Southwest Ethiopia. The study focused on soci- odemographic characteristics, HIV knowledge, perceived institutional supportand HIV-related stigma and discrimination. The study revealed that testing and disclosing test results was done without consent without the consent of the peop- le involved. The study also indicated that clients found to be HIV positive were not only denied treatment but were unnecessarily referred to ot- her healthcare institutions. It emerged that higher levels of stigma and discrimination against PL- HIV were associated with lack of in-depth know- ledge on HIV and orientation to policies on stig- ma and discrimination. The study recommends that health managers should ensure institutional support through availing of clear policies and gui- delines and the provision of appropriate training on the management of HIV and Aids. To improve outcomes in HIV and Aids res- ponse, this paper analyses the metaphors entren- ching HIV and Aids-related stigma and discrimi- nation in the County. The conceptual metaphor theory (Lakoff and Johnson, 1980) provides a framework for discussing the metaphors engendering HIV and Aids interventions in Kisii County. It has its be- ginnings in Lakoff and Johnson’s book, Metaphors We Live By (1980). The theory takes metaphor as a conceptual tool for structuring, restructuring and even creating reality. A conceptual metaphor is understanding one domain of experience (that is typically abstract) in terms of another (that is typically concrete). Thus, a conceptual metaphor can be viewed both as a process and as a product. The cognitive process of understanding a domain is the process aspect of metaphor, while the re- sulting conceptual pattern is the product aspect. Metaphors have the following features. First, they are all pervasive (Lakoff and Johnson, 1980). This means that metaphors are ubiquitous as they can be found on TV, radio, dictionaries, routine spoken discourses, in newspapers, in Language Circle: Journal of Language and Literature 14(2) April 2020 140 genres and, in language in general. According to McGlone(2007)linguistic manifestations can pro- ve the presence of conceptual metaphors. Second, the theory underscores the claim for systematic mappings between two conceptual domains. In this way, a conceptual metaphor is a systematic set of correspondences between two domains of experience. This implies that one domain mirrors another. Thirdly, conceptual metaphor theory al- lows movement from the concrete domain to the abstract domain. A distinction is made between the source domain and the target domain, repre- senting concrete domain and abstract domain res- pectively. In the example LIFE IS A JOURNEY (Lakoff and Johnson, 1980), journey is more con- crete (source domain) than life (target domain). In this way, the theory proposes that more physi- cal domains typically serve as source domains for more abstract targets. Fourth, metaphors occur in thought. There is a tendency to use metaphors not only to speak about certain aspects of the world but also to think about them. Conceptual metaphor theory makes a distinction between metaphors; that is, exemplars of conceptual pat- terns we rely on in our daily living to think about aspects of the world. For instance, what people will say about HIV and Aids is a reflection of their thinking. The thinking is shaped by society, culture and is expressed metaphorically through language. Fifth, conceptual metaphors are groun- ded in the sense that the source domain is paired with a particular target domain. In other words, there is a similarity or resemblance between two things or events. This paper makes an effort to establish how comparisons involving HIV and Aids and real life as socially constructed could be entrenching stigma and discrimination thereby rendering HIV and Aids interventions ineffective. In sum, it can be observed that the Conceptual Metaphor Theory as postulated by Lakoff and Johnson (1980, 2008) ascribes to the conceptual and the linguistic dimensions of metaphor. There has been a spate of interest by rese- arch communities in establishing the different mo- dalities of metaphor expression, and in particular the visual modality. Such communities include marketing theory (e.g. Phillips & McQuarrie, 2004; Ng & Koller, 2013), cognitive psychology (e.g. van Weelden, Maes, Schilperoord & Swerts, 2012), linguistics (e.g. Perez-Sobrino, 2016) and media (e.g. Forceville, 2005). Onchoke & Wen (2017) conducted a cog- nitive analysis of woman metaphors in EkeGusii language. The study indicates that a woman is perceived as an object, a plant or an animal. The study also shows that a woman can be depicted by the appropriate behavior she exhibits based on values such as immorality, selfishness, beauty, ugliness, harshness, talkativeness, age, and faith- fulness. The cultural background plays an impor- tant role in the conceptualization and interpreta- tion of these metaphors. The study recommends more research of metaphors in other languages to enable comparisons. Another theoretical framework in this paper defines and categorizes stigma and discri- mination (MoH, 2014). The framework identi- fies five categories of stigma and discrimination based on a stigma index study in Kenya. The pur- pose of the survey was to guide interventions and policies to address HIV related stigma and discri- mination in order to enhance the quality of life of PLHIV. The study identified five forms of stigma and discrimination and established a composite stigma rating of 45.16% in Kenya which was ra- ted high. Details of the survey are summarized in Table 1. Patterns in Table 1 indicate that three forms of stigma have recorded very high in- cidences. These are: experience of stigma’s negative effects (74), concern about disclosure of HIV status (70), and judgment or blame of PLHIV (47). Though people fearful of contract- ing HIV from noninvasive contact with PLHIV and PLHIV who experience stigma’s negative Table 1. Stigma and Discrimination Index by Category Form of stigma Score Unit Value Index PLHIV who are concerned about disclosing their status 70.00 20.00 14.05 People fearful of contracting HIV from non-invasive contact with PLHIV 18.00 20.00 3.60 People who judge or blame PLHIV for their illness 47.00 20.00 9.36 PLHIV who think they have experiences stigma in the last year 17.00 20.00 3.44 PLHIV who experience stigma’s negative effects on themselves, the family, and the community 74.00 20.00 14.70 Composite stigma rating for Kenya 100.00 45.16 Language Circle: Journal of Language and Literature 14(2) April 2020 141 effects recorded lower scores of 18 and 17 re- spectively, the forms can still impede HIV and Aids mitigation efforts profoundly. The table shows a composite stigma rating for 45.16%. In the study reported in this paper, the five cat- egories will be used to classify the metaphors that entrench HIV-related stigma and discrimi- nation. Since stigma and discrimination have been found to undermine effective implemen- tation of HIV and Aids interventions in Kisii County, this paper delves into metaphors that underpin counter-productive cultural mind- sets. This could provide a targeted frontier in HIV and Aids response. METHODOLOGY Research Site The study was carried out in Kisii Coun- ty of Western Kenya. The County is among the 47 counties in Kenya. It neighbours Nyamira County to the North East, Narok to the South, Homabay and Migori to the West. Kisii County lies between latitude 30° and 10° S and longitude 35°38’ and 35° East. The County covers a total area of 1,317.5km2. It is divided into nine (9) Sub-Counties namely Bobasi, Bomachoge, Bora- bu, Bonchari, South Mugirango, Kitutu Chache North, Kitutu Chache South, Nyaribari Masaba, Nyaribari Chache and Bomachoge Chache (Figu- re 1). Figure 1. Kisii County Map Ethical considerations To anchor the study reported in this paper within acceptable ethical standards, the research proposal, data collection instruments and the in- formed consent form were reviewed and approved (Approval Number CU/IERC/NCST/18/53) by a registered Institutional Ethics Committee. The study was then issued with Research Permit Number NACOSTI/P/18/50245/24190 by the National Commission for Science, Technology & Innovation. Before data collection, all respon- dents were fully debriefed about the purpose of the study and asked to sign an informed consent form. They were assured of anonymity and con- fidentiality. Sampling The population of the study comprised people living with HIV (PLHIV) working as peer counsellors in HIV Testing Centres (HTCs) and Comprehensive Care Centres (CCCs) in selected health facilities in the County. The study popu- lation also included women living with HIV but have never transmitted HIV to their children du- ring breastfeeding. This category is called men- tor mothers and leaders of support groups in the Prevention of Mother-to-Child Transmission (PMTCT) units in health facilities in the County. The study population also included HIV Testing Service (HTS) counsellors, and clinicians. To se- lect these groups from selected health facilities, purposeful sampling method was used. This method involves identifying and selecting indi- viduals or groups of individuals that are especi- ally knowledgeable about or experienced with a phenomenon of interest (Cresswell & Clark, 2011). The study was interested in participants knowledgeable about HIV and Aids-related stig- ma and discrimination and also willing and able to communicate their experiences and opinions in an articulate, expressive, and reflective manner. Therefore, those who provided informed consent and produced metaphor-rich cases during inter- views and focus group discussions were identified and selected as the study sample. Data Collection One method of data collection employed in this study was the focus group discussion. Ochie- ng, Wilson, Derrick, Mukherjee (2018) have re- commended this method when there is need to obtain data from a purposely selected group of individuals rather than from a statistically repre- sentative sample of a broader population. This Language Circle: Journal of Language and Literature 14(2) April 2020 142 method was therefore deemed suitable for gai- ning an in-depth understanding of the metapho- rical construction of stigma and discrimination in HIV and Aids interventions in Kisii County. Support groups in the County included people living with HIV and Aids of between 10 and 30 members organized according to such va- riables as gender, age group, and HIV viral load. The groups also included peer counsellors, HIV Testing Service counsellors, mentor mothers and clinicians. The focus group discussions took place during monthly meetings in facilities by support groups as they receive their anti-retroviral therapy (ART). Introducing ourselves as researchers from various universities and after discussing the in- formed consent form with them, they allowed us to participate in their discussion and collect the data we needed in the process. Two active focus groups (the ante natal, lactating mothers) were used for discussions. Themes covered included people’s perception of HIV and Aids, disclosure of their HIV status, relationships at home, coping with medication, and hygiene. To complement focus group data, follow- up interviews involving caregivers of orphan- ed and vulnerable children, clinicians, mentor mothers and peer counsellors were carried out. DeJonckheere & Vaughn (2019) argue that fol- low-up interviews present an opportunity for collecting open-ended data and exploring partici- pant thoughts, feelings and beliefs about a parti- cular topic and delving deeply into personal and sometimes sensitive issues. It was therefore better suited to elicit sensitive HIV and Aids informati- on in unfolding and iterative interactions between us and the interviewees. Each of us interviewed at least a care giver, clinician, mentor mother and peer counsellor se- parately guided by a pre-determined open ended interview guide. The interview allowed the res- pondents to narrate anecdotes coloured by me- taphors engendering stigma and discrimination. We also recorded the interview sessions. Later on, each of us transcribed audio texts followed by plenary sessions for joint selection of texts bearing HIV and Aids metaphors on stigma and discrimination. This exercise gave us an oppor- tunity to build consensus on metaphoric words and expressions and the stigma/discrimination meanings they espouse. Data analysis Analysing focus group discussion and fol- low-up interview data is usually determined by the research question and the purpose for which the data are collected. Focus group discussion and follow-up interviews were used for an in- depth exploration of metaphors instigating HIV and Aids stigma and discrimination about which little is known. For such exploratory research the- refore, a simple descriptive narrative approach to analysis was quite appropriate. The first level of analysis comprised quali- tative processing and categorizing of data on stig- ma and discrimination according to the classifica- tion scheme by MoH (2014). This was followed by categorization and synthesis of metaphoric words and expressions with HIV and Aids stigma and discrimination connotations into source and target domains in line with the conceptual me- taphor theory (Lakoff and Johnson, 1980). The outcome was used to present a descriptive nar- rative. RESULTS AND DISCUSSION Data from this study revealed metaphors whose underlying conceptual logic matches the cultural beliefs and psyche of the AbaGusii peop- le of Western Kenya. The following descripti- ve narrative adopts the schema by MoH (2014) where stigma and discrimination is classified into concern about disclosure of HIV status, judging and/or blaming PLHIV for illness, PLHIV who have experienced stigma in the past and PLHIV who have experienced stigma in the past. The ca- tegories are discussed stepwise. Concern about disclosure of HIV status One of the ways HIV and Aids entrench stigma and discrimination among the people is through concern about disclosure of HIV status. People living with the condition do not want their HIV status to be known by others including their intimate partners. Accounts gathered from res- pondents revealed that knowledge of one’s HIV status could lead to either rejection or isolation. For instance, in one of the Level 4 medical facili- ties in Kisii County, an HIV Testing Service coun- selor attested that it is hard for people living with HIV to disclose their HIV status or the possibility of infecting others. Her narration is captured in Text 1: TEXT 1 “We have a case where a 19-year-old is very bitter with the mother for transmitting HIV to him. The boy contracted HIV through mother-to- child transmission. The mother has been picking ARVs for the boy without explaining to him that he is HIV positive. The boy only discovered re- cently through provider notification. As a result, Language Circle: Journal of Language and Literature 14(2) April 2020 143 the boy doesn’t want to see his mother. When we asked her why she couldn’t disclose the boy’s condition to him, she said: Tintageti o’mwana o’ne aniinkoorwe n’abande e’sukuru. (I don’t want my child to be isolated by others in school)” In the italicized text, o’mwana o’ne (my child) and a’ninkoorwe (be abandoned and disc- riminated) suggest that a PERSON LIVING WITH HIV IS A PARIAH. This means that PL- HIVcannot mingle with uninfected people. They ought to be isolated at all times. Similarly, owing to the presumptive stig- ma and discrimination associated with HIV and Aids, a woman is in denial and does not know how to disclose her HIV status to her spouse in a Level 3 hospital. An HIV testing counsellor re- counted the case as follows: TEXT 2 “A woman tested positive in this clinic. She doesn’t know how to disclose this outcome to her husband whom she claimsis very hosti- le. She said: Aise komanya ng’a ni’ndwarete nigo a’gonseeria. (Should he know that I am sick, he will send me away from my matrimonial home). She has therefore refused to own the results. She is therefore unable to begin medication for fear of being discovered by the husband. As a result, she has become weak and anaemic. She has also been attacked by TB.” In the italicized bold expressions, ni’ndwarete (I am living with HIV) and nigo agon- seeria (will divorce me), show correspondence bet- ween a person living with HIV and a divorcee. The conceptual mapping can be expressed as A PERSON LIVING WITH HIV IS A DIVOR- CEE. Another HIV testing counsellor recounted a case of a person living with HIV who had diffi- culties disclosing her status to her spouse for fear of the consequences. The counsellor narrates: TEXT 3 “A 38-year-old woman tested positive for HIV in 2012 and was put on ART. She has never disclosed her status to her husband. All the while, she has been taking her medication under cover. Recently, we conducted a family testing exercise where she asked the HTS providers not to come to their home. On a separate occasion, the hus- band visited the hospital for medical check-up. He was tested for HIV as per the MoH policy but was found to be HIV negative. The woman said: o’mosacha o’ne amanye ng’a ni’ndwarete, ni’go a’kong’anekera mamincha y’okogania kwane. (If my husband knows that I am living with HIV/Aids, he will disclose it to people against my wish). In the italicized words, o’mosacha o’ne a’manye ng’a ni’ndwarete, (my husband knows that I am living with HIV), ni’go a’kong’anekera mamin- cha y’okogania kwane (he will disclose my status and shame me against my wish). The ontological correspondence emerging is a PERSON LIVING WITH HIV IS A PUBLIC SHAME. Another form of stigma is where a person living with HIV opts for care services in far-flung areas leaving facilities in close proximity to where they live and/or work. In a focus group discus- sion, an HIV testing services counsellor said the following about a client: TEXT 4 “A 59-year old male soldier in the KDF travels all the way from West Pokot which is over 400 km away to this facility for ART. He has been doing this for the last five years. When I asked him why he cannot transfer to a clinic near his place of work he asked me: O’boare mbokong’u ki bobwate?(What is the problem with distance?) He challenges us to say when he has ever come late or missed to pick his medication as scheduled.” The implication in the question, O’boare mbokong’u ki bobwate?(What is the problem with distance?) is that healthcare facilities offer ART services to people from far. The conceptual cor- respondence is a PERSON LIVING WITH HIV IS A PARIAH AT HOME.As such, they seek care support services very far from home. Judging and/or blaming PLHIV for illness Another way stigma manifests itself is through the avoidance of getting tested for HIV for fear of being judged or blamed. Given that HIV is taken as a deadly condition, people would rather prefer to live with it without knowing than getting tested. In a Level 5 Private Hospital in the County, a man has been living with the fear of undertaking an HIV test both for himself and for his sickly 16-year old son. In a focus group dis- cussion, an HIV testing counsellor in the facility narrated to us the details about him: TEXT 5 “A man brought a 16-year son with enlar- ged lymph nodes. He explained that the boy has been ill on an on-an-off basis. The man refused the HTS staff to test the son for HIV. He said: Mo’ise ko’renga o’momura o’yo ni’go ngw’eita. (I will commit suicide if you test this boy). When probed further, the father said he was the source of the trouble the son was going through. Becau- se he had lost his wife through HIV-related comp- Language Circle: Journal of Language and Literature 14(2) April 2020 144 lications, he thought he was HIV positive and sus- pected the son was also positive though he had not taken a test to confirm. After rigorous coun- selling, the man agreed to be tested with the son. They both tested negative! He couldn’t believe it.” The words Mo’ise ko’renga o’momura o’yo (if you test this boy for HIV) can be mapped onto ni’go ngw’eita (I will kill myself). Conceptually, it can be deduced that HIV TESTING IS DEATH. The perception therefore is that people will rather die than know their HIV status or that of their close relatives. In another case reported in the same facili- ty, the same counsellor narrated: TEXT 6 “A mother attending the Ante Natal Clini- cin this hospital was found to be HIV positive. We requested her to bring along the spouse the follo- wing day for the HIV test. She told us that when she requested the husband to go for the test, he angrily retorted:“Kwendahuko! Kwani ni mimi niko na mimba?” (Go away! Am I the one pregnant?)” In the italicized text, there is the emerging belief among men that women are responsible for the transmission of HIV and Aids. In terms of the conceptual metaphor theorytherefore HIV AND AIDS ISA WOMEN AFFAIR. It is evi- dent from this attitude that people are either ig- norant about HIV and Aids or they are resistant to interventions that can prevent further spread. In a broader sense, there is the perception that HIV is a problem of PLHIV. This is alluded to by UNAIDS (2002, P.9) where it is noted that stigma can cause people to perceive individuals with or at risk of HIV as the other (“them”), reinforcing the feeling that HIV “couldn’t happen to me.” Another form of judging or blaming a person living with HIV involves the non-infected population discriminating the infected people thereby heightening stigma and discrimination.A mentor mother in a Level 3 facility living with HIV remembers how a neighbor who was privy to her HIV status warned her friend against kee- ping her company: TEXT 7 Tiga go’tara n’omonto o’bwate enyamoreo. (Stop keeping the company of someone with the disease that emaciates) In this text, the word e’nyamoreo implies that HIV/Aids is a condition that eats up one’s flesh.The conceptual correspondence therefore would be HIV IS AN EMACIATOR. This sta- tement Tiga go’tara n’omonto o’bwate enyamoreo (Stop keeping the company of someone with the disease that emaciates) connotes that the stigma and discrimination that people living with HIV are subjected to is extended to those they asso- ciate with. Therefore, people are warned against the company of people living with HIV. Clearly, the belief that one can contract HIV by merely keeping the company of a person living with the condition is indicative of people’s discriminating perceptions. This view is reinforced by Mittelberg (2007, P.34) who notes that metaphors convey the images, feelings, customs, values and thought patterns found in our cultures. In the same facility, a peer navigator re- counted how a man commented about her condi- tion to other men when she was down with pneu- monia. He is quoted to have said: TEXT 8 “Rigwa riamobetire. Ngotiira are.” (She has been pricked by a thorn. She is ascending - to Heaven) The conceptual correspondence in this text is HIV IS A JOURNEY TO DEATH. The- re is a belief among the AbaGusii that once you have been pricked by a thorn, a life threatening infection can find way into the body and kill one gradually. It is therefore understood that once one contracts the HIV virus, the person would have embarked on a slow journey to death. This observation corroborates work by Nyakoe et al (2014) based on the basic metaphor HIV IS A JOURNEY TO DEATH. In the study, EkeGusii speakers perceive a seropositive individual as a traveller on an endless journey of taking ARVs or death. The perception emerges in the text above …Ngotiira are (She is ascending to Heaven) A 20-year-old female peer navigator in a Level 4 public health facility recounted how she faces stigma and discrimination on a daily basis. She remembers how they had gone for commu- nity based HIV and Aids campaigns and testing. She overheard a person say the following from the crowd: TEXT 9 No’rora o’moiseke oria o’norete iga, na’bwate o’morero o’ria o’monene (Although that girl looks fat, she has that huge fire) In this text, it can be conceptually deduced that HIV IS A HUGE FIRE. A huge fire is kno- wn to consume a body into charred remains. This destructive power of fire is compared to assumed debilitating effects of HIV and Aids. With cynical messages such as these, PLHIV may either fail to enroll for anti-retroviral therapy or, if enrolled, fail to adhere to drug taking regimen. Clearly, ad- Language Circle: Journal of Language and Literature 14(2) April 2020 145 herence concerns will undermine the quality of care for PLHIV. A sex worker working as a peer navigator in an HTS clinic targeting key populations such as Sex Workers (SWs), People Who Inject Drugs (PWID), and Men who have Sex with Men (MSM) recounted a remark a person made after an encounter with a male client: TEXT 10 “O’tachire egwayay’esitima.”(He has stepped on an electric wire) The conceptual mapping in this text can be expressed as HIV IS AN ELECTRIC CUR- RENT, implying that contracting HIV and Aids is a sure way to death just as happens when a per- son is electrocuted.The metaphor also communi- cates the meaning that HIV IS AN ACCIDENT. This compares withNyakoe&Yakub (2017) who observed that HIV infection employs the accident metaphor expressed in THE HUMAN BODY IS A MACHINE metaphor and also in reference to CONTRACTING HIV IS A THORN IN THE FLESH. A middle-aged mentor mother had always freely disclosed her HIV status duringcommu- nity-based HIV testing outreaches. At one such event, she narrated how she was once taken ill and hospitalized. She was diagnosed with Tuber- culosis and found to be HIV positive. Her brother in-law remarked to a visitor who had come to vi- sit her in hospital. TEXT 11 E’ngori yamonasire. (The noose has tighte- ned around her neck) The conceptual correspondence in this text is summarized as HIV IS THE HANGMAN’S NOOSE. This text suggests that HIV and Aids kills rapidly the way a noose kills through strangu- lation. The metaphor has the effect of harming PLHIV psychologically and deflecting them from their social routines and work. Stigma arising from such metaphors can work against HIV and Aids prevention interventions (UNAIDS, 2002). PLHIV who have experienced stigma in the past Another form of stigma and discriminati- on affects PLHIV who have experienced the same before. One case in point involves a stigma-free mentor mother in an HTS clinic in a dispensa- ry in Kisii County. She narrated to us how she experienced stigma and discrimination soon af- ter losing her husband to HIV-related complica- tions and how what she was told has affected her to this day.One day, her chicken strayed into a neighbour’s vegetable garden and, in a fit of an- ger, the neighbor remarked: TEXT 12 Tiga konya gotwerorera. A’ye n’omonto o’bwate E’nyamoreo. (Stop the pride. You have Aids) Text 12 seems to allude that people living with HIV have no future. They only have to wait for death. In conceptual terms therefore we can say that APERSON LIVING WITH HIV IS DEAD. The metaphor reinforces the conceptua- lization of stigma by UNAIDS (2002) where it is viewed as a mark of shame or discredit on PL- HIV. The effects of negative metaphors on HIV and Aids have a long-term effect on PLHIV. The same mentor-mother narrated anot- her incident whereher cows once strayed into the neighbour’s land. The neighbor ran towards them brandishing a stick shouting: TEXT 13 E’nyamoreo ya’soire mo’gondo! E’nyamoreo ya’soire mo’gondo! (Aids has strayed into (my) land! Aids has strayed into the (my) land!) It can be inferred from the text that anyt- hing that is associated with a PLHIV is con- nected to their HIV status. Therefore, the con- ceptual correspondence can be expressed as: A PLHIV’S POSSESSIONS ARECONDEMNED. The implication of this text is that a PLHIV and all that they possess are isolated and discrimi- nated against. The word E’nyamoreo negatively describes the physical effect of emaciation due to the effects of HIV. This view is corroborated by Kamau (2012) who notes that PLHIVin Central Kenya are labeled according to their physical ap- pearance. She points out, for example, that the la- bel “Mukingo” is used to signify “long neck” and “skinny”. Another mentor mother in the same fa- cility narrated how she would be frowned upon anytime she wanted to say anything. In a parti- cular incident, she had a little disagreement with a man who publicly alluded to her HIV status which continues to hurt her anytime she remem- bers. The man had told her: TEXT 14 Renda e’kere ime yao. (Take care of what is in you) In this text, one may correspond HIV and Aids to the deadliest condition that cannot allow PLHIV to think about anything else. They should not exercise their right to expression and associa- Language Circle: Journal of Language and Literature 14(2) April 2020 146 tion or engage in any economic activity because they are dying anyway. In other words, PLHIV are doomed. PLHIV experiencing stigma’s negative effects This category describes how PLHIV are disadvantaged because of their HIV status. Data drawn from the study reveals that PLHIV expe- rience stigma’s negative effects in various ways. One such way is refusal by people to buy your wares. A mentor mother narrated as follows: TEXT 15 I am a milk and vegetable vendor. When I go out to sell, those who know my HIV status cannot buy from me. I only sell to those who do not know my HIV status. I remember an insensi- tive remark which has hurt me to date: Ti’nkogoria monto o’rwarete e’nyamoreo mabere. A’mabere ayio nabwate e’binyinyi (I won’t buy milk from a person living with HIV. The milk is contaminated.) The conceptual correspondence in the italicized expression is WARES BELONGING TO A PERSON LIVING WITH HIV ARE IN- FECTED. The perception therefore is that people living with HIV can contaminate everything they handle. This therefore puts PLHIV at an econo- mic disadvantage. Negative effects may also take the form of mistreatment. An HTS counsellor in a Level 3 hospital in Kisii County recounted how caregi- vers of HIV positive orphaned children mistreat the children. The caregivers do this out of misin- formation and ignorance about the nature and manifestation of HIV. The HTS counsellor nar- rated as follows: TEXT 16 A caregiver of a 5-year-old orphan brought the boy for ARVs. She asked me, “Sister, when is this boy likely to die?” I assured her that the boy will live a normal life if he takes medication as required and with good nutrition. I also learnt from the caregiver that the boy is not allowed to share a bedroomwith other children. He is not al- lowed to share a meal or even utensils with the other children. Asking her why she does this, she told me: Tintageti bana bane banyore o’borwaire obo- be. (I don’t want my children to contract the bad disease). Conceptual mapping in this text can be ex- pressed as HIV IS CONTAGIOUS and therefore PLHIV should be quarantined if possible. A simi- lar case involves a 21-year-old peer navigator who lost a job as a house help when her employer dis- covered that she was HIV positive. She narrated: TEXT 17 One day my employer stumbled on my month’s ARVs in a packet stacked under my mat- tress. She confronted me and asked: Nigo o’bwate boria o’bonene o’tari goteeba? Nigo o’tagete kong’itera abana? (You have the big one and you have never told us? Do you want to kill my children?). She asked me to pack and go. Sacking a PLHIV is a serious form of disc- rimination which places affected people in po- verty. To metaphorically imply that PLHIV can transmit the condition to another person by mere physical proximity or contact will certainly cause them psychosocial trauma which will entrench stigma. Arising from the qualitative analysis of data, metaphors engendering stigma and discri- mination are marks of shame or discredit on PL- HIV. It is notable that stigma can manifest itself in a variety of ways, including ignoring the needs of a person or group to psychologically or physi- cally harming those who are stigmatized. Failure to control development and use of stigma-insti- gating metaphors may jeopardize success rates envisaged in HIV and Aids programs touching on prevention, quality of care and policy. Ac- cording to UNAIDS (2002), messages targeting PLHIV should be positive and devoid of blaming or stigmatizing as these can backfire by diverting people’s attention to and uptake of support ser- vices. CONCLUSION In sum, it is logical to state that there is deep HIV and Aids-related stigma and discrimi- nation in Kisii County. The words and expres- sions used to depict the condition are perhaps one of the greatest sources of stigma and discri- mination. It is evident from the texts analysed in this paper that people structure their understan- ding and experiences of HIV and Aids through conceptual metaphors derived from what Lakoff and Johnson (1980) call sensorimotor and spatial concepts learned earlier in life. Therefore, it can be said that HIV and Aids related metaphors are founded on the cultural norms of the AbaGusii people. It is imperative that PLHIV who adhere to treatment regimen prescribed to them by pro- fessional healthcare providers can live normal lives. The paper recommends the County and implementing partners to develop refutational messages and counter metaphors which deny that HIV and Aids are necessarily death senten- ces. Behaviour change communication models can be used to unlearn the metaphors based on Language Circle: Journal of Language and Literature 14(2) April 2020 147 cultural myths and misinformation and learning well-crafted messages based on success stories on HIV and Aids response. ACKNOWLEDGEMENTS The work reported in this paper was a re- sult of concerted efforts for which we are greatly indebted. 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