Are Integrated HIV Services Less Stigmatizing Than Stand-alone Models of Care? A Comparative Case Study from Swaziland

April 2013 - Structural Prevention

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Church, K., Wringe, A., Fakudze, P. et al. Journal of Acquired Immune Deficiency Syndromes (January 2013), 16:17981.

A mixed-methods comparative case study that explored HIV stigma experiences across four HIV care models in Swaziland found that the model of care influenced stigma associated with perceived HIV status exposure; however, the relationship was complex. Antiretroviral therapy (ART) was offered in the same room as sexual and reproductive health (SRH) (integrated), in the same building as SRH (partially-integrated), in an outpatient clinic on a hospital campus (partially stand-alone), in an HIV testing- and ART-only site (stand-alone). Integrated care increased confidentiality for some clients. Partially integrated/stand-alone models were associated with the greatest risk of exposure; yet most clients at stand-alone sites preferred ART to remain separate due to mutual support from other people living with HIV. The results indicated an overall perception that HIV status could be exposed at the clinics, yet most clients trusted staff to maintain confidentiality. Forty-four percent of participants had a high perceived risk of exposure. Interviews showed that clients who accepted their own HIV status were more comfortable in HIV clinics. HIV services should include strategies to ensure privacy and reduce stigma related to structural factors, e.g., room labeling or ART client cards. The authors recommended considering the benefits of stand-alone models, particularly in high-prevalence settings, while consideration of integrating HIV care into other health services continues.

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