Why Increasing Availability of ART Is Not Enough: A Rapid, Community-based Study on How HIV-related Stigma Impacts Engagement to Care in Rural South Africa

March 2016 - Structural Prevention

March 2016 Prevention Update (PDF, 440.24 KB)
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Treves-Kagan, S., Steward, W.T., Ntswane, L., et al. BMC Public Health (January 2016), 16(1):87. doi: 10.1186/s12889-016-2753-2.

This study examined the effect of stigma on access to antiretroviral therapy (ART) in settings where ART was available in almost all local health clinics. The authors conducted secondary analysis of data from a rapid community-based qualitative assessment for a combination HIV prevention project in two districts of South Africa. Transcriptions of 31 interviews and focus group discussions showed that community perceptions still strongly associated HIV with promiscuity and adultery. HIV-positive community members could thus be treated differently or be socially isolated both from the general community and from family. Participants, especially those from key populations (youth, sex workers, and men who have sex with men) also reported feeling stigmatized by health care providers. They described using strategies to manage who learns of their HIV status, mostly avoiding disclosure by describing their HIV infection as some other condition. Simply being seen at a health clinic meant risking exposure of one’s HIV status. This perception was considered a major barrier to accessing health facilities for testing or treatment, and a reason for delaying access to care until advanced sickness. The authors underlined the urgency of increasing cultural acceptance of being seropositive, integrating HIV care into general primary care, and normalizing access to health care by men and young people.

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