HIV-positive status disclosure in patients in care in rural South Africa: implications for scaling up treatment and prevention interventions.

CAPRISA, 2015Abstract available in pdf

Stigma experiences among substance users with HIV

Two conditions that are highly stigmatized are substance use and HIV. In this qualitative study, we investigated, through thematic analyses of verbatim transcripts, 15 substance users’ experiences with receiving their diagnosis, making disclosure decisions, and receiving and dealing with stigmatizing reactions. Motivations to disclose included being in poor health, having visible symptoms, others seeing HIV medication, poor medication access without disclosure, being asked directly, emotional catharsis, believing that the target will maintain confidentiality, notifying a partner of risk, and disclosing to reduce stigma. Reasons for concealment were needing time to process the diagnosis, fear of stigmatization, previous negative experiences with disclosure, being advised to conceal, not wanting to burden others, and believing that one’s HIV is irrelevant. Stigmatizing reactions from others included increased physical distance, excessive precautions, social avoidance, abandonment, rejection, exclusion, judgment, blame, name calling, gossip, denial, and requests to conceal status. Layered stigma was prevalent and substance use stigma was reported to be greater than HIV stigma. Emotional and social consequences were reported, as were a number of coping strategies. Findings are important input for stigma reduction

Positive and stigmatizing interactions between people with HIV and health care providers

People living with HIV experience stigmatization in numerous settings including health care. Through semi-structured interviews, we explored the perspectives of both PLWH (n=22) and health care providers (n=14) on their interactions. PLWH reported a number of negative and positive experiences. Negative experiences included awkward interactions, rude behaviour, excessive precautions, compromised care, and breached confidentiality while health care providers perceived their interactions to be adequate and appropriate. Positive experiences were being treated equally, receiving extra attention, feeling valued, social support provision, and assurances of confidentiality. Health care providers reported having limited but adequate HIV-related knowledge and feeling that their interactions with PLWH are appropriate and professionals. At the same time, they reported taking extra precautions and labelling patient files to reduce occupational risks. These findings point to a discrepancy in the perception and experience of interactions between PLWH and health care providers. They also suggest that stigmatization on the part of health providers is likely unintentional and instrumental rather than symbolic. Implications for interventions will be discussed