Community Perceptions of HIV Stigma, Discriminatory Attitudes, and Disclosure Concerns: A Health Facility-Based Study in Selected Health Districts of South Africa

Abstract

Research data about HIV stigma perceptions and discriminatory attitudes among the general population are limited. Furthermore, the willingness of HIV-negative individuals to engage with HIV prevention and disclosure interventions has not been established in South Africa. The study investigated community perceptions of stigma as well as discriminatory attitudes towards HIV disclosure to understand if and how these perceptions might influence the uptake of disclosure interventions. This facility-based study used a validated questionnaire to measure the four constructs of HIV stigma among 670 adults recruited from health districts of two provinces of South Africa. Of these, 72% were female, 87% had ever been tested for HIV, and 31% knew someone who has HIV. Stigma towards people living with HIV (PLHIV) is widespread in the general population. A high proportion (75%) endorsed disclosure concerns, 75% perceived stigma to be common, and 56% endorsed negative statements indicating perceived stigma in communities. Fear, moral and social judgement, and rejection underlined their perceptions about PLHIV. Almost half (45.7%) were unwilling to care for family members sick with AIDS, suggesting negative distancing reactions and discriminatory attitudes towards PLHIV. The widespread discriminatory attitudes and the perceived stigma that is evident in the general population might heighten the disclosure concerns endorsed, promote non-disclosure, and increase HIV transmission. To design interventions, it is crucial to be cognisant of disclosure concerns, discriminatory attitudes, and perceived stigma evident in communities. Thus, the findings underscore the need to increase efforts to challenge and reduce community drivers of negative discriminatory attitudes and perceived stigma.

Structural, Familial, and Psychosocial Factors Affecting Long-Term Antiretroviral Treatment Adherence amongst Adolescents Living with Perinatally Acquired HIV in Limpopo, South Africa

“…Furthermore, the fear of stigma affected clinic attendance as some of them skipped their clinic appointment to avoid being seen collecting their medication. Other studies reported similar findings [14,15,30]. Similar to previous studies, APHIV felt burdened by keeping their HIV status secret, which deprived them of emotional and psychosocial support from significant others [3,10,33].…”

“…Fear of stigma was a major challenge that contributed to APHIV keeping their HIV status a secret. Previous studies reported on how stigma and prejudice against HIV influenced APHIV to keep their HIV status a secret [13,[30][31][32]. Secrecy affected their adherence to ART as they missed taking their medication in the presence of friends and other people [4].…”

Health Workers’ Responses to COVID-19 Pandemic’s Impact on Service Delivery to Adolescents in HIV Treatment in Cape Town, South Africa: A Qualitative Study

“…Evidence from this present study suggests that anticipated and experienced stigma within communities are barriers to healthcare access and treatment adherence for people living with HIV. Research shows that high and persistent levels of anticipated stigma may result in non-adherence to ART, disengagement in care, and non-disclosure amongst ALHIVs [ 51 , 52 , 53 , 54 ]. Additionally, a study conducted in Rwanda found that anticipated stigma was common amongst PLHIV, as it was sometimes experienced within communities and health facilities, often leading to early disengagement from care [ 55 ].…”

Ubuntu Is a Critical Component in the Fight against Human Immunodeficiency Virus and Tuberculosis Stigma: Nursing Students’ Perceptions

“…Therefore, putting Ubuntu ethics to use, one may prevent the stigmatization of HIV and TB and the hatred that fuels it. Additionally, treating PLHIV with dignity and respect will accept them as fellow human beings, especially in South Africa, where stigma and discriminatory attitudes are pervasive [41]. As a result, TB and PLHIV will be able to live dignified lives and experience the humanity that Ubuntu promises.…”