HIV/AIDS-related stigma in South African alcohol-serving venues and its potential impact on HIV disclosure, testing and treatment-seeking behaviours

Abstract

Alcohol-serving venues in South Africa are sites for high-risk behaviours that may lead to HIV transmission. Prevention and treatment interventions are sorely needed in these settings, but HIV-related stigma may limit their effectiveness. This study explored expressions of stigma among alcohol-serving venue patrons in Cape Town and examined the potential impact of stigma on HIV disclosure, testing, and treatment-seeking behaviours. A total of 92 in-depth interviews with male and female, Black and Coloured patrons were conducted. Transcripts were analysed via memo-writing and diagramming techniques. Many participants mentioned knowing other patrons living with HIV/AIDS (PLWH), and this visibility of HIV impacted expressions of HIV-related stigma. Participants discussed four forms of HIV-related stigma in the venues: fearing PLWH, fearing HIV acquisition, blaming others for spreading HIV, and isolating PLWH. HIV visibility and expressions of HIV-related stigma, particularly fear of isolation, influenced participants’ willingness to disclose their status. HIV-related stigma in the venues also appeared to indirectly influence testing and treatment-seeking behaviour outside the venue. Results suggest that efforts to change norms and reduce expressions of HIV-related stigma in alcohol-serving venues are necessary to successfully deliver tailored HIV prevention interventions and increase uptake of HIV testing and care in this important social setting.

Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa

“…There is good reason to expect that reducing traumatic stress would increase individuals’ care engagement (57), but this research has not yet been conducted. Further, women said that they gained confidence when witnessing others who were living adaptively with HIV, and that this sense of community made them feel less alone in their situation, a phenomenon that has been noted elsewhere (58). The fact that women in this study willingly spoke in great detail to the interviewer about their sexual trauma experiences, and that they universally expressed that the interview itself had a therapeutic effect, suggests that HIV-positive women may be open to participating in, and may benefit from, interventions where they could openly share their trauma experiences in a safe environment, and find solidarity with other women.…”

Factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa

“…Higher levels of HIV-related stigma were here associated with a reduction in the odds of any alcohol use prior to pregnancy. This may be explained by women experiencing higher levels of stigma avoiding alcohol-serving venues, where HIV-related stigma may be prevalent (Velloza et al, 2015), although more than half of the women in this sample were only diagnosed with HIV when they entered antenatal care, after the reference period for pre-pregnancy alcohol use, and this particular finding should thus be interpreted with caution. In a systematic review of the predictors of alcohol use during pregnancy it was noted that while many studies have explored the impact of educational attainment on alcohol use, findings are inconsistent (Skagerstróm et al, 2011; Kitsantas et al, 2014).…”

Gender, HIV Testing and Stigma: The Association of HIV Testing Behaviors and Community-Level and Individual-Level Stigma in Rural South Africa Differ for Men and Women

“…Individual perceived stigma, or the fear of being stigmatized if positive, have long been associated with delays in testing or decisions not to test, and this had been shown to be the case both before [12–19] and after South Africa expanded access to HIV care and treatment [20–22]. To date, most of what is known about the relationship between stigma and HIV testing has focused on individual-level models, or those that examine an individual’s perception of HIV-related stigma and its association with testing decisions [23].…”