“I don’t want them to know”: how stigma creates dilemmas for engagement with Treat-all HIV care for people living with HIV in Eswatini

Horter, Shona; Bernays, Sarah; Thabede, Zanele; Dlamini, Velibanti; Kerschberger, Bernhard; Pasipamire, Munyaradzi; Rusch, Barbara; Wringe, Alison

doi:10.2989/16085906.2018.1552163

Cited by 40 publications

(34 citation statements)

References 52 publications

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“…Gossip (at the individual, household, and community levels) is rampant among rural communities of Eswatini, and being the subject of gossip is regarded as an egregious insult to one's character [56]. In our study, patients worried that if people became aware of their HIV status, they would become the subject of gossip among family and community members.…”

Section: Discussionmentioning

confidence: 81%

Individual, household, and community level barriers to ART adherence among women in rural Eswatini

et al. 2020

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Background Despite access to free antiretroviral therapy (ART) for all people living with human immunodeficiency virus (HIV), noncompliance to treatment continues to be a significant challenge in Eswatini. Yet studies investigating barriers to ART adherence in Eswatini are scarce. Most notably, there is a lack of research regarding rural women in Eswatini, who are currently the country's most vulnerable to HIV infection. Therefore, the objective of the study is to investigate individual, household, and community level barriers to ART adherence among rural women living with HIV. Methods We conducted a qualitative study to investigate individual, household, and community level barriers to ART adherence. We conducted focus group discussions with HIV-infected women (n = 4) from rural villages in Eswatini, and in-depth interviews with healthcare workers (n = 8) serving the area clinics. Open and axial coding techniques were used for data analysis and interpreted within a social ecological framework. Results Our findings revealed several individual level barriers including hunger, side effects of ART, personal stress, lack of disclosure of HIV status, alcohol use, and forgetting to take ART. Lack of food, unemployment and scarcity of financial resources were identified as critical barriers at the household level. Community and institutional barriers encompassed factors related to health delivery such as lack of privacy, travel time, transportation costs, excessive alcohol use by healthcare workers, maltreatment, public and self-stigma, gossip, and long waits at clinics.

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Section: Discussionmentioning

confidence: 81%

Individual, household, and community level barriers to ART adherence among women in rural Eswatini

et al. 2020

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“…Firstly, same-day ART may not address patients` concerns about expedited ART initiation, and not give enough time to conceptualize lifelong therapy. [44][45][46][47][48][49] This may have contributed to immediate disengagement from care after treatment initiation, with 9% of patients under same-day ART never returning for a follow-up visit.…”

Section: Effect Of Same-day Artmentioning

confidence: 99%

The impact of same-day antiretroviral therapy initiation under the WHO Treat-All policy

Kerschberger

Boulle

Kuwengwa

et al. 2020

Preprint

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Background: The World Health Organization recommends rapid initiation of antiretroviral therapy (ART) for people living with HIV, with the option to start treatment on the day of diagnosis (same day ART). However, the effect of same day ART remains unknown in realistic public sector settings. Methods: We established a cohort of ≥16 year old patients who initiated first-line ART under Treat-All in Eswatini between 2014-2016, either on the day of HIV care enrolment (same day ART) or 1-14 days thereafter (early ART). Directed acyclic graphs, flexible parametric survival analysis and targeted maximum likelihood estimation (TMLE) were used to estimate the effect of same day ART initiation on the composite unfavourable treatment outcome (loss to follow-up;death;viral failure). Results: Of 1328 patients, 839 (63.2%) initiated same day ART. The adjusted hazard ratio of the unfavourable outcome was increased by 48% (95% CI:1.16-1.89) for same day ART compared with early ART. TMLE suggested that after 1 year, 28.9% of patients would experience the unfavourable outcome under same day ART compared with 21.2% under early ART (difference: 7.7%; 1.3-14.1%). This effect varied over time in regression analysis and TMLE, with a higher hazard during the first year after HIV care enrolment and a similar hazard thereafter. Conclusions: Caution is needed in implementing same day ART in routine settings.

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“…Healthy individuals living with HIV may face additional barriers to ART initiation, limiting the impact of universal Test and Treat policies. Existing literature show that healthy clients may see little benefits to early ART initiation and instead, associate ART initiation with time and financial costs, as well as fear of unwanted disclosure and side effects [11][12][13][14]. However, only a handful of studies on ART barriers have been conducted after the implementation of universal Test and Treat [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…Existing literature show that healthy clients may see little benefits to early ART initiation and instead, associate ART initiation with time and financial costs, as well as fear of unwanted disclosure and side effects [11][12][13][14]. However, only a handful of studies on ART barriers have been conducted after the implementation of universal Test and Treat [12,13]. Literature from Option B +, a policy that has provided universal treatment for pregnant/breastfeeding women since 2016, found unique barriers to ART initiation among healthy women, including concerns about partner support, feeling healthy, poor knowledge about early ART initiation, needing time to accept their new status, and fear of side effects [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Optimizing Test and Treat in Malawi: health care worker perspectives on barriers and facilitators to ART initiation among HIV-infected clients who feel healthy

Dovel

Phiri²,

Mphande³

et al. 2020

Global Health Action

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Background: Test and Treat has been widely adopted throughout sub-Saharan Africa, whereby all HIV-positive individuals initiate antiretroviral therapy (ART) immediately upon diagnosis and continue for life. However, clients who feel healthy may delay ART initiation, despite being eligible under new treatment guidelines. Objective: We examined health care worker (HCW) perceptions and experiences on how feeling healthy positively or negatively influences treatment initiation among HIV-positive clients in Malawi. Methods: We conducted 12 focus group discussions with 101 HCWs across six health facilities in Central Malawi. Data were analyzed through constant comparison methods using Atlas.ti7.5. Results: Feeling healthy influences perceptions of ART initiation among HIV-positive clients. HCWs described that healthy clients feel that there are few tangible benefits to immediate ART initiation, but numerous risks. Fear of stigma and unwanted disclosure, disruption of daily activities, fear of side effects, and limited knowledge about the benefits of early initiation were perceived by HCWs to deter healthy clients from initiating ART. Conclusion: Feeling healthy may exacerbate barriers to ART initiation. Strategies to reach healthy clients are needed, such as chronic care models, differentiated models of care that minimize disruptions to daily activities, and community sensitization on the benefits of early initiation.

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“I don’t want them to know”: how stigma creates dilemmas for engagement with Treat-all HIV care for people living with HIV in Eswatini

Abstract: View related articlesView Crossmark data Citing articles: 7 View citing articles African Journal of AIDS Research is co-published by NISC (Pty) Ltd and Informa UK Limited (trading as Taylor & Francis Group)

Cited by 40 publications

References 52 publications

Individual, household, and community level barriers to ART adherence among women in rural Eswatini

Individual, household, and community level barriers to ART adherence among women in rural Eswatini

The impact of same-day antiretroviral therapy initiation under the WHO Treat-All policy

Optimizing Test and Treat in Malawi: health care worker perspectives on barriers and facilitators to ART initiation among HIV-infected clients who feel healthy

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