Informing Comprehensive HIV Prevention: A Situational Analysis of the HIV Prevention and Care Context, North West Province South Africa

Abstract

ObjectiveBuilding a successful combination prevention program requires understanding the community’s local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa.MethodThe situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO’s Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews.ResultsWe conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV.ConclusionsUnderstanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four ‘themes’ identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis process successfully shaped key programmatic decisions and cultivated a deeper collaboration with local stakeholders to support program implementation.

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

“…People with HIV have valid reasons to remain wary of others learning of their infection. This reality reflects stigma’s continuing role in perpetuating existing power structures and social norms, such as placing restrictions over women’s sexuality and reinforcing masculine norms that idealize being “healthy and virile” and not needing help or health care [ 3 , 22 ].…”

“…The data utilized in this analysis were drawn from a larger situational analysis intended to broadly understand the local HIV-related healthcare systems. Although stigma was not the primary focus of the project at the outset, it emerged in the course of data collection as a key theme [ 22 ]. As a result, it is possible that our interviews and analysis may have missed nuances in how stigma manifests, as we did not purposefully target HIV-positive participants for interviews (though many community members revealed their status in the course of study participation).…”

“…We conducted a secondary data analysis on data collected as part of the rapid community-based qualitative assessment to inform a combination HIV prevention project being conducted in the Bojanala Platinum and Dr. Ruth Segomotsi Mompati Districts of South Africa [ 21 , 22 ]. The primary purpose of the research was to engage community members and stakeholders and tailor intervention activities to the local context prior to program implementation.…”

“…One week of rapid data collection, including in-depth-interviews (IDIs), focus group discussions (FGDs), and health facility assessments, was conducted in each site between April 2012 and September 2013. Details on methods and results, including impact on program design, are described elsewhere [ 21 , 22 ].…”

“…We examined community perceptions of stigma and sought to understand if and how these perceptions influence people’s engagement with HIV prevention and treatment within the context of expanding access to ART at four sites in two high prevalence districts in the North West Province of South Africa [ 21 , 22 ]. The Republic of South Africa, which has the highest number of people living with HIV (6.4 million) and the second highest number of HIV-related deaths in the world, has undertaken mass HIV testing campaigns and decentralized and expanded access to ART [ 23 – 25 ].…”