Perceived Stigma as a Contextual Barrier to Early Uptake of HIV Testing, Treatment Initiation, and Disclosure; the Case of Patients Admitted with AIDS-Related Illness in a Rural Hospital in South Africa

Abstract

We explored the extent to which perceived HIV-related stigma influences the disclosure and concealment of HIV status to family among adult patients hospitalised for AIDS-related illness, and described reports of negative responses and enacted stigma following disclosure. We conducted interviews with a purposeful sample of 28 adult patients in a rural South African hospital. Data analysis was deductive and inductive and followed the thematic approach. We found evidence of delayed HIV diagnosis and initiation of treatment. There was delayed and selective disclosure as well as concealment of the HIV-positive status. The disclosure was delayed for months or even years. During that time, there was active concealment of the HIV status to avoid stigma from family, friends, and community. When disclosure occurred, there was selective disclosure to close family members who would keep the secret and respond favorably. Although the participants disclosed mostly to close family, some of their post-disclosure experiences included incidents of enacted stigma and discrimination. The fear of perceived stigma and self-stigma influenced the active concealment of their HIV status from others. Continuous concealment of one’s HIV status and delayed disclosure limit the opportunities for support and care. There is a need to take into consideration the interaction between HIV-related stigma and disclosure to develop disclosure-counselling strategies in primary health care settings.

Psychosocial support for HIV serodiscordant couples

“…The findings of this study showed that some participants disclosed their HIV status to a select few confidants, one or two family members due to fear of stigma and discrimination. These findings concur with those of a study conducted in South Africa by Madiba, Ralebona, and Lowane ( 2021 ), who posit that disclosure to family and friends about one’s HIV status is usually deliberate, selective, and often planned, where PLWHIV tend to weigh the risks and benefits associated this planned disclosure. Related to this, study findings by Antonini et al ( 2021 ) emphasise the importance of professional counselling and psycho-social support in assisting couples to cope with HIV-discordance and related disclosure.…”

Viral suppression among pregnant adolescents and women living with HIV in rural KwaZulu-Natal, South Africa: a cross sectional study to assess progress towards UNAIDS indicators and Implications for HIV Epidemic Control

“…Whilst decentralization of services provides easier access to services, new modalities of HIV testing including self -testing [ 24 ] may have not reached saturation in some communities. Furthermore, many individuals in these communities face structural and individual level barriers that decrease access to both information about services and to the services themselves, and may also include fear of stigma and discrimination, all of which pose major obstacles to HIV testing [ 34 – 36 ]. Many individuals may also be unaware of the benefits and services to which they are entitled to and often lack skills required to engage with authorities around services.…”

Why adult patients on antiretroviral therapy miss clinical appointments in rural villages of Limpopo Province, South Africa: An exploratory study

“…It was also noted that participants who reported rejection were those who disclosed their HIV status to their family members (Evangeli & Wroe 2017 ; Madiba, Ralebona & Lowane 2021 ). A study conducted in China about families’ reactions and responses towards HIV among the infected members revealed that most family members were less concerned about the health and feelings of their HIV-positive relatives (Yu et al 2016 ).…”