Stigma and disclosure as barriers to regular dental care for people living with HIV/AIDS in Kwazulu-Natal and Western Cape, South Africa

Abstract

Purpose – The purpose of this paper is to determine the oral health care experiences of people living with HIV in Kwazulu-Natal (KZN) and the Western Cape (WC) and also to identify the role of stigma and discrimination in the oral health care experiences for people living with HIV in KZN and the WC. Design/methodology/approach – This study was a survey among HIV-positive people attending selected Community Health Centres and regional hospitals, HIV clinics in KZN and WC provinces in South Africa. The sample consisted of people living with HIV that were 18 years or older and who had given written, informed consent. A cross-sectional study structure has been employed using a standardized format using a semi-structured interview and an administered questionnaire to collect data. The study classified participants as living in metropolitan or non-metropolitan areas. Findings – Apprehension of loss of confidentiality, stigma and discrimination were the barriers that deterred participants from seeking care. Respondents stated that they feared what the dentist and staff would think of them being HIV positive and feared being discriminated against by the dentist and staff. In some instances there appears to be a difference between policy and practice regarding the oral health care needs of and services rendered to people living with HIV in public health facilities as there are still patients who do not obtain care and for whom the attitudes of the health care provider constitutes the major barrier to accessing that care. Research limitations/implications – The results are specific to KZN and WC and have to be extrapolated with caution to the rest of South Africa. Additionally, this study did not have a control group of HIV-negative people which would have enabled one to determine whether certain barriers were unique to people living with HIV. Practical implications – To make recommendations with respect to addressing the issue of stigma and discrimination in the oral health care experiences for people living with HIV in KZN and the WC as there is a definite need for the government to address the resource needs of rural areas and less developed areas of South Africa. Health care is a much-needed resource in these high prevalence areas and governments must ensure that all their HIV/AIDS projects and policies should have a rural component built into them. Social implications – This study emphasizes the importance of embracing people that are being discriminated and marginalized by society such as people living with HIV to ensure that they feel a franchised member of society who can take the initiative to be in control of their own health and, with the necessary aid from public resources and societal support, join forces to reduce the public health burden and its impact on the socio-economic milieu. Originality/value – To the best of the author's knowledge, there is no other study that has compared differences in the use of oral health care services by people with HIV in South Africa and these results serve as an indication of some the important issues in this regard.

Oral health care experiences of people living with HIV in Kwazulu-Natal and Western Cape, South Africa

“…In this study, 347 participants had experienced oral health problemsthis represents 79.8 per cent of the sample and is consistent with the very high prevalence of oral health problems in people living with HIV/AIDS (Turton and Naidoo, 2014;SANAC, 2007). The majority reported that they were treated for the problem.…”

“…These factors are even more pertinent for the people living with HIV who have increased need for dental care (Capilouto et al, 1991). Many studies have reported that people living with HIV have unmet needs for dental care (Shapiro et al, 1999;Patton et al, 2003;Turton and Naidoo, 2014). A study similar to the current study concluded that discrimination of people living with HIV is still prevalent and people living with HIV felt that they were being discriminated against because of their HIV status (Turton and Naidoo, 2014).…”

“…The issues of discrimination, stigmatisation and loss of confidentiality were also raised. These results draw a striking picture of the disparities in service delivery across the provinces (Shisana et al, 2014;Turton and Naidoo, 2014;SANAC, 2007). In KZN, there is a greater need for the wider distribution of services.…”

“…Many studies have documented the dental care experiences of people living with HIV/AIDS (Turton and Naidoo, 2014;Jacobsen et al, 1989;Robinson and Croucher, 1993;Terry et al, 1994). One of the earliest studies by Jacobson et al (1989) investigated the dental care experiences of HIV-infected men in Chicago (Jacobsen et al, 1989).…”

“…Many studies have reported that people living with HIV have unmet needs for dental care (Shapiro et al, 1999;Patton et al, 2003;Turton and Naidoo, 2014). A study similar to the current study concluded that discrimination of people living with HIV is still prevalent and people living with HIV felt that they were being discriminated against because of their HIV status (Turton and Naidoo, 2014). The authors emphasised the importance of embracing people that are being discriminated and marginalised by society such as people living with HIV to ensure that they feel a franchised member of society who can take the initiative to be in control of their own health and, with the necessary aid from public resources and societal support, join forces to reduce the public health burden and its impact on the socio-economic milieu (Turton and Naidoo, 2014).…”