The Convergence of Disclosure Concerns and Poverty Contributes to Loss to HIV Care in India: A Qualitative Study

Perlo, Jared; Colocci, Isabella; Rajagopal, Sai Shanthanand; Betancourt, Theresa S.; Pradeep, Amrose; Mayer, Kenneth H.; Kumarasamy, Nagalingeswaran; O’Cleirigh, Conall; Chan, Betty

doi:10.1177/2325958220934606

Cited by 5 publications

(5 citation statements)

References 25 publications

(25 reference statements)

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“…Likewise, a previously reported study in India ascertained that patients tended to postpone engaging in medical care until their CD4 counts became lower owing to economic limitations. 42 Apart from poverty, fear of adverse effects of ART would also potentially contribute to the non-initiation of ART among PLHIV. This study revealed that the anticipation of drug side effects could discouraged the participants from initiating antiretroviral therapy early.…”

Section: Discussionmentioning

confidence: 99%

Experiences of Antiretroviral Therapy Initiation Among HIV-Positive Adults in Ethiopia: A Descriptive Phenomenological Design

Tefera¹,

Mavhandu-Mudzusi²

2022

HIV

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Purpose The aim of the study was to explore and describe the lived experiences of HIV-positive adults on antiretroviral therapy (ART) initiation in West Shoa Zone, Ethiopia. Materials and Methods A descriptive phenomenological design was utilized in the study to gain insight into participants’ lived experiences regarding ART initiation in West Shoa Zone, Ethiopia. Data were collected through semi-structured in-depth interviews and analyzed by means of thematic analysis. Results The study found that spousal influence, denial of status, inconsistent ART initiation protocol, poverty, fear of side effects, religion and shortages of staff were factors that caused delayed ART initiation. A low CD4 count, the development of opportunistic infections and the prevention of future illness were factors that promoted ART initiation. Conclusion This study provides an overview of experiences of adults living with HIV regarding ART initiation. The study emphasizes the need to improve adequate provision of resources to address issues related to finance, human capital, guidelines and inequity to enhance early ART initiation among HIV-positive adults in West Shoa Zone. The study findings have implications for policy implementation, ART service delivery, and the enhancement of prompt ART initiation in the study settings.

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Section: Discussionmentioning

confidence: 99%

Experiences of Antiretroviral Therapy Initiation Among HIV-Positive Adults in Ethiopia: A Descriptive Phenomenological Design

Tefera¹,

Mavhandu-Mudzusi²

2022

HIV

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“…Indeed, spousal HIV status was the strongest predictor of HIV positivity in the women studied, followed by poverty which is well established by health disparities research. 23 Observed age trends indicate that HIV transmission may occur soon after marriage, reinforcing the need for HIV prevention interventions immediately after marriage. In particular, increased access to broad-based couples-based HIV counseling and testing (HCT) pre- and post-marriage is an important first step.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of human immunodeficiency virus infection among spouses of married men who have sex with men in India

et al. 2022

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Background Men who have sex with men (MSM) in low-to-middle-income countries bear a high burden of HIV and a significant proportion marry women to satisfy socio-cultural norms. It has previously been demonstrated that HIV prevalence is higher among married versus unmarried MSM, but limited data are available on HIV prevalence among their wives. Methods We recruited 149 married MSM couples where the husband disclosed his MSM behavior to his wife (disclosed MSM) and 150 married MSM who had not disclosed their MSM behavior to their wives (undisclosed MSM), in three Indian cities. All participants completed interviewer-administered surveys and underwent HIV testing. Multivariable logistic regression was used to assess correlates of HIV among wives of MSM. Descriptive statistics were used to compare characteristics of disclosed and undisclosed MSM. Results HIV prevalence in disclosed MSM, their wives, and undisclosed MSM was 46.9%, 27.9%, and 34.9%, respectively. In multivariable analysis, the strongest predictor of HIV prevalence among wives of MSM was husband’s HIV positive status (adjusted odds ratio: 13.4; 95% confidence interval: 5.44–33.2). Both disclosed and undisclosed MSM reported high levels of risk behavior including infrequent condom use. Most undisclosed MSM reported that they did not intend to disclose MSM behavior due to stigma. Conclusions We observed an extremely high HIV prevalence among women married to MSM despite low levels of individual risk behavior. Interventions are urgently needed in this vulnerable population particularly given the challenges related to disclosure of same sex behavior among their husbands.

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“…In our study, participants preferred private facilities to public facilities because of unconsented disclosure which was also highlighted earlier that participants chose to receive care from private facilities than public facilities because of concerns over sero-status disclosure and added that care provided at public hospitals was inferior to care at private facilities. 31 People living with HIV are willing to spend money to receive treatment in a more confidential setting instead of utilizing the free care at the public health facilities to avert unintended disclosure. 31 This implies that Reinforcing confidentiality policy and human rights sensitization in these hospitals will help to minimize unintended disclosure thereby reducing HIV-related stigma.…”

Section: Discussionmentioning

confidence: 99%

“… 31 People living with HIV are willing to spend money to receive treatment in a more confidential setting instead of utilizing the free care at the public health facilities to avert unintended disclosure. 31 This implies that Reinforcing confidentiality policy and human rights sensitization in these hospitals will help to minimize unintended disclosure thereby reducing HIV-related stigma.…”

Section: Discussionmentioning

confidence: 99%

“Men Are Scared That Others Will Know and Will Discriminate Against Them So They Would Rather Not Start Treatment.” Perceptions of Heterosexual Men on HIV-Related Stigma in HIV Services in Blantyre, Malawi

Kazuma-Matululu

Nyondo-Mipando

2021

J Int Assoc Provid AIDS Care

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Background: Although the concept of treatment as prevention has generated optimism that an AIDS-free generation is within reach, the success of this approach centers upon early diagnosis and linkages to care for people living with HIV. Unfortunately, people continue to present for HIV care at late stages of disease and HIV-related stigma has been recognized as the major impediment to HIV prevention and treatment efforts. Given the relevance of addressing stigma to improve access and utilization of HIV services among men, this secondary analysis assessed perceptions of heterosexual men in HIV-related stigma on HIV testing and ART services in Blantyre District. Methods: Purposive sampling was done with maximum variation which included men with unknown statuses, newly diagnosed with HIV infection and not yet on ARVs and those with HIV infection on ART. These participants were varied according to age and area of residency and included men from urban, semi urban and rural areas. Health care workers were included depending in the participation in the provision of HIV services. Eighteen (18 IDIs) and sixteen (16) KIIs were done at private facilities and a total of twenty (20) IDS and seventeen (17) KIIs interviews were conducted at public facilities and fourteen (14) FGD were conducted at public facilities as well. The data were collected from January to July 2017 and March to September 2018. Results: Men perceived that there are barriers and enablers that influence men from accessing HIV testing and ART services. These factors include individuals, family, community and workplace. The surroundings can be a person, community and a family and it plays an integral part in ones’ decision to get tested or initiate on ART. At all these levels, men would navigate the options of accessing the services while risking stigma and discrimination. Conclusion: HIV-related stigma exists and impedes access to HIV testing and ART services in men. Men preferred private hospitals to public facilities because of their ability to maintain respect to privacy and confidentiality to their client's. Imitating these policies into the public hospitals can help to improve the perception of HIV-related stigma in heterosexual men.

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The Convergence of Disclosure Concerns and Poverty Contributes to Loss to HIV Care in India: A Qualitative Study

Cited by 5 publications

References 25 publications

Experiences of Antiretroviral Therapy Initiation Among HIV-Positive Adults in Ethiopia: A Descriptive Phenomenological Design

Experiences of Antiretroviral Therapy Initiation Among HIV-Positive Adults in Ethiopia: A Descriptive Phenomenological Design

Prevalence and correlates of human immunodeficiency virus infection among spouses of married men who have sex with men in India

“Men Are Scared That Others Will Know and Will Discriminate Against Them So They Would Rather Not Start Treatment.” Perceptions of Heterosexual Men on HIV-Related Stigma in HIV Services in Blantyre, Malawi

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