The impact of increased availability of ART |
Fewer HIV-related deaths reported, HIV has transitioned from a “death sentence” to a chronic disease |
HIV-related stigma declining but still present |
HIV remains highly associated with promiscuity and adultery |
Efforts to control knowledge about a person’s HIV infection |
Avoided disclosure for fear of abandonment or prejudice |
“Counterfeiting,” or citing TB, other illnesses or witchcraft as cause of illness instead of HIV, a common way to avoid disclosure |
Did not take treatment to avoid explaining need for medications to family or people they are living with |
Seeking care is in conflict with keeping HIV status private |
Being seen at the clinic (for any reason) caused suspicion of HIV or gossiping; this significantly delayed HIV testing or engagement in care and was especially problematic for youth and men |
Home based care workers visiting a house could signal to neighbors that someone was HIV positive; false contact information given or care from home based care workers was refused |
Clinic infrastructure such as HIV specific rooms, filing systems, different colored folders and coding systems revealed HIV status to other patients |
There was a severe distrust of health care workers breaking confidentiality, partially fuelled by patients knowing nurses at local health facilities |
Attempts to increase engagement to care and combat stigma met with varying success |
Reduced initiation of treatment or adherence because treatment had to be picked up at clinics. |
Community members spend more money and/or time to go to a private doctor or attend facilities in a different community |
Clinics tried to facilitate support groups or encourage an ART “supporter” for PLHIV—these were met with varying success |
Male dominated spaces (i.e. mine health facilities & truck stop clinics) were more successful in engaging men in care |