How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa

2017 ◽  
Vol 26 (4) ◽  
pp. 6-13 ◽  
Author(s):  
Kabelo Maleke ◽  
Joseph Daniels ◽  
Tim Lane ◽  
Helen Struthers ◽  
James McIntyre ◽  
...  
Keyword(s):  
South Africa ◽  
Social Stigma ◽  
Clinical Care ◽  
Traditional Healers ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Care Seeking ◽  
Mpumalanga Province ◽  
Sex With Men ◽  
The Impact

There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.

scholarly journals Pain, Anger, and the Fear of Being Discovered Persist Long after the Disclosure of HIV Serostatus among Adolescents with Perinatal HIV in Rural Communities in South Africa

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 261
Author(s):  
Yvonne Maseko ◽  
Sphiwe Madiba
Keyword(s):  
South Africa ◽  
Rural Communities ◽  
Psychosocial Support ◽  
Emotional Health ◽  
Clinical Care ◽  
Hiv Care ◽  
Emotional Wellbeing ◽  
Perinatal Hiv ◽  
Hiv Serostatus ◽  
The Impact

Informing adolescents of their HIV serostatus forms part of their HIV care and is a critical step in the transition to adult clinical care services. This article describes the experiences of adolescents with perinatal HIV in regard to disclosure, and examines the impact disclosure has on their emotional health and behaviors. We used a qualitative design to conduct interviews with 21 adolescents aged 12–19 years recruited from a rural district in South Africa. NVivo 10 computer software was used for thematic analyses. All adolescents were aware of their HIV-serostatus. The findings show that delayed disclosure, was a one-time event, and was unplanned. Disclosure occurred at the clinic rather than the adolescent’s home. For most adolescents, feelings of anger, pain, sadness, negative perceptions of self, internalized stigma, and denial persisted long after disclosure occurred. They lived in constant fear of having their serostatus being discovered, and they developed a sense of fear of self-disclosure. Their negative emotions undermined treatment adherence. In contrast, other adolescents that described disclosure as a positive event, had accepted their HIV status, and lived similar to other adolescents. The prolonged negative reactions underscore the importance of ongoing post-disclosure interventions for adolescents in rural settings where psychosocial support services are insufficient to address their emotional wellbeing.

scholarly journals Engaging the ‘Missing Men’ in the HIV Treatment Cascade: Creating a Tailored Intervention to Improve Men’s Uptake of HIV Care Services in Rural South Africa: A Study Protocol

2021 ◽  
Vol 18 (7) ◽  
pp. 3709
Author(s):  
Oluwafemi Adeagbo ◽  
Kammila Naidoo
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Treatment Cascade ◽  
Hiv Care Cascade ◽  
Care Services ◽  
The Social ◽  
Hiv Treatment Cascade ◽  
Male Specific

Men, especially young men, have been consistently missing from the HIV care cascade, leading to poor health outcomes in men and ongoing transmission of HIV in young women in South Africa. Although these men may not be missing for the same reasons across the cascade and may need different interventions, early work has shown similar trends in men’s low uptake of HIV care services and suggested that the social costs of testing and accessing care are extremely high for men, particularly in South Africa. Interventions and data collection have hitherto, by and large, focused on men in relation to HIV prevention in women and have not approached the problem through the male lens. Using the participatory method, the overall aim of this study is to improve health outcomes in men and women through formative work to co-create male-specific interventions in an HIV-hyper endemic setting in rural KwaZulu-Natal, South Africa.

Impact of the Ebola epidemic on clinical outcomes of HIV-infected soldiers and their dependents in Sierra Leone

2018 ◽  
Vol 30 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Elizabeth Nagel ◽  
Michael J Blackowicz ◽  
Foday Sahr ◽  
Olamide D Jarrett
Keyword(s):  
Clinical Outcomes ◽  
Sierra Leone ◽  
Repeated Measures ◽  
Disease Outbreaks ◽  
Armed Forces ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Increased Risk ◽  
The Republic ◽  
The Impact

The impact of the 2014–2016 Ebola epidemic in West Africa on human immunodeficiency virus (HIV) treatment in Sierra Leone is unknown, especially for groups with higher HIV prevalence such as the military. Using a retrospective study design, clinical outcomes were evaluated prior to and during the epidemic for 264 HIV-infected soldiers of the Republic of Sierra Leone Armed Forces (RSLAF) and their dependents receiving HIV treatment at the primary RSLAF HIV clinic. Medical records were abstracted for baseline clinical data and clinic attendance. Estimated risk of lost to follow-up (LTFU), default, and number of days without antiretroviral therapy (DWA) were calculated using repeated measures general estimating equations adjusted for age and gender. Due to missing data, 262 patients were included in the final analyses. There was higher risk of LTFU throughout the Ebola epidemic in Sierra Leone compared to the pre-Ebola baseline, with the largest increase in LTFU risk occurring at the peak of the epidemic (relative risk: 3.22, 95% CI: 2.22–4.67). There was an increased risk of default and DWA during the Ebola epidemic for soldiers but not for their dependents. The risk of LTFU, default, and DWA stabilized once the epidemic was largely resolved but remained elevated compared to the pre-Ebola baseline. Our findings demonstrate the negative and potentially lasting impact of the Ebola epidemic on HIV care in Sierra Leone and highlight the need to develop strategies to minimize disruptions in HIV care with future disease outbreaks.

Utility and acceptability of text messages for PMTCT: a qualitative assessment of user experiences (Preprint)

2021 ◽  
Author(s):  
Melinda Brown ◽  
May Maloba ◽  
Catherine Wexler ◽  
Natabhona Mabachi ◽  
Sharon Koech ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Clinical Care ◽  
Text Messages ◽  
Hiv Care ◽  
Qualitative Assessment ◽  
Women Living With Hiv ◽  
Pregnancy And Postpartum ◽  
Living With Hiv ◽  
The Impact

BACKGROUND Evidence that text messages can support patient adherence to HIV care is growing. We conducted a pilot study of the HIV Infant Tracking System (HITSystem 2.0), an intervention that includes SMS to patients to support maternal medication adherence, appointment attendance, and hospital-based deliveries during the antenatal period. OBJECTIVE The objective of this study was to qualitatively assess women’s experiences receiving SMS to understand message utility and acceptability with the goal of refining and strengthening the intervention. METHODS As part of an intervention development pilot study, we conducted semi-structured interviews with 33 women living with HIV who received SMS through the HITSystem 2.0 throughout their pregnancy and postpartum period. Interview questions assessed women’s feedback of the SMS, the impact of the SMS on their PMTCT care, and suggestions for improvement. RESULTS Participants described how SMS reinforced existing strategies for medication adherence and served as cues to action for antenatal appointments and hospital-based deliveries. SMS also provided encouragement and enhanced their sense of engagement with their clinical care team. Given the neutral content of the messages, most women reported no concerns about message confidentiality. Recommendations to enhance utility included greater customizability (timing and frequency of messages) and a few women suggested more comprehensive counseling regarding the SMS content to anticipate at the time of enrollment. CONCLUSIONS SMS content was deemed useful and acceptable by pregnant and postpartum women living with HIV and engaged in PMTCT services. Participant recommendations to increase message customization options have been adopted to enhance the intervention. CLINICALTRIAL Trial registration: clinicaltrials.gov, NCT02726607. Registered 01 April 2016. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02726607

‘What will it take’: addressing alcohol use among people living with HIV in South Africa

2019 ◽  
Vol 30 (11) ◽  
pp. 1049-1054 ◽  
Author(s):  
K Sorsdahl ◽  
NK Morojele ◽  
CD Parry ◽  
CT Kekwaletswe ◽  
N Kitleli ◽  
...  
Keyword(s):  
South Africa ◽  
Alcohol Use ◽  
Brief Intervention ◽  
Hiv Treatment ◽  
Hiv And Aids ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Screening And Brief Intervention ◽  
Treatment Services ◽  
Living With Hiv

Given that hazardous and harmful alcohol use has been identified as a significant barrier to adherence to antiretroviral therapy (ART) in South Africa, alcohol reduction interventions delivered within HIV treatment services are being investigated. Prior to designing and implementing an alcohol-focused screening and brief intervention (SBI), we explored patients’ perceptions of alcohol as a barrier to HIV treatment, the acceptability of providing SBIs for alcohol use within the context of HIV services and identifying potential barriers to patient uptake of this SBI. Four focus groups were conducted with 23 participants recruited from three HIV treatment sites in Tshwane, South Africa. Specific themes that emerged included: (1) barriers to ART adherence, (2) available services to address problematic alcohol use and (3) barriers and facilitators to delivering a brief intervention to address alcohol use within HIV care. Although all participants in the present study unanimously agreed that there was a great need for SBIs to address alcohol use among people living with HIV and AIDS, our study identified several areas that should be considered prior to implementing such a programme.

scholarly journals The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

PLoS ONE ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. e0231872 ◽  
Author(s):  
Melissa A. Stockton ◽  
Michael Udedi ◽  
Kazione Kulisewa ◽  
Mina C. Hosseinipour ◽  
Bradley N. Gaynes ◽  
...  
Keyword(s):  
Mental Health ◽  
Antiretroviral Therapy ◽  
Treatment Program ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Care Outcomes ◽  
The Impact

scholarly journals Challenging the HIV Epidemic in Ontario Through PrEP and HIV Testing

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Steven Winkelman
Keyword(s):  
Hiv Testing ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Annotated Bibliography ◽  
Hiv Care ◽  
Post Exposure Prophylaxis ◽  
Non Profit ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Priority Populations

The Ontario HIV Treatment Network (OHTN) is a non-profit network which collaborates with health clinics, AIDS service and community organizations, and policy leaders in order to improve the health and wellbeing of people living with and at risk of HIV. I joined the OHTN as a member of the Collective Impact team, with a focus on examining the barriers and facilitators to Pre-Exposure Prophylaxis (PrEP) uptake in Ontario. PrEP is a once-daily pill which is highly effective in preventing HIV infections for HIV-negative people, however usage remains relatively low in Ontario. In this role, I liaised with the Knowledge Synthesis team at OHTN to collect, analyse, and synthesize recent scientific literature on Pre and Post-exposure prophylaxis (PEP) in order to create a comprehensive annotated bibliography on PrEP research. Key findings were drawn from the research to identify potential next steps to increase PrEP use for priority populations in Ontario. Findings from the annotated bibliography were presented to OHTN staff, and have been used to assist in the development of two PrEP study proposals; 1) a cisgender and transgender women-focused PrEP education package and HIV risk screening tool, and 2) a pharmacist-led PrEP delivery pilot. I also worked with the Testing and Clinical Initiatives team at the OHTN, to aid in the implementation and evaluation of two HIV-testing projects: the GetaTest pharmacy-based HIV-testing study, and the GetaKit HIV self-testing pilot program. In this role I drafted health communication materials; analysed survey data and drafted project reports for stakeholders; and provided perspectives on the HIV-care continuum, particularly on PrEP initiation, adherence, and efficacy. My work with the OHTN was important to public health because it sought to expand access to HIV testing and prevention services for priority populations in Ontario, including men who have sex with men, and cis and trans women.

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