Paradox of HIV stigma in an integrated chronic disease care in rural South Africa: Viewpoints of service users and providers

Abstract Background: An integrated chronic disease management (ICDM) model was introduced by the National Department of Health in South Africa to tackle the dual burden of HIV/AIDS and non-communicable diseases. One of the aims of the ICDM model is to reduce HIV-related stigma. There is a dearth of literature on reduction of HIV stigma attributable to the ICDM model. This paper describes the viewpoints of health care users and providers on HIV stigma in an ICDM model in rural South Africa.Methods: A qualitative case study of HIV stigmatisation in the context of the implementation of an ICDM model in seven primary health care (PHC) facilities and their catchment communities was conducted in 2013 in the rural Agincourt sub-district, South Africa. Eight Focus Group Discussions were used to obtain data from 61 purposively selected participants who were 18 years and above. Seven In-Depth Interviews were conducted with the nurses-in-charge of the facilities. The transcripts were thematically analysed using MAXQDA 2018 qualitative software. The emerging themes on HIV stigma and HIV-related concerns were inductively analysed. Results: Both service providers and users perceived implementation of the ICDM model may have led to reduced HIV stigma in the facilities. On the other hand, service users and providers thought HIV stigma increased in the communities because community members thought that home-based carers visited the homes of HIV-infected people. Service users thought that routine HIV testing, intended for pregnant women as stipulated in the World Health Organization guidelines, was associated with unwanted pregnancies among adolescents who wanted to use contraceptives but refused to take a HIV test as a precondition for receiving contraceptives. Caregivers of ill persons wanted full disclosures of the HIV status of their family members to enable them to protect their health and contribute to enhancing adherence to anti-retroviral therapy of HIV-infected family members.Conclusions: Although the ICDM model was perceived to have contributed to reducing HIV stigma in the health facilities, it was associated with stigma in the communities. Remodelling the community component of the ICDM model could contribute to HIV stigma reduction in the study setting and elsewhere in South Africa.

Download Full-text

Quality of integrated chronic disease care in rural South Africa: user and provider perspectives

Health Policy and Planning ◽

10.1093/heapol/czw118 ◽

2016 ◽

pp. czw118 ◽

Cited By ~ 13

Author(s):

Soter Ameh ◽

Kerstin Klipstein-Grobusch ◽

Lucia D’ambruoso ◽

Kathleen Kahn ◽

Stephen M. Tollman ◽

...

Keyword(s):

South Africa ◽

Chronic Disease ◽

Rural South ◽

Chronic Disease Care ◽

Provider Perspectives ◽

Rural South Africa

Download Full-text

Socioeconomic gradients in chronic disease risk behaviors in a population-based study of older adults in rural South Africa

International Journal of Public Health ◽

10.1007/s00038-018-1173-8 ◽

2018 ◽

Vol 64 (1) ◽

pp. 135-145 ◽

Cited By ~ 1

Author(s):

Lindsay C. Kobayashi ◽

Sarah Frank ◽

Carlos Riumallo-Herl ◽

David Canning ◽

Lisa Berkman

Keyword(s):

South Africa ◽

Older Adults ◽

Chronic Disease ◽

Risk Behaviors ◽

Disease Risk ◽

Population Based ◽

Rural South ◽

Population Based Study ◽

Chronic Disease Risk ◽

Rural South Africa

Download Full-text

Leveraging the ART Advantage: diabetes and hypertension along the HIV care cascade in rural South Africa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.137 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S58-S58

Author(s):

Jennifer Manne-Goehler ◽

Mark Siedner ◽

Pascal Geldsetzer ◽

Guy Harling ◽

Livia Montana ◽

...

Keyword(s):

South Africa ◽

Chronic Disease ◽

Regression Models ◽

Self Report ◽

Hiv Care ◽

Linear Regression Models ◽

Rural South ◽

Hiv Care Cascade ◽

Care Cascade ◽

Rural South Africa

Abstract Background Participation in antiretroviral therapy (ART) programs has been associated with greater utilization of care for diabetes and hypertension in rural South Africa. However, there is limited data about whether this apparent “ART advantage” translates into improved chronic disease management indicators. Methods The Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) is a cohort of 5,059 adults >40 in Agincourt. The study collects data on demographics, healthcare utilization, height, weight, blood pressure (BP), and blood glucose. HIV infection, HIV-1 RNA viral load (VL) and ART drug levels are tested via dried blood spots. We defined hypertension (HTN) based on measured BP or self-report of diagnosis by a healthcare provider or use of antihypertensive medication and diabetes (DM) by measured glucose or self-report of diagnosis by a healthcare provider or the use of DM medications. Our primary predictor of interest was stage along the HIV care cascade (HIV-, HIV+ not on ART, ART with a detectable VL, and with a suppressed VL). We compared the proportion in each sub-group who were aware of and treated for their hypertension or diabetes diagnosis, and fit adjusted linear regression models to estimate differences in systolic BP and glucose among those with diagnosed HTN or DM. Results Rates of HTN and DM were higher in HIV- than those with a suppressed VL (HTN: 68.4% v. 46.4%, DM: 12.9% vs.. 8.8%, respectively). However, the suppressed VL group had higher crude rates of awareness of HTN diagnosis and treated HTN as compared with the HIV- group (Aware: 69.9% vs.. 65.2%, p = 0.118; Treated: 50.2% vs.. 46.4%, p = 0.002). There were no significant differences in awareness or treatment rates for DM. In adjusted linear regression models among those with diagnosed HTN or DM, having a suppressed VL was associated with lower mean systolic BP (-5.94mm Hg, 95% CI: -9.68 – -2.20) and lower mean glucose (-3.74 mmol/L, 95% CI: -5.95 – -0.58), compared with being HIV-. This effect was preserved in models restricted to overweight and obese participants. Conclusion The HIV care delivery platform in South Africa appears to offer a vehicle for healthcare delivery for other chronic conditions. Future studies are needed to assess causality of these relationships, and to determine optimal methods of integrating chronic disease with HIV management. Disclosures All authors: No reported disclosures.

Download Full-text