Community Perceptions of HIV Stigma, Discriminatory Attitudes, and Disclosure Concerns: A Health Facility-Based Study in Selected Health Districts of South Africa

A mixed methods process evaluation: understanding the implementation and delivery of HIV prevention services integrated within sexual reproductive health (SRH) with or without peer support amongst adolescents and young adults in rural KwaZulu-Natal, South Africa

BACKGROUND

Combination prevention interventions, when integrated with community-based support, have been shown to be particularly beneficial to adolescent and young peoples' sexual and reproductive health. Between 2020 and 2022, the Africa Health Research Institute in rural South Africa conducted a 2 × 2 randomised factorial trial among young people aged 16-29 years old (Isisekelo Sempilo) to evaluate whether integrated HIV and sexual and reproductive health (HIV/SRH) with or without peer support will optimise delivery of HIV prevention and care. Using mixed methods, we conducted a process evaluation to provide insights to and describe the implementation of a community-based peer-led HIV care and prevention intervention targeting adolescents and young people.

METHODS

The process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed.

RESULTS

The intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people's sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people.

CONCLUSION

The results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them.

Ubuntu Is a Critical Component in the Fight against Human Immunodeficiency Virus and Tuberculosis Stigma: Nursing Students' Perceptions

Stigma is one of the documented barriers to achieving universal access to human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment, care, and support programs. The lack of African social theories to emphasize these issues may be the cause of the continent's failure to reduce stigma. We can use Ubuntu, an African philosophy that emphasizes sociability and ethics, to deepen our understanding of how to reduce HIV- and TB-related stigma in South Africa. In many African regions, Ubuntu values and principles were found to assist in reducing problems related to HIV. Ubuntu is a comprehensive phrase used by Africans to signify the characteristics that incorporate the core human virtues of compassion and humanity. We explored the perceptions of nursing students regarding the use of Ubuntu in the fight against HIV and TB stigma. Qualitative participatory research was used to engage all first- and second-level nursing students enrolled for the 2023 academic year at the selected university in South Africa. Purposive sampling was used to recruit the participants. An interactive workshop was used to gather data. The data from the recordings and flip charts were analysed together. Throughout the study, trustworthiness and ethical principles were upheld. Two primary themes emerged as expressions of Ubuntu in relation to a reduction in HIV and TB stigma and recognition of Ubuntu as a tool to combat stigma associated with HIV and TB. This confirms that within Ubuntu, there are elements that might be applied to reduce stigma attached to HIV and TB.

Qualitative Study on the Voices of Adolescents Living with Perinatally Acquired HIV in Selected Clinics in the Limpopo Province of South Africa

The disclosure of HIV status among adolescents living with perinatally acquired HIV (APHIV) has become one of the core challenges in the management of APHIV. Disclosure is a challenge that undermines positive advances and achievements in HIV management. There is limited literature on the voices of APHIV on disclosure of their status. This study aims to explore the current disclosure process and how it affects APHIV. A qualitative exploratory design was employed to conduct one-on-one in-depth interviews using a semi-structured interview guide. Purposive sampling was used to sample 21 APHIV in 16 selected health facilities in the Vhembe district of Limpopo Province, South Africa. Data were analyzed using Tesch's qualitative data method. The findings of this study reflect the gaps in the current disclosure process and guidelines while acknowledging the importance of disclosure to APHIV. A notable finding in this study is that most APHIV, especially those in early adolescence, did not want to know their HIV status due to the stigma attached to an HIV-positive diagnosis. This study suggests that proper training and support of parents and/or guardians in the disclosure process are needed, as they are the primary caregivers of APHIV. The disclosure of HIV status must be a comprehensive part of the management and care of HIV for APHIV. Furthermore, dedicated support programs should be developed and implemented to improve their lives post-disclosure.

The mediating effect of psychological resilience between social support and anxiety/depression in people living with HIV/AIDS-a study from China

Objective To understand the relationship between psychological resilience in social support and anxiety/depression in people living with HIV/AIDS and to verify whether there is a mediating effect. Methods The questionnaire was administered to 161 people living with HIV/AIDS in a hospital. The questionnaire contained a general questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Psychological Resilience Inventory (CD-RICS), and the Social Collaborative Support Scale (PSSS), and Pearson correlation analyses were used to explore the correlation between the factors and anxiety/depression, stratified linear regression analyses were used to validate the mediation model, and the bootstrap method was used to test for mediating effects. Results Anxiety was negatively correlated with psychological resilience and social support (r=-0.232, P < 0.01; r=-0.293, P < 0.01); depression was negatively correlated with psychological resilience and social support (r=-0.382, P < 0.01; r=-0.482, P < 0.01); there was a mediation effect model of social support between psychological resilience and anxiety/depression; psychological resilience played a fully mediating role in social support and anxiety/depression, with an effect contribution of 68.42%/59.34% and a 95% CI(-0.256~-0.036)/(-0.341 to~-0.106). Conclusion Psychological resilience plays a complete mediating effect between social support and anxiety/depression. It is recommended that more channels of social support be provided to patients with HIV/AIDS, thereby enhancing their psychological resilience and reducing anxiety/depression levels.

Predictors of HIV status disclosure among people living with HIV (PLHIV) in Ghana: the disclosure conundrum and its policy implications in resource limited settings

BACKGROUND

Globally, over 40 million lives have been claimed by HIV/AIDS. In Ghana, more than 350,000 people are living with HIV. Non-disclosure of HIV status is a major barrier to HIV/AIDS eradication; yet, little is known of the determinants of HIV status disclosure in resource limited settings in Africa like Ghana.

OBJECTIVE

Determine the predictors of HIV status disclosure among people living with HIV (PLHIV) and stimulate policy discourse on support systems for self-disclosure in Africa.

METHODS

This is a descriptive cross-sectional study among PLHIV (n = 181) in sub-Saharan Africa, specifically the Volta region of Ghana. Bivariate probit regression was run to determine factors associated with HIV status disclosure among PLHIV.

RESULTS

HIV status self-disclosure was reported by 50% of the respondents; nearly 65% disclosed their status to non-family members and non-partners. Significant correlates of HIV status disclosure either to partners or non-partners were marital status, monthly income, type of occupation, and being divorced due to HIV status (p < 0.05).

CONCLUSIONS

HIV status disclosure remains low in Ghana like many African countries. There is the need for a renewed policy debate on tailored guidelines for HIV status self-disclosure and targeted support systems for PLHIV to ameliorate their predicaments and promote eradication of the epidemic in Africa.

Structural, Familial, and Psychosocial Factors Affecting Long-Term Antiretroviral Treatment Adherence amongst Adolescents Living with Perinatally Acquired HIV in Limpopo, South Africa

After more than two decades of the expansion of antiretroviral treatment (ART) in adolescents living with perinatal HIV (APHIV) in sub-Saharan Africa, there is still poorly sustained long-term adherence to ART due to multifactorial factors with the consequence of increased mortality and morbidity. There are little data available on the familial and structural factors which affect sustenance to long-term adherence to ART. A qualitative exploratory design was used to conduct in-depth interviews with 21 APHIV attending HIV care and management in the rural health facilities of Vhembe district in Limpopo Province, South Africa. Transcripts were translated verbatim into English, and data were analyzed using Tesch's eight steps of qualitative data analysis. The sample consisted of APHIV 10-19 years old who were aware of their HIV status, and all had received ART for more than 5 years. They lived in extended, disrupted, grandparent- and child-headed households. They experienced food insecurities due to poverty or orphanhood, as well as living in disrupted households, which deterred them from long-term adherence. In addition, dependency on social support grants to sustain their livelihoods affected long-term adherence. APHIV had challenges with structural factors such as inconsistent clinic attendance, clashes between school activities and clinic appointments, and the lack of transport fare to the clinic, which affected adherence. Although APHIV were on one-pill fixed-dose ART, they were not able to sustain long-term adherence due to various familial, structural, and psychosocial challenges. In addition to institution-based interventions, there is a need for family, community-based, and multi-sectorial interventions to support long-term ART adherence among APHIV.