Why increasing availability of ART is not enough: a rapid, community-based study on how HIV-related stigma impacts engagement to care in rural South Africa

摘要: Stigma is a known barrier to HIV testing and care. Because access antiretroviral therapy reduces overt illness mortality, some scholars theorized that HIV-related stigma would decrease as treatment availability increased. However, the association between ART accessibility has not been straightforward originally predicted. We conducted “situational analysis”—a rapid, community-based qualitative assessment inform combination prevention program in high prevalence communities. In context of this research, we semi-structured interviews focus groups with 684 individuals four low-resource sub-districts North West Province, South Africa. addition using data programming, examined impact on uptake services. Findings suggested anticipated remains Although participants reported less enacted stigma, or hostility toward people living HIV, they also felt synonymous promiscuity infidelity. Participants described community members taking steps avoid being identified HIV-positive, including avoiding healthcare facilities entirely, traditional healers, paying for private doctors. Such behaviors led delays accessing care, problems adhering medications, especially men youth no other health condition could plausibly account their utilization medical conclude providing alone will end stigma. Instead, remain hesitant seek care long fear doing so lead prejudice discrimination. It critical combat trend by increasing cultural acceptance seropositive, integrating into general primary normalizing youths’