HIV-stigma reduction and responsible disclosure management in a primary health care setting

Abstract

Worldwide human immunodeficiency virus (HIV) related stigma is viewed as a complex concept with far reaching consequences for people living with HIV (PLWH), people living close (PLC) to PLWH, communities in different contexts, as well as health care settings especially the primary health care (PHC) settings like clinics. The mentioned HIV-stigma does not only impact the mentioned groups or contexts but also interferes with the disclosure of HIV status in these various groupings or contexts. PHC clinics which forms the focus of this research is the first point of entry for the health care needs of many South Africans including PLWH. Government has accomplished much in HIV management and care through strategies, guidelines and policies but unfortunately failing to specifically manage HIV-stigma or disclosure practices. Literature confirms the existence of several intervention and program studies for HIV-stigma reduction and disclosure management in different contexts or for various target populations but there are seemingly limited studies focusing on specifically PHC settings, indicating a paucity in research in this regard. This study used a qualitative descriptive design to first explore and describe nurses’ and health care workers’ (HCWs) perceptions of HIV-stigma reduction and disclosure management practices in three PHC clinics in the North West Province of South Africa. These two groups of participants were selected through purposive sampling. This was followed by the development and implementation of a PHC-based HIV-stigma reduction and responsible disclosure management intervention in the same three clinics, followed by the description of the explored experiences of nurses, HCWs, counsellors, PLWH and people living close (PLC) to PLWH involved in the intervention. The counsellors and PLWH were also selected through purposive sampling, while the PLC were selected by using snowball sampling. The intervention was accomplished through a planned series of workshops in specifically PHC clinics and facilitated by the researchers and a PLWH. The findings suggested a dissonance between the nurses’, HCW’s and counsellor’s (also present in the clinics) perceptions of the stigma and disclosure management practices, suggesting a disconnection in their relationship. A system disconnect was also noted that negatively impact on these practices. The dissonance and lack of HIV-stigma and disclosure management practices in the clinics unfortunately impact negatively on PLWH: stigma increases; disclosure decreases; PLWH do not access clinics and default; they have less support and their overall quality of live decreases. Regarding the experiences of nurses, HCWs, counsellors, PLWH and PLC of the PHC-based HIV-stigma reduction and responsible disclosure management intervention, the intervention was seen as successful on several levels. All five groups gained a greater awareness and understanding of stigma as well as experiencing positive effects and empowerment following the intervention. Only two groups, counsellors and PLWH experienced aspects related to counselling. Three of the five groups (nurses, PLWH and PLC) reflected on patient behaviour, assistance to disclose and coping strategies following the intervention. Each group experienced growth but the five groups also had a crossover effect on one another leading to reduction in HIV-stigma and increased disclosure. This study recommends the need for improved stigma reduction and responsible disclosure management practices in PHC settings. Nurses, HCW and counsellors are the mayor role players in these practices and should be the main focus during in-service training. The dissonance should be handled. The focus should be on identified constructive practices. The clinic should ensure that it is a support system for PLWH linking wider networks. Clinics should provide well sustained and organised HIV-stigma reduction and responsible disclosure management programs