“I don’t want them to know”: how stigma creates dilemmas for engagement with Treat-all HIV care for people living with HIV in Eswatini

“Treat-all” programmes aim to improve clinical outcomes and to reduce HIV transmission through regular HIV testing and immediate offer of antiretroviral therapy (ART) for those diagnosed HIV-positive, irrespective of immunological status and symptoms of disease. Global narratives on the benefits of Treat-all anticipate reduced HIV-related stigma and increased “normalisation” of HIV with Treat-all implementation, whereby HIV is remoulded as a manageable, chronic condition where stigmatising symptoms can be concealed. Drawing on Goffman’s stigma work, we aimed to investigate how stigma may influence the engagement of clinically asymptomatic people living with HIV (PLHIV) with Treat-all HIV care in Shiselweni, Eswatini (formerly Swaziland). This longitudinal research comprised 106 interviews conducted from August 2016 to September 2017, including repeated interviews with 30 PLHIV, and one-off interviews with 20 healthcare workers. Data were analysed thematically using NVivo 11, drawing upon principles of grounded theory to generate findings inductively from participants’ accounts.

Stigma was pervasive within the narratives of PLHIV, framing their engagement with treatment and care. Many asymptomatic PLHIV were motivated to initiate ART in order to maintain a “discreditable” status, by preventing the development of visible and exposing symptoms. However, engagement with treatment and care services could itself be exposing. PLHIV described the ways in which these “invisibilising” benefits and exposing risks of ART were continually assessed and navigated over time. Where the risk of exposure was deemed too great, this could lead to intermittent treatment-taking, and disengagement from care. Addressing HIV related stigma is crucial to the success of Treat-all, and should thus be a core component of HIV responses.     

Inconsistent Counselor Fidelity in Delivering an Evidence-Based Adherence Intervention During a PrEP Trial

AIDS and Behavior - Evidence-based adherence counseling interventions must be delivered with fidelity to ensure that their effectiveness is retained, but little is known regarding how counselors in...     

Enhancing Coordination for Effective Management of Oil Spill Pollution in South Africa

Although multi-sectoral coordination in disaster risk management has been progressing in South Africa for over two decades,there has been limited commitment to an integrated regime in managing marine oil spill incidents.Poor incident management persists despite the availability of data,protocols,legislation,and resources housed in different government and private sector entities.This study identified practices that enhance a coordination process for the effective management of oil spill pollution.A grounded theory approach is applied to the coordination issue,which is characterized by an interactive process of simultaneously considering theoretical grounding during our empirical research.Empirical evidence includes observations of 47meetings and three oil spill exercises with 79 delegates from 32 different organizations,which supports the coordination process of instituting a national Incident Management System for marine oil spills in South Africa.An additional 44 individual open-ended questionnaires supplement this earlier body of evidence for data triangulation and validation.Analysis of development of the Incident Management System process revealed that,when designing a novel long-term project that is reliant on a shared vision from multiple organizations,enhanced coordination and collaboration for successful implementation is dependent on the following practices:(1)obtaining political commitment,(2)bridging knowledge gaps,and(3)sharing resources.     

Acceptability of Interventions to Improve Engagement in HIV Care Among Pregnant and Postpartum Women at Two Urban Clinics in South Africa

Maternal and Child Health Journal - Pregnant women initiating antiretroviral therapy (ART) in sub-Saharan Africa have been shown to have sub-optimal engagement in care, particularly after delivery,...     

How nurses' experiences of domestic violence influence service provision: study conducted in North-west province, South Africa

This study was undertaken to determine whether nurses' experiences of domestic violence (DV) influence their management of DV and rape cases. In total, 212 nurses were interviewed in two South African health districts using a standardized questionnaire. We measured sociodemographic characteristics, quality of care in the areas of rape and DV management, and experiences of DV in their own lives and amongst family and friends. A total of 39% nurses reported having experienced either physical or emotional abuse themselves and 40.6% amongst family and friends. Having personally experienced DV had no influence on DV identification and management. Those with experience from friends and family were more likely to have provided better care for patients who presented after DV (mean quality of care score = 23.1), while nurses who reported no personal experience of DV, either in their own lives or among family and friends, had a lower quality of care score of 19.8 (P = 0.02). Having ever intervened in a domestic dispute was associated with higher quality of care (P < 0.001). This suggests that the greater degree to which nurses identify with DV and intervene, the more likely they are to provide higher quality of care. Training of nurses in DV must try to build such empathy.     

Unmasking a silent killer: Prevalence of diagnosed and undiagnosed diabetes mellitus among people living with HIV in rural South Africa

Objectives

To document the prevalence of impaired glucose tolerance (IGT) and undiagnosed diabetes mellitus (DM) and to identify factors associated with undiagnosed DM in people living with HIV (PLWH).

Methods

Cross-sectional study performed at Ndlovu Medical Center, Limpopo, South Africa including PLWH aged ≥18 years. Between August and November 2017, 356 HIV-positive participants were included. Information was collected on socio-demographics, DM symptoms and risk factors for DM. IGT and DM were diagnosed using random plasma glucose and/or HbA1c. Factors associated with undiagnosed DM were assessed by comparing participants with newly diagnosed DM to participants without DM.

Results

IGT was diagnosed in 172 (48.3%) participants. Twenty-nine (8.1%) participants met the definition of DM, of whom 17 (58.6%) were newly diagnosed. Compared to participants without DM, participants with DM were on average 5 years older, were more likely to have a positive family history for DM, were less physically active and had higher systolic blood pressure, body mass index and waist circumference. Factors associated with undiagnosed DM included age ≥45 years (odds ratio [OR] = 3.59) and physical inactivity (OR = 3.17).

Conclusions

The prevalence of IGT and DM among PLWH is high and more than half of DM cases were undiagnosed. Regular screening for DM in PLWH is recommended, especially in an ageing population with additional cardiovascular disease risk factors.