The effect of HIV-related stigma on retention in care in rural South Africa

Abstract

Retention in HIV-care among people with HIV in rural South Africa is a major problem. Yet retention in care is crucial to HIV-treatment success and better health outcomes. A possible reason for poor retention-in-care outcomes is the presence of HIV-related stigma. This affects people’s motivation to seek care and stay in care. Our understanding of the influence of HIV-related stigma on retention in care is limited. Taking existing quantitative data from the ITREMA-trail in rural Elandsdoorn, this study used logistic regression analyses and mediation, moderation and conditional process analyses (Hayes, 2017) to study the direct and indirect relations between HIV-related stigma and retention in care, operationalized as loss to follow-up. Also, statistical mediation by mental health problems and moderation by different coping styles were studied. The outcomes of analyses showed that there is a significant positive relation between HIV-related stigma and loss to follow-up. This relation is mediated by mental health problems. Furthermore, there was some evidence that the relations between HIV-related stigma and loss to follow-up, and between stigma and mental health problems, are moderated by coping styles. Task-oriented coping and avoidance-oriented coping styles strengthened the (in)direct relation between HIV-related stigma and loss to follow-up. One of the recommendations based on this study is to pay more attention to the mental health of people with HIV to prevent loss to follow-up.