Experiences of HIV-related stigma in Johannesburg, South Africa: a qualitative study.

Abstract

HIV is recognized as a chronic disease with which, if treated, one can live well. However, research shows that HIV stigma is still present and acts as a barrier to HIV care. While South Africa has of the world’s largest anti-retroviral therapy (ART) programs and a high HIV prevalence, HIV stigma still has a significant impact on treatment adherence. Given such insights, this thesis explores how people living with HIV internalize stigma during the various stages from HIV diagnosis to treatment adherence. This thesis focuses on the following question: How do people with HIV (PWH) internalize HIV stigma during different stages from HIV diagnosis to treatment adherence in the context of Johannesburg, South Africa (SA)? To provide a framework for understanding these experiences, this work adopts a modified version of the HIV stigma framework (Earnshaw et al., 2009). The HIV stigma framework states that it is important to distinguish between different stigma mechanisms because they may have different relationships with health-related outcomes for people living with HIV (PWH; Earnshaw et al., 2009). This study focuses on internalized stigma, and the conceptual model established further guided the deductive thematic content analysis. Pre-existing data was used, and the methodology included 22 semi-structured interviews with PWH in Johannesburg, SA. The findings suggest that PWH internalize HIV stigma in the early stages of HIV testing and diagnosis by developing a negative self-image, which manifests itself in negative emotions, feelings of despair, anger, self-blame, suicidal tendencies, and denial of the HIV diagnosis. In the second stage of starting treatment, PWH experience fear of disclosing. In the third stage of living with HIV and adhering to treatment, internalized stigma is manifested through concealment to avoid stigmatization.