Perception of stigma experienced by people living with HIV at a health facility in Khayelitsha sub-district, Cape Town

Abstract

HIV stigma is still affecting People Living with HIV (PLHIV) despite biomedical and structural interventions to reduce this phenomenon. Stigma, particularly health facility related stigma, experienced by PLHIV is reported to fuel poor access to services. As a result, considerable interventions to reduce the stigma among PLHIV have been proposed. However, poor HIV indicators are still reported. Little is reported about PLHIV’s lived experiences of stigma, especially at health facilities, which might be the contributor to poor health outcomes. Hence, this study sought to explore and describe the stigma experienced by PLHIV at a health facility in Khayelitsha Sub-District, Cape Town, South Africa. A qualitative approach, using an exploratory design was followed. Participants were purposively selected, and unstructured interviews were conducted. In total, 15 participants were anticipated to be interviewed. However, saturation occurred after 12 participants were interviewed, but the researcher went further to interview 14 participants. Audiotaped interviews were transcribed verbatim by the researcher (those in English) and assistant researchers (isiXhosa and Afrikaans). Data were then organised and entered into ATLAS.Ti version 8, a Computer Assisted Qualitative Data Analysis Software (CAQDAS) used for analysis of large sets of data. An independent coder was given raw data, and the two outcomes were discussed to reach a consensus on generated themes. The supervisor reviewed the analysed data. Rigour was ensured through the criteria of credibility, dependability, transferability and conformability. The ethical clearance for this study was obtained from the Biomedical Research Ethics Committee (BMREC) at the University of the Western Cape and the City of Cape Town. Six themes emerged from the data because of participants’ experience of stigma at the facility. These include: existence of stigma triggers, participants’ experience of stigma at the clinic, direct stigmatising behaviour, and PLHIV’s characterisation of stigma types, PLHIV’s directed health outcomes, and activism as a secondary health outcome. The results of the study revealed that stigma was perpetuated in the health facility in numerous forms. These were: physical demarcation of the facility, negative behaviour of nurses towards People living with HIV and incompetence of the nurses. This gave rise to recommendations in nursing practice, to policymakers and a need for further research on the topic.