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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Are integrated HIV services less stigmatizing than stand-alone models of care? A comparative case study from Swaziland
Journal of the International AIDS Society, Volume 16, Article 17981, Year 2013
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Description
Introduction: Integrating HIV with primary health services has the potential to reduce HIV-related stigma through delivering care in settings disassociated with HIV. This study investigated the relationship between integrated care and felt stigma. The study design was a comparative case study of four models of HIV care in Swaziland, ranging from fully integrated to fully stand-alone HIV care. Methods: An exit survey (N=602) measured differences in felt stigma across model of care; the primary outcome "perception of HIV status exposure through clinic attendance" was analyzed using multivariable logistic regression. In-depth interviews (N = 22) explored whether and how measured differences in stigma experiences were related to service integration. Results: There were significant differences in perceived status exposure across models of care. After adjustment for potential confounding between sites, those at a partially integrated site and a partially stand-alone site had greater odds of perceived status exposure than those at the fully stand-alone site (aOR 3.33, 95% CI 1.98-5.60; and aOR 11.84, 95% CI 6.89-20.36, respectively). There was no difference between the fully stand-alone and the fully integrated clinic. Qualitative data suggested that many clients at HIV-only sites felt greater confidentiality knowing that those around them were positive, and support was gained from other HIV care clients. Confidentiality was maintained in various ways, even in stand-alone sites, through separate waiting areas for HIV testing and HIV treatment, and careful clinic and room labelling. Conclusions: The relationship between model of care and stigma was complex, and the hypothesis that stigma is higher at standalone sites did not hold true in this high prevalence setting. Policy-makers should ensure that service integration does not increase stigma, in particular within partially integrated models of care. © 2013 Church K et al; licensee International AIDS Society.
Authors & Co-Authors
Church, Kathryn
Unknown Affiliation
Wringe, Alison
Unknown Affiliation
Fakudze, Phelele
Unknown Affiliation
Kikuvi, Joshua
Unknown Affiliation
Simelane, Dudu
Unknown Affiliation
Mayhew, Susannah Harding
Unknown Affiliation
Cleland, John G.F.
Unknown Affiliation
Askew, Ian D.
Unknown Affiliation
Warren, Charlotte E.
Unknown Affiliation
Du-Preez, Natalie Friend
Unknown Affiliation
Colombini, Manuela
Unknown Affiliation
Guise, Andy
Unknown Affiliation
Green, Judy
Unknown Affiliation
Sloggett, Andy
Unknown Affiliation
Statistics
Citations: 37
Authors: 14
Affiliations: 3
Identifiers
Doi:
10.7448/IAS.16.1.17981
e-ISSN:
17582652
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Case Study
Study Approach
Qualitative
Quantitative
Study Locations
Eswatini