"Being seen" at the clinic: Zambian and South African health worker reflections on the relationship between health facility spatial organisation and items and HIV stigma in 21 health facilities, the HPTN 071 (PopART) study

Virginia Bond; Sinazo Nomsenge; Monde Mwamba; Daniel Ziba; Alice Birch; Constance Mubekapi-Musadaidzwa; Nosivuyile Vanqa; Lario Viljoen; Triantafyllos Pliakas; Helen Ayles; James Hargreaves; Graeme Hoddinott; Anne Stangl; Janet Seeley; HPTN 071 (PopART) study team

doi:10.1016/j.healthplace.2018.11.006

"Being seen" at the clinic: Zambian and South African health worker reflections on the relationship between health facility spatial organisation and items and HIV stigma in 21 health facilities, the HPTN 071 (PopART) study

Health Place. 2019 Jan:55:87-99. doi: 10.1016/j.healthplace.2018.11.006. Epub 2018 Dec 7.

Authors

Affiliations

¹ Zambart, School of Medicine, Ridgeway Campus, University of Zambia, Lusaka, Zambia; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. Electronic address: [email protected].
² Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, K-Floor, Clinical Building, Tygerberg Medical Campus, Francie van Zyl Drive, Tygerberg 7505, South Africa.
³ Zambart, School of Medicine, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
⁴ Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
⁵ Department of Clinical Research, Faculty of Infectious and Tropical Diseases, Keppel Street, London WC1E 7HT, UK.
⁶ International Center for Research on Women, Washington. D.C., USA.
⁷ Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
⁸ Zambart, School of Medicine, Ridgeway Campus, University of Zambia, Lusaka, Zambia; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, K-Floor, Clinical Building, Tygerberg Medical Campus, Francie van Zyl Drive, Tygerberg 7505, South Africa; Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, Keppel Street, London WC1E 7HT, UK; International Center for Research on Women, Washington. D.C., USA.

Abstract

Health workers in 21 government health facilities in Zambia and South Africa linked spatial organisation of HIV services and material items signifying HIV-status (for example, coloured client cards) to the risk of People Living with HIV (PLHIV) 'being seen' or identified by others. Demarcated HIV services, distinctive client flow and associated-items were considered especially distinguishing. Strategies to circumvent any resulting stigma mostly involved PLHIV avoiding and/or reducing contact with services and health workers reducing visibility of PLHIV through alterations to structures, items and systems. HIV spatial organisation and item adjustments, enacting PLHIV-friendly policies and wider stigma reduction initiatives could combined reduce risks of identification and enhance the privacy of health facility space and diminish stigma.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Ambulatory Care Facilities*
Anti-Retroviral Agents / therapeutic use
Community Health Workers*
Confidentiality
Female
HIV Infections / drug therapy
HIV Infections / psychology*
Humans
Male
Privacy / psychology*
Qualitative Research
Social Stigma*
South Africa
Zambia

Substances

Anti-Retroviral Agents