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

"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  1 , Sinazo Nomsenge  2 , Monde Mwamba  3 , Daniel Ziba  3 , Alice Birch  3 , Constance Mubekapi-Musadaidzwa  2 , Nosivuyile Vanqa  2 , Lario Viljoen  2 , Triantafyllos Pliakas  4 , Helen Ayles  5 , James Hargreaves  4 , Graeme Hoddinott  2 , Anne Stangl  6 , Janet Seeley  7 ; HPTN 071 (PopART) study team  8
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"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 et al. Health Place. 2019 Jan.

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.

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Figures

Fig. 1
Fig. 1
Sequence and Detail of Research Methods and Tools. *Note: In South Africa, two health workers participated in both the mapping and the HIV stigma experience discussion. In Zambia, 13 health workers participated in both discussions.
Fig. 2
Fig. 2
SA Map: Participants assessment of comfort, discomfort, being talked badly about and location of HIV testing. Key:- Blue: Comfortable, Purple: Mixed outcome – comfortable and uncomfortable, Yellow: Location of HIV Testing, ART/ARV: Antiretroviral (department), MCH: Mother & Child Department, OPD: Out-Patient Department.
Fig. 3
Fig. 3
Zambia Map: Participants assessment of comfort, discomfort, being talked badly about and location of HIV testing. Key:- Blue: Comfortable, Green: Uncomfortable, Purple: Mixed outcome – comfortable and uncomfortable, Red: People Spoken about Badly, Yellow: Location of HIV Testing, ART/ARV: Antiretroviral (department), MCH: Mother & Child Department, OPD: Out-Patient Department.
Fig. 4
Fig. 4
HIV client flow chart in South African clinics.
Fig. 5
Fig. 5
HIV client flow chart in Zambian clinics.
See this image and copyright information in PMC

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