Slow to share: social capital and its role in public HIV disclosure among public sector ART patients in the Free State province of South Africa

Abstract

HIV serostatus disclosure to community members has been shown to have potential public and personal health benefits. This study examined the impact of bonding and bridging social capital (i.e. close and distant ties) on public disclosure and described the complex relationship between bonding and bridging social capital in the context of serostatus disclosure among AIDS patients enrolled in South Africa's public sector antiretroviral treatment (ART) program. Data were collected from a cohort of patients enrolled in the public sector ART program in the Free State province of South Africa. Semi-structured, face-to-face interviews were conducted with a random sample of 268 patients at three points in time (<6 months of ART, 6–12 months of ART, and 18–24 of months ART). The relationship between bonding and bridging social capital and the impact of different forms of social capital on public disclosure were determined using a fully cross-lagged regression model. The impact of bonding social capital (treatment and emotional buddy) on public disclosure was positive and invariant across time. The results from the cross-lagged regression indicated that bridging social capital (community health worker and support group) only encouraged public disclosure in the second year of treatment. At the start of treatment, bivariate analysis showed a strong negative association between bonding and bridging social capital, which diminished at follow-up and eventually disappeared in the second year of treatment. This study identified bonding social capital as a leverage to maximize potential benefits and minimize potential risks in order to shift the balance toward consistent public disclosure. Furthermore, the importance of bridging social capital initiatives is demonstrated, especially for the most vulnerable patients, those who cannot capitalize their bonding social capital by disclosing their HIV serostatus to family and friends at the start of treatment.

Keywords:

• antiretroviral treatment
• HIV/AIDS
• disclosure
• social capital
• South Africa

Acknowledgements

We sincerely thank the patients in the ART program for their time and energy in sharing their views and experiences. In similar vain, we wish to acknowledge Kobus Meyer, the data manager for collecting, cleaning and providing the data. Sponsorship. This study was funded by the Research Foundation - Flanders, the International Development Research Centre of Canada, the Joint Economics, AIDS and Poverty Programme (with support of the Australian Agency for International Development, the United States Agency for International Development, the Department for International Development, and the United Nations Development Program), and the National Research Foundation of South Africa.

Notes

1. That is, Lejweleputswa, Motheo, Thabo Mofutsanyana, Fezile Dabi and Xhariep. As there were less than 80 eligible patients in Xhariep, a census of all treatment and non-treatment patients was conducted.

2. The list distinguished between those patients who were receiving treatment at baseline (“treatment” cases) and those who were certified as ready to commence treatment but not yet receiving it (“non-treatment” cases).

3. The main reasons for attrition at T2 and T3 included death, refusal to be interviewed and failure to determine the current whereabouts of patients.

4. These variables are used as measures of bonding social capital because descriptive analysis demonstrates that 97.4% of treatment buddies and 98.8% of emotional support buddies are either immediate family or close friends of the respondent.

5. Cross-lagged regression analysis is a statistical method that enables us to examine the interrelationships between multiple variables over time. This method requires, at minimum, two variables measured synchronously at two points in time.

6. If we examine the interaction between PLWHA and their bonding and bridging associates, patients’ responses to a series of open-ended questions allow us to discern three broad categories of support provided by these social capital initiatives: treatment support (stimulating health-enhancing behavior and ART adherence), domestic support (household work and self-care) and emotional and social support (encouragement and empathy). These results confirm previous qualitative studies on the role of lay health workers in the Free State health care (Schneider, Hlope, & Van Rensburg, 2008; Van Rooyen, 2002).