Barriers to care among people living with HIV in South Africa: Contrasts between patient and healthcare provider perspectives

Abstract

We collected qualitative data (semi-structured interviews with 11 healthcare providers and 10 patients; 8 focus groups with 41 patients) to identify barriers to linkage to care among people living with HIV in South Africa who were not yet taking antiretroviral treatment. Patients and providers identified HIV stigma as a sizable barrier. Patients felt that stigma-related issues were largely beyond their control, fearing discrimination if they disclosed to employers or were seen visiting clinics in their community. Providers believed that patients should take responsibility for overcoming internal stigma and disclosing serostatus. Patients had considerable concerns about inconvenient clinic hours, long queues, difficulty in appointment scheduling, and disrespect from staff. Providers seemed to minimize the effects of such barriers and not recognize the extent of patient dissatisfaction. Better communication and understanding between patients and providers are needed to facilitate greater patient satisfaction and retention in HIV care.

Keywords:

• linkage to care
• HIV/AIDS
• qualitative methods
• South Africa
• stigma

Acknowledgements

This work was supported in part by the National Institute of Mental Health: R01 MH090326 (Ingrid V. Bassett); R01 MH073445 (Rochelle P. Walensky); the National Institute of Allergy and Infectious Disease; the Harvard University Center for AIDS Research P30 AI060354; the National Institute of Arthritis and Musculoskeletal and Skin Diseases: K24AR057827 (Elena Losina); the National Center for Research Resources (the Harvard Catalyst UL1 RR 025758); the Burke Global Health Fellowship (Ingrid V. Bassett), and the Claflin Distinguished Scholar Award (Ingrid V. Bassett).

We are grateful to the staff and patients of McCord Hospital in Durban, South Africa, as well as to Makhosi Dlalisa, Khanyisile Makhanya, and Matilda Mazibuko for their assistance with data collection and transcription.