Abstract
Adolescents and men are two populations that perform poorly within the HIV cascade of care, having worse AIDS-related health outcomes, and experiencing higher levels of HIV-related stigma. This paper explores institutional health system discrimination as experienced by adolescent boys with perinatally-acquired HIV, situating them within the social and gendered contexts of the Eastern Cape Province, South Africa. Life history narratives (n = 36) and in-depth semi-structured interviews (n = 32) with adolescent boys living with HIV aged 13–22 were conducted in 2017-2018. In-depth semi-structured interviews with biomedical and traditional health practitioners (n = 14), analysis of health facility files (n = 41) and clinic observations were also conducted. Together, triangulated sources point to an incongruence between the complex needs of adoelscent boys and young men living with HIV and their experiences within the health system. Two institutional discrimination-related deterrents to retention in care were identified: (1) lack of confidentiality due to health facility layouts and practices that visibilised people living with HIV; and (2) mistreatment in the form of shouting. This article contributes to the limited literature on the experiences of young men within the HIV continuum of care, focusing on how stigma influences how young men experience and engage with the health sector.
Acknowledgements
First and foremost, thanks go to the research participants for sharing their perspectives and experiences that formed the basis of this research. Evidence was gathered within the auspices of a large longitudinal study on medicine-taking in the Eastern Cape, the Mzantsi Wakho study. We are grateful to co-principal investigators Lucie Cluver and Elona Toska, study collaborators at the Universities of Cape Town and Oxford, and the researchers who supported data collection and analysis, Thank you to Christopher Colvin for supervising the doctoral thesis on which this paper builds.
Disclosure statement
No potential conflict of interest was reported by the author(s).