The association between self-reported stigma and loss-to-follow-up in treatment eligible HIV positive adults in rural Kwazulu-Natal, South Africa

Michael Evangeli, Marie-Louise Newell, Linda Richter, Nuala McGrath PLoS ONE, 2014; DOI: 10.1371/journal.pone.0088235 The association between self-reported stigma and loss-to-follow-up in treatment eligible HIV positive adults in rural Kwazulu-Na

No linear link emerges between non-attendance at scheduled clinic visits and stigma. Data was gathered over a four-year period in an area of high HIV prevalence and anti-retroviral therapy (ART) use. They show that higher rates of loss-to-follow up (LTFU) are independently associated with:

  • lower age
  • male gender
  • not having children
  • social support (greater openness with and less reliance on friends/ family)
  • social capital (belief in community working together to solve problems)

However, there were few correlating patterns among these factors, and the mechanism by which these factors may impact upon LTFU needs to be clarified. 

In terms of stigma, the study offers two possible explanations:

  1. High levels of social exposure to HIV in the area could have reduced the levels of stigma, as well as the effect of stigmas on LTFU.
  2. Alternatively, anticipated stigma related to HIV disclosure in the community may motivate individuals to seek support from HIV professionals and therefore higher rates of stigma are related to lower rates of LTFU. 

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