Marseille 2007
Marseille 2007
Abstract book
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Abstract #254  -  Constructing a stigma free environment: provider influence on disclosure and implications for prevention, treatment and mental health among patients enrolled in an ART program in rural South Africa
Session:
  6.13: Posters A (Poster) on Monday   in  Chaired by
Authors:
  Presenting Author:   Mrs Molly Fitzgerald - London School of Hygiene and Tropical Medicine, United Kingdom
 
  Additional Authors:  Dr Victoria Hosegood, Ms Zandile Gumede, Ms Martine Collumbien,  
Aim:
Meeting the treatment and support needs of ART patients hinges on the ability of providers to deliver non-judgemental, confidential services. The positive role that providers may play in reducing stigma has been less well documented. We examined social interactions between providers and patients as key features of the context within which treatment occurs and crucial to the understanding of adherence, mental health, and treatment outcomes for patients.
 
Method / Issue:
Three indigenous practitioners and five health care providers were interviewed about their attitudes and interactions with patients seeking ART. Two in-depth interviews were undertaken with thirty ART initiators enrolling into a hospital based program. The first interview took place at the onset of treatment, the second four months later. The community context to participant experiences was explored in interviews with nine lay people reportedly providing support to the patients.
 
Results / Comments:
Interim and long term challenges for ART scaling up without undermining patient support needs and satisfaction include replicating a relatively non stigmatizing, confidential environment at rural clinic level. This rural site demonstrated that providers exerted considerable social influence; their positive influence was felt beyond the programme participants themselves, extending indirectly to their families. The setting was conducive to disclosure, and this perception directly influenced interactions and outcomes for ART adherence, secondary prevention and mental health.
 
Discussion:
Findings highlight the potential to construct relative stigma free environments even where individual and community based stigma is pervasive.
 
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