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Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma

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  • Lucia Knight

    (Division of Social & Behavioural Sciences, School of Public Health, University of Cape Town, Rondebosch, Cape Town 7701, South Africa)

  • Enid Schatz

    (Department of Public Health, University of Missouri, Columbia, MO 65211, USA)

Abstract

The number of older people living with HIV (OPLWH) (aged 50-plus) in South Africa is increasing as people age with HIV or are newly infected. OPLWH are potentially vulnerable because of the intersection of age-related and HIV stigmas, co-morbidities, and lack of social support. Evidence from younger populations suggests that social support can improve ART adherence and retention in care. Further, HIV status disclosure plays a role in mediating social support and may reduce stigma by facilitating access to social support. This paper draws on qualitative research with OPLWH to explore the complex associations between disclosure, social support, and HIV stigma among OPLWH in urban Western Cape. The findings demonstrate that OPLWH receive most of their support from their family and this support can facilitate adherence to ART and retention in care. However, social support is facilitated by participants’ disclosure, thus, when perceived stigma limits disclosure, social support is less accessible. Gender, age, and pre-existing vulnerability also affect disclosure to and support from kin and community. Given that social support, particularly from family members, amplifies HIV care access and ART adherence, encouraging disclosure stimulating household HIV competency is likely to both address anticipated stigma and support improved OPLWH’s health outcomes.

Suggested Citation

  • Lucia Knight & Enid Schatz, 2022. "Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma," IJERPH, MDPI, vol. 19(18), pages 1-16, September.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:18:p:11473-:d:912887
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    References listed on IDEAS

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    1. Marianne Bertrand & Sendhil Mullainathan & Douglas Miller, 2003. "Public Policy and Extended Families: Evidence from Pensions in South Africa," The World Bank Economic Review, World Bank, vol. 17(1), pages 27-50, June.
    2. Caroline Masquillier & Edwin Wouters & Dimitri Mortelmans & Brian Van Wyk, 2015. "On the Road to HIV/AIDS Competence in the Household: Building a Health-Enabling Environment for People Living with HIV/AIDS," IJERPH, MDPI, vol. 12(3), pages 1-29, March.
    3. Hosegood, Victoria & Preston-Whyte, Eleanor & Busza, Joanna & Moitse, Sindile & Timaeus, Ian M., 2007. "Revealing the full extent of households' experiences of HIV and AIDS in rural South Africa," Social Science & Medicine, Elsevier, vol. 65(6), pages 1249-1259, September.
    4. Linda Campbell & Caroline Masquillier & Estrelle Thunnissen & Esther Ariyo & Hanani Tabana & Neo Sematlane & Anton Delport & Lorraine Tanyaradzwa Dube & Lucia Knight & Tair Kasztan Flechner & Edwin Wo, 2020. "Social and Structural Determinants of Household Support for ART Adherence in Low- and Middle-Income Countries: A Systematic Review," IJERPH, MDPI, vol. 17(11), pages 1-28, May.
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    1. Mbokazi, Nonzuzo & van Pinxteren, Myrna & Murphy, Katherine & Mair, Frances S. & May, Carl R. & Levitt, Naomi S., 2023. "Ubuntu as a mediator in coping with multimorbidity treatment burden in a disadvantaged rural and urban setting in South Africa," Social Science & Medicine, Elsevier, vol. 334(C).

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