General News

HIV treatment refused because of stigma, hunger and… beauty

Date: Jul 21, 2016

Perceptions of their own health can lead people living with HIV to refuse treatment, a South African study has found.

Over 1,000 people were enrolled in the study, conducted in Gugulethu and Soweto, which mapped their health over a six-month period. The average age of participants was 35 and 57 % were unemployed.

Presenting the results in a session titled "Understanding the underserved" at the International AIDS Conference 2016 in Durban, physician-scientist Dr Ingrid Katz said that 20 % of adults who presented for testing refused treatment.

Almost 40 percent of those refusing treatment – many of whom had TB and high CD4 counts – said they didn’t need medication because they "felt healthy".

A CD4 count is a test that measures the health of the immune system, the body’s natural defence against sickness. For people living with HIV, a low CD4 count can lead to serious illnesses, such as TB, as their immune systems are compromised.

In 2014/2015, there were an estimated 270,000 new TB infections amongst people living with HIV out of a total of 450,000 new TB infections. TB is the leading cause of death for people living with HIV in South Africa.

If a person is HIV positive and has a high CD4 count but doesn’t show symptoms of the HIV, their health could appear to be "normal".

According to Katz, one HIV positive female respondent refused treatment because she said she was "still beautiful and healthy".

"Self assessed health, fatalism (a sense of hopelessness), denial, access to medication and lack of social support were the most common reasons for treatment refusal," said Katz.

The stigma associated with disclosure also topped the list of reasons for refusal, she said.

"A rural area is a small place. People in the study told us that others visiting the clinics and the healthcare providers knew them, and those people also know that if you go through ‘that door’, it is for HIV treatment," she said.

The South African Stigma Index Survey, carried out in 2014, found that 36 % of people living with HIV had experienced "some form of external stigma and discrimination", while 43 % had experienced internal stigma, something the department of health described as "unanticipated" and "high".

Internalised stigma was experienced in the form of guilt (29%), shame (28%) and self-blame (30%).

As for externalised stigma, the National Communication Survey found that almost 90 % of respondents would remain friends with a person who was known to be HIV positive, while 16 % said they would be embarrassed to be seen with a person known to have HIV.

Socio-economic factors also contributed to treatment refusal, said Katz.

A female respondent told researchers that she would not take HIV treatment because she did not have food. "If I had food, I would take this medication," she said.

But others questioned the efficacy of treatment, which led to sustained refusal, she said.

Katz said the results of the study, which has not yet been released, would be used to tailor specific programmes for the marginalised and vulnerable.

South Africa has an estimated 6,3 million people living with HIV, with over 3 million receiving treatment, making it the biggest antiretroviral programme in the world.

With over 50 % of those infected still needing treatment, government, NGOs and civil society groups were involved in a push to "close the gap".

Investing in treatment programmes was necessary, for according to South Africa’s Health Minister Dr Aaron Moetsoaledi, it was important "because of the large number of people who are HIV positive in our country, as well as the evidence that putting people on treatment saves lives and prevents new infections".

--ANA--

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