Lived experiences of stigma and discrimination among people on antiretroviral therapy: A qualitative study in Ilala municipality, Dar es salaam

Abstract

Background: There is little qualitative research on lived experiences of stigma and discrimination among the growing cohort of people in resource-limited settings who have had their health restored by Antiretroviral Therapy (ART). Broad objective: To explore lived experiences of stigma and discrimination among people on antiretroviral therapy attending care and treatment clinic. Methodology: This study employed a phenomenological approach. It took place at Mnazi mmoja Care and Treatment Clinic in Ilala Distict, Dar es Salaam Region. A total of 26 PLHIV who have been on ART for more than two months, aged 18 years old and above were interviewed. A non probability, purposive sampling method was employed. Data were collected through in-depth interviews. Interviews were audio recorded, transcribed verbatim, translated and analyzed using thematic analysis. Results: The study found that, participants experienced different forms of HIV-related stigma such as verbal stigma, social stigma, and perceived stigma (fear of stigma associated with disclosing HIV status). Furthermore, the participants experienced various forms of discrimination, including: relational discrimination, mistreatment by health care workers, blame and rejection by spouses and workplace discrimination. It was also found that HIV related stigma and discrimination compromised ART adherence by reinforcing concealment of HIV status and undermining social suppport. The main coping mechanisms that emerged from participants’ narrations included: spiritual devotion, becoming secretive; acceptance of the illness; seeking information and/or exchanging views about the illness; and pre-emptive disclosure.

Conclusions: After nearly a decade of scaling up provision of ART in Tanzania, PLHIV still experience various dimensions of stigma and discrimination – albeit to a smaller extent compared to the pre-ART era. Overall, this study has provided useful information for managers of HIV care and treatment services about the dimensions of stigma and discrimination and coping strategies being applied. This understanding will enable planning of supportive interventions.