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Does integration lead to reduction in HIV-related stigma?

Summary: Integration can lead to a reduction in HIV-related stigma, but this only happened when confidentiality was protected.

Detail: The cohort data, linked qualitative data with women living with HIV in Kenya and Swaziland and the HIV sub-study in Swaziland were analysed to assess facility related stigma and also client preferences for integrated/ specialised care. The key findings were that:

  • Integrated clinics have the capacity to reduce HIV-related stigma, but this only happened when confidentiality was protected. When integrating services, special attention needs to be made to ensure clients are not ‘labelled’ unintentionally. Stand-alone sites can ensure confidentiality and may offer a source of mutual support unobtainable in an integrated environment.
  • Clients generally prefer getting everything under one roof, but many PLHIV also have preferences to get care in an ‘HIV-only’ environment (Integrating SRH into specialist HIV sites may be beneficial).
  • In the FP cohort, there was no clear association between preferences for integration and level of integrated services attended. HIV clients, however, were more likely to favour separated services if already attending an HIV-only clinic.
  • Preferences for ‘types of care’ are complex, and relate to many dimensions of care; some are impacted positively by integration, but some also positively by stand-alone HIV clinics. Choice of model is important for different types of clients. For example some clients preferred fully integrated services to save time and money. However, a number of women living with HIV preferred sexual and reproductive health services, such as family planning, to be integrated into specialist HIV units because they trusted the providers at these facilities, enjoyed continuity of care from them, had reduced fear of stigma within specialist sites, and benefited from the opportunity to meet other clients living with HIV.

 

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