‘Remember there is that thing called confidentiality’ : experiences of institutional discrimination in the health system among adolescent boys and young men living with HIV in the Eastern Cape province of South Africa

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Authors

Gittings, Lesley
Hodes, Rebecca
Kom, Phakamani
Mbula, Sinebhongo
Pantelic, Marija

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Journal ISSN

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Publisher

Taylor and Francis

Abstract

Adolescents and men are two populations that perform poorly within the HIV cascade of care, having worse AIDS-related health outcomes, and experiencing higher levels of HIV-related stigma. This paper explores institutional health system discrimination as experienced by adolescent boys with perinatally-acquired HIV, situating them within the social and gendered contexts of the Eastern Cape Province, South Africa. Life history narratives (n = 36) and in-depth semi-structured interviews (n = 32) with adolescent boys living with HIV aged 13–22 were conducted in 2017-2018. In-depth semi-structured interviews with biomedical and traditional health practitioners (n = 14), analysis of health facility files (n = 41) and clinic observations were also conducted. Together, triangulated sources point to an incongruence between the complex needs of adoelscent boys and young men living with HIV and their experiences within the health system. Two institutional discrimination-related deterrents to retention in care were identified: (1) lack of confidentiality due to health facility layouts and practices that visibilised people living with HIV; and (2) mistreatment in the form of shouting. This article contributes to the limited literature on the experiences of young men within the HIV continuum of care, focusing on how stigma influences how young men experience and engage with the health sector.

Description

Additional Data collection support was provided by the Mzantsi Wakho Study, funded by the Nuffield Foundation; Janssen Pharmaceutica N.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson; the Regional Inter-Agency Task Team for Children Affected by AIDS– Eastern and Southern Africa (RIATT-ESA); UNICEF Eastern and Southern Africa Office (UNICEF-ESARO); the International AIDS Society through the CIPHER grant; Claude Leon Foundation ; the Leverhulme Trust; the Oak Foundation; the University of Oxford’s ESRC Impact Acceleration Account; and the John Fell Fund.

Keywords

Stigma, Adolescence, Masculinity, South Africa (SA), Human immunodeficiency virus (HIV), Care, Institutional discrimination, Health system, Eastern Cape Province (ECP), SDG-03: Good health and well-being

Sustainable Development Goals

SDG-03:Good heatlh and well-being

Citation

Lesley Gittings, Rebecca Hodes, Phakamani Kom, Sinebhongo Mbula & Marija Pantelic (2024): ‘Remember there is that thing called confidentiality’: experiences of institutional discrimination in the health system among adolescent boys and young men living with HIV in the Eastern Cape province of South Africa, Culture, Health & Sexuality, vol. 26, no. 5, pp. 575-587, DOI: 10.1080/13691058.2023.2232023.