Keeping up appearances – the reasons people living with HIV who are not yet ill, give for starting ART

Factors that motivated otherwise healthy HIV-positive young adults to access HIV testing and treatment in South Africa.

Lambert RF, Orrell C, Bangsberg DR, Haberer JE. AIDS Behav. 2017 Feb 11. doi: 10.1007/s10461-017-1704-y. [Epub ahead of print]

The World Health Organization recommends early initiation of HIV antiretroviral therapy (ART) for all those infected with the virus at any CD4 count. Successfully reaching individuals with relatively high CD4 counts depends in large part on healthy individuals seeking testing and treatment; however, little is known about factors motivating this decision. We conducted a qualitative study to explore this issue among 25 young HIV-positive adults (age 18-35) with a CD4 count >350 cells/mm3 who recently started or made the decision to start ART in Gugulethu, South Africa. Using an inductive content analytical approach, we found that most individuals sought testing and treatment early in the disease progression because of a desire to appear healthy thereby avoiding stigma associated with AIDS. Other factors included social support, responsibilities and aspirations, normalcy of having HIV, and accessible services. These findings suggest that maintenance of physical appearance should be included in the development of novel testing and treatment interventions.

Abstract access   [1]

Editor’s notes: A lot has been written on why people delay entry into care, when they are living with HIV. The guidance that all people living with HIV should now start treatment means that many people who are healthy are being offered treatment. The authors of this paper found that in a small sample of people in South Africa, looking healthy mattered. There was a value in the message that ART could maintain health, and in the words of one participant in their study, to ‘remain beautiful’. In addition, other positive anticipated results of taking ART emerged from the data. Young people saw the benefit in maintaining their health so they can help their family in the future, for example. However, despite the positive messages on appearance and a future role for the family and society, many concerns remained. Participants wanted privacy to live with HIV without others knowing. Fears of stigma, fears of an altered appearance and faltering strength haunted participants. The authors stress the value of the positive messaging of ART as an aid to sustaining a healthy appearance. They suggest that this messaging could be used to encourage people to start ART promptly. 

Africa [9]
South Africa [10]
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