%0 Journal Article
%T Are integrated HIV services less stigmatizing than stand-alone models of care? A comparative case study from Swaziland
%A Kathryn Church
%A Alison Wringe
%A Phelele Fakudze
%A Joshua Kikuvi
%J Journal of the International AIDS Society
%D 2013
%I 
%R 10.7448/ias.16.1.17981
%X Introduction: Integrating HIV with primary health services has the potential to reduce HIV-related stigma through delivering care in settings disassociated with HIV. This study investigated the relationship between integrated care and felt stigma. The study design was a comparative case study of four models of HIV care in Swaziland, ranging from fully integrated to fully stand-alone HIV care. Methods: An exit survey (N=602) measured differences in felt stigma across model of care; the primary outcome ˇ°perception of HIV status exposure through clinic attendanceˇ± was analyzed using multivariable logistic regression. In-depth interviews (N=22) explored whether and how measured differences in stigma experiences were related to service integration. Results: There were significant differences in perceived status exposure across models of care. After adjustment for potential confounding between sites, those at a partially integrated site and a partially stand-alone site had greater odds of perceived status exposure than those at the fully stand-alone site (aOR 3.33, 95% CI 1.98¨C5.60; and aOR 11.84, 95% CI 6.89¨C20.36, respectively). There was no difference between the fully stand-alone and the fully integrated clinic. Qualitative data suggested that many clients at HIV-only sites felt greater confidentiality knowing that those around them were positive, and support was gained from other HIV care clients. Confidentiality was maintained in various ways, even in stand-alone sites, through separate waiting areas for HIV testing and HIV treatment, and careful clinic and room labelling. Conclusions: The relationship between model of care and stigma was complex, and the hypothesis that stigma is higher at stand-alone sites did not hold true in this high prevalence setting. Policy-makers should ensure that service integration does not increase stigma, in particular within partially integrated models of care.
%K systems integration
%K health services research
%K stigma
%K HIV
%K primary care
%K reproductive health services
%U http://www.jiasociety.org/index.php/jias/article/view/17981/2796