Social constraints to TB/HIV healthcare: Accounts from coinfected patients in South Africa

被引:46
作者
Daftary, Amrita [1 ]
Padayatchi, Nesri [2 ]
机构
[1] Columbia Univ, ICAP, Mailman Sch Publ Hlth, New York, NY 10027 USA
[2] Univ KwaZulu Natal, Ctr AIDS Programme Res S Africa CAPRISA, Durban, South Africa
来源
AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV | 2012年 / 24卷 / 12期
基金
美国国家卫生研究院; 加拿大健康研究院;
关键词
South Africa; patient perspectives; TB/HIV coinfection; integration; qualitative methods; HIV TREATMENT; TB PATIENTS; STIGMA; GENDER; AIDS; ADHERENCE; BARRIERS; AREA;
D O I
10.1080/09540121.2012.672719
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
There is a growing imperative to improve the coordination and collaboration of tuberculosis (TB) and HIV healthcare services in response to escalating rates of TB/HIV coinfection. Patient-specific challenges associated with the delivery of TB/HIV care have been minimally explored in this regard. As part of a larger study conducted in South Africa, this article highlights coinfected patients' experiences with TB and HIV healthcare in light of their broader social environments. Qualitative, in-depth interviews were conducted with 40 adult, coinfected patients (24 women and 16 men) and eight key-informant healthcare workers at three urban/peri-urban, ambulatory, public health clinics in the high-burden province of KwaZulu-Natal. Transcribed interviews were analyzed under a modified grounded theory approach to capture subjective meanings of healthcare experience subsequent to patients' codiagnosis with TB and HIV. Emerging analytic themes highlighted critical sociomedical constraints to TB/HIV care in relation to patients' income and employment, eligibility for social assistance and antiretroviral treatment, fears around illness disclosure, social and material support, and treatment adherence. Patients' healthcare experiences were bound by their poor access to essential resources, multiple life responsibilities, disparate gender roles, limits within the healthcare system, and the stigmatizing social symbolism of their illness. Overlapping social inequalities perpetuated coinfected patients' experiences with stigma and collectively mediated their health decisions around disclosure, adherence, and retention in medical care. The study urges a contextualized understanding of the social challenges associated with TB/HIV healthcare and helps inform more patient-sensitive and socially responsive interventions against the co-epidemic.
引用
收藏
页码:1480 / 1486
页数:7
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