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Factors that Motivated Otherwise Healthy HIV-Positive Young Adults to Access HIV Testing and Treatment in South Africa

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Abstract

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.

Resumen

La Organización Mundial de la Salud recomienda el inicio temprano de la terapia antirretroviral del VIH (ARV) para todos los infectados con el virus en cualquier recuento de CD4. Llegar exitosamente a individuos con conteos de CD4 relativamente altos depende en gran parte de individuos sanos que buscan pruebas y tratamiento; sin embargo, poco se sabe sobre los factores que motivan esta decisión. Se realizó un estudio cualitativo para explorar esta cuestión entre 25 adultos jóvenes VIH-positivos (edad 18–35) con un recuento de CD4 >350 células/mm3 que recientemente comenzó o tomó la decisión de iniciar el tratamiento antirretroviral en Gugulethu, Sudáfrica. Usando un enfoque analítico de contenido inductivo, encontramos que la mayoría de los individuos buscó pruebas y tratamiento temprano en la progresión de la enfermedad debido a un deseo de parecer saludable, evitando así el estigma asociado con el SIDA. Otros factores incluyeron el apoyo social, las responsabilidades y aspiraciones, la normalidad de tener el VIH y los servicios accesibles. Estos hallazgos sugieren que el mantenimiento de la apariencia física debe incluirse en el desarrollo de nuevas pruebas y intervenciones de tratamiento.

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Acknowledgements

All authors contributed to the conception and design of the study, data analysis and interpretation, and/or development of the manuscript. The manuscript was drafted by R.F.L. and J.E.H. All authors critically reviewed the manuscript, suggested revisions and editorial changes, and approved the final version. The authors gratefully acknowledge Vivie Situlo, who collected qualitative data, and the following study staff: Nicola Kelly, Anna Cross, Zoleka Xapa, Pearl Pahlana, Ingrid Courtney, Nomsa Ngwenya, Nosiphiwo Mzamo, Alienah Mpahleni and other members of the ‘Examining HIV Treatment Adherence During Early Disease’ study team. Financial support for the qualitative research presented here was provided by the Bill and Melinda Gates Foundation (J.E.H., C.O.), the Harvard Medical School Class of 1984 Scholarship (R.F.L.) and the Harvard Medical School Center for Primary Care (R.F.L.).

Funding

This study was funded by the Bill and Melinda Gates Foundation (Grant No. OPP113634) and Harvard Medical School Center for Primary Care.

Author information

Authors and Affiliations

  1. Harvard School of Dental Medicine, Harvard University, Boston, MA, USA

    R. Frederick Lambert

  2. Desmond Tutu HIV Foundation, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa

    Catherine Orrell

  3. Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Suite 722, Boston, MA, 02114, USA

    David R. Bangsberg & Jessica E. Haberer

  4. Harvard Medical School, Harvard University, Boston, MA, USA

    David R. Bangsberg & Jessica E. Haberer

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  1. R. Frederick Lambert
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  2. Catherine Orrell
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  4. Jessica E. Haberer
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Corresponding author

Correspondence to Jessica E. Haberer.

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Conflict of interest

R. Frederick Lambert declares that he has no conflict of interest. Catherine Orrell receives grant funding from Desmond Tutu HIV Foundation and the University of Cape Town. She declares that she has no conflict of interest. David R. Bangsberg declares that he has no conflict of interest. Jessica E. Haberer receives grant funding from NIH, the Gates Foundation, and USAID. She has received consulting fees from Merck, the WHO and the NIH. She own stock in Natera. She declares that these financial interests do not constitute a conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by Partners Healthcare Institutional Review Board, Boston, MA (Protocol#: 2015P000841), Harvard University Faculty of Medicine Office of Human Research Administration, Boston, MA (Protocol#: IRB15-1948), University of Cape Town Faculty of Health Sciences Human Research Ethics Committee, Cape Town, South Africa (HREC REF: 078/2015), and the Western Cape Provincial Health Research Committee (Reference: WC_2015R26_119). Written consent was obtained from all participants.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Lambert, R.F., Orrell, C., Bangsberg, D.R. et al. Factors that Motivated Otherwise Healthy HIV-Positive Young Adults to Access HIV Testing and Treatment in South Africa. AIDS Behav 22, 733–741 (2018). https://doi.org/10.1007/s10461-017-1704-y

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