Can HIV Stigma increase ARV adherence? Results from a qualitative study in Southwestern Nigeria

The purpose of this study was to explore the cultural context of HIV patients' experience of stigma. Participants were recruited through HIV support networks in Southwestern Nigeria. 23 women and men participated in a 90 minutes in-depth interviews and focus group discussion which were audio-taped. Without using the word ‘stigma', interviews and discussions were guided by four questions exploring participants' reaction to HIV diagnosis; challenges experienced; changes made (positive and negative); and family, friends and community members reaction to their HIV status. Participants' age ranged from 22 to 58 with an average of 2.5 years since clinical diagnosis of HIV/AIDS. All participants were receiving ARV through the PEPFAR program. Using content analysis, three major themes emerged: life before ARV, life after ARV, and strategies used in ARV adherence. All participants self-reported high adherence to ARV medications out of "fear of looking sickly and people suspecting" they were HIV positive. Many reported experiencing stigma and discrimination along with rejection before they started ARV medications. Participants talked about friends and families “returning to them” and "apologizing for abandoning" them once they started "looking well after taking ARVs." Some participants chose not to confirm or deny their serostatus to family/friends that ask what was "wrong before when you look so skinny and sickly." Participants also discuss 'negotiating' and 'navigating' strategies used to ensure adherence to medications when out of their home or with family and friends. These findings have implications for policy on ARV provisions and programs designed to reduce HIV stigma.