The correlates and experiences of HIV-related intersectional stigma among caregivers of adolescents living with HIV during COVID-19 in KwaZulu-Natal, South Africa: Results from a mixed method study

Abstract

Caregivers play a critical role in promoting HIV adherence and positive mental health among adolescents living with HIV (ALHIV). However, the health and wellbeing of caregivers are often compromised by HIV-related stigma. Furthermore, in sub-Saharan Africa, the effects of HIV-related stigma are amplified by intersecting forms of stigma, such as poverty and gender. If we can identify the key drivers of HIV-related intersectional stigma, then we can develop targeted strategies to improve caregiver wellbeing. We used a mixed-method study design, utilising quantitative and qualitative baseline data from an economic incentive trial with n = 100 caregivers of ALHIV sampled from peri-urban clinics in Durban, KwaZulu-Natal, South Africa between November and December 2021. We drew on the trial's survey dataset that examined socio-demographics, mental health and wellbeing, and stigma. We conducted descriptive statistics and fitted a linear regression model to assess correlates of HIV-related intersectional stigma using STATA (V18). In-depth interview data (n = 16 caregivers) were analysed guided by the Health Stigma and Discrimination Framework in NVivo. Of the 100 caregivers in the analysis, 86% were female, with a median age of 43 years (IQR:34-50) and 75% living with HIV. Seventy-eight caregivers reported experiencing HIV-related intersectional stigma. More than half (52%) were experiencing depressive symptoms, 51% were living in severely food-insecure households, and 59% were experiencing a high caregiver burden. Caregiver burden and total direct cost of caregiving were correlated with HIV-related intersectional stigma. Key domains from the qualitative data suggest that HIV-related intersectional stigma increased caregiver burden, diminished psychological well-being, and was linked to the cost associated with caregiving. Results highlight the need for multi-sectoral HIV-related intersectional stigma programmes that focus on economic empowerment and mental health coping strategies to equip carers with the skills needed to manage HIV-related intersectional stigma.