Segregated healthcare impact on patients living with HIV in a clinic in Botswana

Abstract

Background: Despite Botswana’s progress in achieving the 95–95–95 goals, some health systems continue to provide segregated services for people living with HIV through Infectious Disease Care Centres (IDCCs) located within public health facilities. This may lead to stigma arising from unintended disclosure of an HIV status and cause a detrimental impact on patient health-seeking behaviour.
Objectives: This study explores the impact of segregation on patients living with HIV and the perception with which they view it, specifically: voluntary testing, disclosure of HIV status, treatment initiation, and continuation of treatment.
Method: Fourteen in-depth interviews supplemented with field notes were conducted using the phenomenological approach. Data were analysed by the researcher and co-authors using manual coding and the Atlas Ti version 8 software.
Results: Seven themes were derived from the data and included service provision, stigma and discrimination, disclosure of HIV status, treatment initiation and adherence, psychological impact and ethical considerations, barriers to service provision, and positive impact of IDCC-based care.
Conclusion: Patients experienced both challenges and benefits with segregated care. Integrated HIV and general medical services leveraging on positive aspects of IDCC care and counselling for patients is recommended, alongside capacitating healthcare workers with communication skills.