“It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa
Abstract Background South Africa has the highest number of people with HIV (PWH) globally and a significant burden of co-occurring substance use disorder (SUD). Health care worker (HCW) stigma towards SUD is a key barrier to HIV care engagement among PWH with SUD. Support from peers—individuals with...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13722-022-00330-5 |
| _version_ | 1798001658579386368 |
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| author | Jessica F. Magidson Alexandra L. Rose Kristen S. Regenauer Carrie Brooke-Sumner Morgan S. Anvari Helen E. Jack Kim Johnson Jennifer M. Belus John Joska Ingrid V. Bassett Goodman Sibeko Bronwyn Myers |
| author_facet | Jessica F. Magidson Alexandra L. Rose Kristen S. Regenauer Carrie Brooke-Sumner Morgan S. Anvari Helen E. Jack Kim Johnson Jennifer M. Belus John Joska Ingrid V. Bassett Goodman Sibeko Bronwyn Myers |
| author_sort | Jessica F. Magidson |
| collection | DOAJ |
| description | Abstract Background South Africa has the highest number of people with HIV (PWH) globally and a significant burden of co-occurring substance use disorder (SUD). Health care worker (HCW) stigma towards SUD is a key barrier to HIV care engagement among PWH with SUD. Support from peers—individuals with lived experience of SUD—may be a promising solution for addressing SUD stigma, while also improving engagement in HIV care. We evaluated the perceived acceptability of integrating a peer role into community-based HIV care teams as a strategy to address SUD stigma at multiple levels and improve patient engagement in HIV care. Methods Patients and stakeholders (N = 40) were recruited from publicly-funded HIV and SUD organizations in Cape Town, South Africa. We conducted a quantitative assessment of stigma among stakeholders using an adapted Social Distance Scale (SDS) and patient perceptions of working with a peer, as well as semi-structured interviews focused on experiences of SUD stigma, acceptability of a peer model integrated into community-based HIV care, and potential peer roles. Results On the SDS, 75% of stakeholders had high stigma towards a patient with SUD, yet 90% had low stigma when in recovery for at least 2 years. All patients endorsed feeling comfortable talking to someone in recovery and wanting them on their HIV care team. Three main themes emerged from the qualitative data: (1) patient-reported experiences of enacted SUD and HIV stigmas were common and impacted HIV care engagement; (2) both patients and stakeholders considered a peer model highly acceptable for integration into HIV care to support engagement and address SUD stigma; and (3) patients and stakeholders identified both individual-level and systems-level roles for peers, how peers could work alongside other providers to improve patient care, and key characteristics that peers would need to be successful in these roles. Conclusions Findings from this formative work point to the promise of a peer model for reducing SUD stigma among patients and HCWs within community-based HIV care teams in SA. |
| first_indexed | 2024-04-11T11:39:48Z |
| format | Article |
| id | doaj.art-277a0783bf574436bd3130e26e4b0b19 |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-04-11T11:39:48Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-277a0783bf574436bd3130e26e4b0b192022-12-22T04:25:52ZengBMCAddiction Science & Clinical Practice1940-06402022-09-0117111210.1186/s13722-022-00330-5“It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South AfricaJessica F. Magidson0Alexandra L. Rose1Kristen S. Regenauer2Carrie Brooke-Sumner3Morgan S. Anvari4Helen E. Jack5Kim Johnson6Jennifer M. Belus7John Joska8Ingrid V. Bassett9Goodman Sibeko10Bronwyn Myers11Department of Psychology, University of MarylandDepartment of Psychology, University of MarylandDepartment of Psychology, University of MarylandAlcohol, Tobacco and Other Drug Research Unit, South African Medical Research CouncilDepartment of Psychology, University of MarylandDivision of General Internal Medicine, Department of Medicine, University of WashingtonAlcohol, Tobacco and Other Drug Research Unit, South African Medical Research CouncilDepartment of Clinical Research, University Hospital BaselHIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape TownDivision of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical SchoolHIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape TownAlcohol, Tobacco and Other Drug Research Unit, South African Medical Research CouncilAbstract Background South Africa has the highest number of people with HIV (PWH) globally and a significant burden of co-occurring substance use disorder (SUD). Health care worker (HCW) stigma towards SUD is a key barrier to HIV care engagement among PWH with SUD. Support from peers—individuals with lived experience of SUD—may be a promising solution for addressing SUD stigma, while also improving engagement in HIV care. We evaluated the perceived acceptability of integrating a peer role into community-based HIV care teams as a strategy to address SUD stigma at multiple levels and improve patient engagement in HIV care. Methods Patients and stakeholders (N = 40) were recruited from publicly-funded HIV and SUD organizations in Cape Town, South Africa. We conducted a quantitative assessment of stigma among stakeholders using an adapted Social Distance Scale (SDS) and patient perceptions of working with a peer, as well as semi-structured interviews focused on experiences of SUD stigma, acceptability of a peer model integrated into community-based HIV care, and potential peer roles. Results On the SDS, 75% of stakeholders had high stigma towards a patient with SUD, yet 90% had low stigma when in recovery for at least 2 years. All patients endorsed feeling comfortable talking to someone in recovery and wanting them on their HIV care team. Three main themes emerged from the qualitative data: (1) patient-reported experiences of enacted SUD and HIV stigmas were common and impacted HIV care engagement; (2) both patients and stakeholders considered a peer model highly acceptable for integration into HIV care to support engagement and address SUD stigma; and (3) patients and stakeholders identified both individual-level and systems-level roles for peers, how peers could work alongside other providers to improve patient care, and key characteristics that peers would need to be successful in these roles. Conclusions Findings from this formative work point to the promise of a peer model for reducing SUD stigma among patients and HCWs within community-based HIV care teams in SA.https://doi.org/10.1186/s13722-022-00330-5PeerSubstance use stigmaSubstance use treatmentHIV stigmaGlobal mental healthImplementation science |
| spellingShingle | Jessica F. Magidson Alexandra L. Rose Kristen S. Regenauer Carrie Brooke-Sumner Morgan S. Anvari Helen E. Jack Kim Johnson Jennifer M. Belus John Joska Ingrid V. Bassett Goodman Sibeko Bronwyn Myers “It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa Addiction Science & Clinical Practice Peer Substance use stigma Substance use treatment HIV stigma Global mental health Implementation science |
| title | “It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa |
| title_full | “It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa |
| title_fullStr | “It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa |
| title_full_unstemmed | “It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa |
| title_short | “It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa |
| title_sort | it s all about asking from those who have walked the path patient and stakeholder perspectives on how peers may shift substance use stigma in hiv care in south africa |
| topic | Peer Substance use stigma Substance use treatment HIV stigma Global mental health Implementation science |
| url | https://doi.org/10.1186/s13722-022-00330-5 |
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