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"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.
Addict Sci Clin Pract. 2022 Sep 21; 17(1):52.AS

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.

Links

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Authors+Show Affiliations

Magidson JF
Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA. jmagidso@umd.edu.
Rose AL
Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA.
Regenauer KS
Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA.
Brooke-Sumner C
Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa.
Anvari MS
Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, MD, USA.
Jack HE
Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
Johnson K
Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa.
Belus JM
Department of Clinical Research, University Hospital Basel, Basel, Switzerland. University of Basel, Basel, Switzerland.
Joska J
HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Bassett IV
Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
Sibeko G
HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Myers B
Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Parow, South Africa. bronwyn.myers-franchi@curtin.edu.au. HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. bronwyn.myers-franchi@curtin.edu.au. Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Building 408, GPO Box U1987, Perth, WA, 6845, Australia. bronwyn.myers-franchi@curtin.edu.au.

MeSH

HIV InfectionsHumansQualitative ResearchSocial StigmaSouth AfricaSubstance-Related Disorders

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36131304

Citation

Magidson, Jessica F., et al. ""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, vol. 17, no. 1, 2022, p. 52.
Magidson JF, Rose AL, Regenauer KS, et al. "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. Addict Sci Clin Pract. 2022;17(1):52.
Magidson, J. F., Rose, A. L., Regenauer, K. S., Brooke-Sumner, C., Anvari, M. S., Jack, H. E., Johnson, K., Belus, J. M., Joska, J., Bassett, I. V., Sibeko, G., & Myers, B. (2022). "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, 17(1), 52. https://doi.org/10.1186/s13722-022-00330-5
Magidson JF, et al. "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. Addict Sci Clin Pract. 2022 Sep 21;17(1):52. PubMed PMID: 36131304.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "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. AU - Magidson,Jessica F, AU - Rose,Alexandra L, AU - Regenauer,Kristen S, AU - Brooke-Sumner,Carrie, AU - Anvari,Morgan S, AU - Jack,Helen E, AU - Johnson,Kim, AU - Belus,Jennifer M, AU - Joska,John, AU - Bassett,Ingrid V, AU - Sibeko,Goodman, AU - Myers,Bronwyn, Y1 - 2022/09/21/ PY - 2022/01/10/received PY - 2022/08/17/accepted PY - 2022/9/21/entrez PY - 2022/9/22/pubmed PY - 2022/9/24/medline KW - Global mental health KW - HIV stigma KW - Implementation science KW - Peer KW - Substance use stigma KW - Substance use treatment SP - 52 EP - 52 JF - Addiction science & clinical practice JO - Addict Sci Clin Pract VL - 17 IS - 1 N2 - 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. SN - 1940-0640 UR - https://www.unboundmedicine.com/medline/citation/36131304/"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_ DB - PRIME DP - Unbound Medicine ER -
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