'My attitude towards my own journey changed the way others see me and treat me': insights from male peers living with HIV on challenging and changing stigma

BACKGROUND: HIV-related stigma and discrimination remain significant barriers to achieving the UNAIDS 95-95-95 targets and realizing optimal outcomes for people living with HIV (PLHIV). Among healthcare workers (HCW) living with HIV, there is a complex and multi-layered intersection of both externalized and internalized stigma particularly among peer navigators who work closely with communities. Efforts are needed to directly address stigma reduction in HIV programs and create a safe and supportive working environment for HCWs.
DESCRIPTION: Programmes that engage with stigma at both inter-personal and community support environments in which stigma and discrimination are no longer accepted or practiced. We explored the experiences and perceptions of male peer navigators living with HIV- referred to as coaches-, with the aim of understanding how they have addressed stigma in their personal and work lives. We used a qualitative design involving individual semi-structured in-depth discussions with 45 coaches in 5 provinces in South Africa.
LESSONS LEARNED: By embracing their HIV status publicly and countering outdated notions of what it means to live with HIV coaches reported being able to overcome internal stigma by reframing their experience of HIV as a resource for advising and supporting other men living with HIV.
'Self-acceptance is the first step to healing and setting the tone on how others will treat you.' ' Coach, Free State
'Stigma will always be there from lack of information, but we move on, and now we are comfortable in our own skin.' ' Coach, Gauteng
'People do not believe when I disclose my status during campaigns because I am healthy and confident.' ' Coach, Free State
The social and professional standing that they hold as healthcare workers and the purpose and meaning that they find in their work appear to serve as protective factors.
CONCLUSIONS: The Coach intervention has demonstrated that empathy and disclosure from a healthcare worker can reduce stigma and encourage others to seek care. These approaches are interdependent and mutually reinforcing and have consequences for the way in which people react to others in their community as well as within healthcare facilities. This suggests that greater visibility of PLHIV could be a significant element of stigma reduction strategies.

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