Living well with HIV in Nigeria? Stigma and survival challenges preventing optimum benefit from an ART clinic.

Thirty years into the HIV pandemic, the interactions of stigma, social and economic survival, and clinical interventions continue to be key to understanding and managing HIV at both personal and societal levels. With antiretroviral therapy, HIV is increasingly a chronic condition requiring lifelong treatment, near-perfect adherence, and support from both social networks and formal services. This study asked: is stigma still a significant problem for people living with HIV (PLHIV) who have secured access to antiretrovirals (ARVs)? How do PLHIV accessing ARVs in Nigeria experience the social, economic and health service supports intended to address their needs? What are the concerns and challenges of PLHIV and health workers regarding these supports? What are the implications for approaches to stigma and discrimination? This qualitative study at the Antiretroviral (ART) Clinic of the Osogbo State Hospital, Osun State, Nigeria involved in-depth interviews with 15 PLHIV who have been attending the clinic for at least one year, and three health workers. The results reveal both the diversity among even a small number of patients, and persistent cross-cutting themes of stigma, discrimination, poverty, and the psychological impacts of insecure livelihoods and well-intentioned but ultimately stigmatizing supports such as selective food parcels. Both population-based interventions against stigma and poverty, as well as micro-level, contextualized attention to patients', families' and health workers' fear of social exclusion and infection at a clinic and community level are needed if patients - and society - are to live well with HIV in Nigeria.