Stigma-driven bypassing of ART services in Northern Ghana: a qualitative case study

This study analyses the relationship between fear of stigma and bypassing primary ART facilities by ART clients in the Upper East Region of Ghana.

Methodology: The study employed an exploratory case study design, involving 52 participants of: ART clients (n = 37), nurses (n = 7), a counsellor (n = 1), cadres (n = 2), pharmacists (n = 2) and data managers (n = 3) through convenient and purposive sampling techniques. Data was collected using semi-structured interview guides and analysed using a thematic framework.

The study provides ample evidence of the occurrence of stigma-driven bypassing of primary ART facilities by clients. The analysis shows entrenched cultural norms and values and the population's low awareness of the efficacy of ART fuel the processes of stigma and discrimination towards ART clients.

We acknowledge the following limitations and strengths: convenient and purposive sampling procedures may not represent the views of all ART clients on bypassing primary facilities. Sensitive nature of HIV and the location of ART centres, coupled with time constraints in probing into all ART bypassing issues. Yet, given the depth of the issues presented and the scope of participants and ART facilities, we believe relevant data was generated to address the research question.

An integrated approach could be used to address the drivers of stigma and discrimination focusing on awareness creation to undo the entrenched negative cultural beliefs around HIV transmission, and implement anti-HIV stigma legislation to eliminate prejudice towards PLHIV.