UCLA

Background

People living with HIV/AIDS (PLWHA) in rural Anhui, China face tremendous challenges, which may influence access to healthcare. This two-part study explored these issues. First, a quantitative study examined whether (a) two dimensions of HIV-related stigma (i.e., perceived stigma and internalized shame) or (b) three dimensions of social support (i.e., emotional support, tangible support, and affectionate support) are associated with access to care among HIV-positive men and women in rural Anhui, China. Second, a critical performance written and performed by the author applies ethnodrama strategies to explore HIV stigma and social support in Anhui Province.

Methods

The conceptual model integrates theoretical concepts of stigma and social support into Andersen’s Behavioral Model of Health Services Use. This was a secondary analysis of baseline data from participants (N = 522 PLWHA) in the Together for Empowerment Activities (TEA) study, a randomized controlled intervention trial among HIV-affected families in rural Anhui, China. The data were collected between October 2011 and March 2013 via computer-assisted personal interviewing. The analyses involved mixed-effects, multiple linear regression with village-level random effects to control for variance clustering by the village. Conquergood and ethnodrama strategies informed the elements included in the performance: movement, original text, quotes from PLWHA, and spectacle such as photographs, set, and props.

Results

Higher levels of perceived stigma were associated with poorer access to care (estimated difference = – 0.08, p = 0.015). With respect to social support, only higher levels of affectionate support were associated with greater access to care (estimated difference = 0.43, p < 0.0001). Tangible support was inversely associated with access to care (estimated difference = – 0.17, p = 0.003). Neither internalized shame nor emotional support was associated with access to care (p > 0.05).

Discussion

This study underscores complexities between HIV-related stigma, social support and access to care in rural Anhui, China. Future research should explore whether adverse effects exist for managing HIV disease in this region. Performance represents a potentially powerful, non-traditional approach to discussing these issues and disseminating some findings; future work should explore whether this holds in Anhui Province.