Nurses’ Experiences of Stigma and Discrimination in ART Adherence of Prison Inmates Living with HIV/AIDS

Nkhensani Florence Mabunda; Ntavhanyeni Mapholisa

doi:10.25159/2520-5293/20826

Authors

Nkhensani Florence Mabunda Sefako Makgatho Health Science University https://orcid.org/0000-0002-3933-0950
Ntavhanyeni Mapholisa Sefako Makgatho Health Science University https://orcid.org/0000-0002-0681-3876

DOI:

https://doi.org/10.25159/2520-5293/20826

Keywords:

antiretroviral adherence, discrimination, HIV/AIDS, offenders, professional nurses, stigmatisation

Abstract

Antiretroviral therapy adherence among offenders living with HIV/AIDS in South African prisons is a major challenge. Offenders living with HIV/AIDS often experience multiple problems of stigmatisation and discrimination that undermine adherence to antiretroviral therapy within correctional health institutions. Professional nurses are central to HIV care in correctional facilities, making their experiences with antiretroviral therapy adherence pivotal. This study investigated the experiences of professional nurses relating to stigmatisation and discrimination associated with antiretroviral therapy adherence among offenders diagnosed with HIV/AIDS within correctional facilities in South Africa. A qualitative, exploratory, descriptive, and contextual research design was implemented. Data collection was conducted through semi-structured telephone interviews with 22 professional nurses from the Department of Correctional Services’ Management areas, and the data were subsequently analysed using Tesch’s qualitative content analysis methodology. Two major themes emerged: (1) Offenders’ fear of stigmatisation, and (2) Challenges regarding offenders’ privacy and confidentiality. The findings of this study show that stigma and discrimination in South African correctional facilities substantially undermine adherence to antiretroviral therapy among incarcerated people living with HIV/AIDS. These challenges are compounded by persistent tensions between the need to maintain institutional security and the need to protect privacy during clinical encounters, which is vital for safeguarding confidentiality and promoting adherence. Tackling stigma, enhancing nurse training, and introducing policies that carefully balance security demands with patient confidentiality are crucial for improving ART adherence in prison healthcare environments.

References

Abdi, Y. H., Abdi, M. S., Bashir, S. G., Ahmed, N. I., and Abdullahi, Y. B. 2025. “Understanding Global Health Inequality and Inequity: Causes, Consequences, and the Path Toward Justice in Healthcare.” Public Health Challenges 4(4): e70156.

Adeoye‐Olatunde, Omolola A., and Nicole L. Olenik. 2021. “Research and Scholarly Methods: Semi‐Structured Interviews.” Journal of the American College of Clinical Pharmacy 4(10): 1358–1367.

Atinga, B. E., Sarfo-Brobbey, V., Henyo, A., Ayamga, C. A., Konnyebal, G., Braimah, R., and Perekuu, T. 2026. “Nurses’ Care Attitudes Toward Inmate Patients at Selected Hospitals in the Sunyani Municipality of Ghana: A Qualitative Study.” SSRN 5351199.

Babatunde, A. O., Okunlola, P. O., Akoki, D. M., Ilori, O. T., Femi‐Lawal, V. O., Abiona, F. M., and Tundealao, S. T. 2023. “Toward Equitable Health Care: Bridging the Gap in the Health of Incarcerated Individuals in Africa.” Public Health Challenges 3(4): e70020.

Bazrafshan, A., Rafiei-Rad, A. A., Bazrafshan, M. S., Ghalekhani, N., Mehmandoost, S., SeyedAlinaghi, S., and Sharifi, H. 2025. “Facilitators and Barriers to Adherence to Antiretroviral Therapy among Incarcerated People Living with HIV in Iran: Insights from a Qualitative Study.” Harm Reduction Journal 22(1): 4.

Chimoyi, L., Hoffmann, C. J., Hausler, H., Ndini, P., Rabothata, I., Daniels-Felix, D., and Chetty-Makkan, C. M. 2021. “HIV-related Stigma and Uptake of Antiretroviral Treatment among Incarcerated Individuals Living with HIV/AIDS in South African Correctional Settings: A Mixed Methods Analysis.” PloS one 16(7): e0254975.

Creswell, J. W., and Inoue, M. 2025. “A Process for Conducting Mixed Methods Data Analysis.” Journal of General and Family Medicine 26(1): 4–11.

Debie, A., Nigusie, A., Gedle, D., Khatri, R. B., and Assefa, Y. 2024. “Building a Resilient Health System for Universal Health Coverage and Health Security: A Systematic Review.” Global Health Research and Policy 9(1): 2.

Fassett, K. T., Wolcott, M. D., Harpe, S. E., and McLaughlin, J. E. 2022. “Considerations for Writing and Including Demographic Variables in Education Research.” Currents in Pharmacy Teaching and Learning 14(8): 1068–1078.

Fassett, Kyle T., Michael D. Wolcott, Spencer E. Harpe, and Jacqueline E. McLaughlin. 2022. “Considerations for Writing and Including Demographic Variables in Education Research.” Currents in Pharmacy Teaching and Learning 14(8): 1068–1078.

Fisa, R., Mwala, K., DeMoulin, D., Kayamba, V., Shrubsole, M., Shu, X.O., Fwemba, I., Mutale, W., and Lipworth, L. 2025. “Association of Social Support and Religiosity with Survival among Women with Breast Cancer in a Low-income Population in the Southeastern United States.” BMC Public Health 25: 708.

Fobosi, S. C. 2024. “The Protection of Human Rights in South Africa: Unpacking the Duty of the State to Realise the Right to Development.” Potchefstroom Electronic Law Journal (PELJ) 27(1): 120.

Fuge, T. G., Tsourtos, G., and Miller, E. R. 2020. “A Systematic Review and Meta-analyses on Initiation, Adherence and Outcomes of Antiretroviral Therapy in Incarcerated People.” PLoS One 15(5): e0233355.

Gani, S., and Laher, S. 2025. “The Relationship between Coping and Well-being among South African Muslims during the COVID-19 Pandemic.” Journal of Muslim Mental Health 18(3).

Ghazy, R. M., Al Awaidy, S., and Taha, S. H. N. 2023. “Trends of HIV Indicators in Egypt from 1990 to 2021: Time-series Analysis and Forecast toward UNAIDS 90–90–90 Targets.” BMC Public Health 23(1): 625.

Golabi, F., and Mohabatian, A. 2024. “Erving Goffman’s Intellectual Heirs: A Survey of the Impact of Erving Goffman’s Social Thoughts on Theorization of Contemporary Sociological Thinkers.” Ferdowsi University of Mashhad Journal of Social Sciences 21(2): 233–283.

Gray, J. R., and Grove, S. K. 2021. Burns and Grove’s the Practice of Nursing: Appraisal, Synthesis, and Generation of Evidence (9th ed.). St.Louis: Mossouri: Elsevier Health Sciences.

Gray, J.R. 2018. “Introduction to Qualitative Research.” Understanding Nursing Research E-Book: Building an Evidence-Based Practice 59 (2018).

Herce, M. E., Muyoyeta, M., Topp, S. M., Henostroza, G., and Reid, S. E. 2018. “Coordinating the Prevention, Treatment, and Care Continuum for HIV-associated Tuberculosis in Prisons: A Health Systems Strengthening Approach.” Current Opinion in HIV and AIDS 13(6): 492–500.

Kakar, Z. U. H., Rasheed, R., Rashid, A., and Akhter, S. 2023. “Criteria for Assessing and Ensuring the Trustworthiness.” Qualitative Research International Journal of Business Reflections 4 (2): 150–173.

Lim, W. M. 2025. “What is Qualitative Research? An Overview and Guidelines.” Australasian Marketing Journal 33(2): 199–229.

Mabunda, N. F. 2025. “Factors Associated with Family Involvement or Lack Thereof in Caring for Mental Health Care Users: A Qualitative Study.” Psychiatry International 6(1): 30.

Madiba, S., and Mokgatle, M. 2021. “Experiences of Healthcare Workers Providing HIV Care to Inmates in South African Correctional Facilities.” BMC Health Services Research 21(1): 746.

Mahlalela, N. B., Manne-Goehler, J., Ohene-Kwofie, D., B. Adams, L., Montana, L., Kahn, K., and Gómez-Olivé, F. X. 2024. “The Association between HIV-related Stigma and the Uptake of HIV Testing and ART among Older Adults in Rural South Africa: Findings from the HAALSI Cohort Study.” AIDS and Behaviour 28(3): 1104–1121.

Mahlalela, N.B., J. Manne-Goehler, D. Ohene-Kwofie, L.B. Adams, L. Montana, K. Kahn, Julia K. Rohr, T. Bärnighausen, and F. X. Gómez-Olivé. 2024. “The Association between HIV-related Stigma and the Uptake of HIV Testing and ART among Older Adults in Rural South Africa: Findings from the HAALSI Cohort Study.” AIDS and Behavior 28 (3): 1104–1121.

Makurumidze, G., Ross, J. L., Shah, R., Dacarett-Galeano, D., Artz, J., and Cohen, M. A. A. 2021. “HIV Stigma.” In HIV Psychiatry: A Practical Guide for Clinicians, edited by Bourgeois, J.A., Cohen, M.A.A. and Makurumidze, G. pp. 45–66. Cham: Springer International Publishing.

Modiba, M.T. 2021. “Utilising Artificial Intelligence Technology for the Management of Records at the Council for Scientific and Industrial Research in South Africa.” PhD diss., University of South Africa.

Musekene, L. A. 2022. “An Evaluation of Inmates and Offender’s Rights to Freedom and Security of a Person in the Correctional System of South Africa.” Doctoral dissertation, University of Venda.

Naidoo, D., Cloete, A., Skinner, D., Savva, H., Daniels, D., Kose, Z., and Ramatshekgisa, M. G. 2025. “‘You Get HIV because There is No Hope’ A Rapid Qualitative Assessment of the HIV Vulnerabilities of Transgender Women in Three South African Metros.” International Journal of Transgender Health 26(3): 709–724.

Nice, J. K. 2023. “Understanding HIV-Related Stigma and Art Adherence Among Adolescents and Young Adults Living with HIV in South Africa.” Doctoral dissertation, Tulane University.

Nyamboga, T. O., and Obeagu, E. I. 2024. “Strengthening Resilience: Strategic Planning in HIV Vulnerability Management.” Elite Journal of Public Health 2(7): 47–62.

Nyoni, T., and Okumu, M. 2021. “HIV-related Stigma and Access to Healthcare Services among Incarcerated Populations: A Scoping Review.” Frontiers in Public Health 9: 635595.

Petrongolo, M., and R.Toothaker. 2021. “Nursing Students’ Perceptions of Death and Dying: A Descriptive Quantitative Study.” Nurse Education Today 104: 104993.

Polit, D. F., and Beck, C. T. 2017. Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.). Philadelphia: Wolters Kluwer Health.

Rasad, R., Vaisi-Raygani, A., and Abdi, A. 2024. “Nursing Care Experiences of People Living with HIV/AIDS (PLWHA): A Phenomenological Study from the West of Iran.” Heliyon 10(21).

Rybak, N., and Angus, D.J. 2021. “Tracking Conflict and Emotions with a Computational Qualitative Discourse Analytic Support Approach.” Plos one 16(5):e0251186.

Sawaf, S. 2022. “‘Yotes Matter’: Using Art to Reduce Mental Health Stigma at California State University, San Bernardino.” Doctoral dissertation, California Baptist University.

Stevenson, K. A., Podewils, L. J., Zishiri, V. K., Castro, K. G., and Charalambous, S. 2020. “HIV Prevalence and the Cascade of Care in Five South African Correctional Facilities.” PloS one 15(7): e0235178.

Tarkang, E. E., Manu, E., Aku, F. Y., Komesuor, J., Charles-Unadike, V., Khuzwayo, N., and Anaman-Torgbor, J. 2025. “Healthcare Providers’ Experiences and Recommendations for Antiretroviral Therapy Adherence in Ghana: A Facility-based Phenomenological Study.” Plos one 20(10): e0333695.

UNAIDS, O. 2023. “World AIDS Day 2022.” Global HIV and AIDS Statistics‐Fact Sheet.

van Dyk, A. 2020. “Capturing Transients: An Application of Biostatistics to Astronomy.” PhD Thesis, UCT.

Vera-Remartínez, E. J., Zafra-Agea, J. A., Garcia-Guerrero, J., and Molés-Julio, M. P. 2024. “The Experience of Spanish Prison Nurses with the HIV Pandemic.” Healthcare 12(2):184.

Wagner, C., Gossett, K., Hasnain, M., Linsk, N., and Rivero, R. 2025. “Integration of the National HIV Curriculum in Medicine, Nursing, and Pharmacy Programs in the United States.” BMC Medical Education 25(1): 422.

Woznica, D. M., Ntombela, N., Hoffmann, C. J., Mabuto, T., Kaufman, M. R., Murray, S. M., and Owczarzak, J. 2021. “Intersectional Stigma among People Transitioning from Incarceration to Community-based HIV Care in Gauteng Province, South Africa.” AIDS Education and Prevention 33(3): 202–215.

Yang, O., Wilbourn, D., Wang, T., Kalatardi, S., Moodley, Y., and Balkrishnan, R. 2025. “Preparing for Universal Coverage: Challenges for South Africa’s Public Health System.” Integrative Journal of Medical Sciences, 12.

Zuma, K., Simbayi, L. C., and Zungu, N. 2022. “The State of HIV in South African Prisons: Implications for Prevention and Care.” South African Medical Journal 112(8): 623–629.