"Being seen" at the clinic

10 February, 2019

(with thanks to HIFA volunteer John Eyers)

Citation, abstract, highlights,and selected extracts below. Full text here: https://www.sciencedirect.com/science/article/pii/S1353829218306087?via%...

CITATION: "Being seen" at the clinic: Zambian and South African health worker reflections on the relationship between health facility spatial organisation and items and HIV stigma in 21 health facilities, the HPTN 071 (PopART) study.

Health and Place. 55 (pp 87-99), 2019. Date of Publication: January 2019.

Bond V.; Nomsenge S.; Mwamba M.; Ziba D.; Birch A.; Mubekapi-Musadaidzwa C.; Vanqa N.; Viljoen L.; Pliakas T.; Ayles H.; Hargreaves J.; Hoddinott G.; Stangl A.; Seeley J.

ABSTRACT: Health workers in 21 government health facilities in Zambia and South Africa linked spatial organisation of HIV services and material items signifying HIV-status (for example, coloured client cards) to the risk of People Living with HIV (PLHIV) ‘being seen’ or identified by others. Demarcated HIV services, distinctive client flow and associated-items were considered especially distinguishing. Strategies to circumvent any resulting stigma mostly involved PLHIV avoiding and/or reducing contact with services and health workers reducing visibility of PLHIV through alterations to structures, items and systems. HIV spatial organisation and item adjustments, enacting PLHIV-friendly policies and wider stigma reduction initiatives could combined reduce risks of identification and enhance the privacy of health facility space and diminish stigma.


Spatial dimensions of stigma are linked to accessing HIV treatment in clinics.

Distinct demarcation and client flow trigger visibility of People Living with HIV.

Approaching HIV services carries a social risk of unwanted disclosure for PLHIV.

Thoughtful spatial organisation and labelling reduces the chance of “being seen”.


“The colour coded clinic cards makes PLHIV feel uncomfortable because it identifies them as HIV positive to the public”

“Another thing that causes people not to go for treatment at the clinic is that there is one clinic building and then behind the clinic there is another one designated to people who have TB and those who are HIV positive. So, no matter what I have gone to the clinic for, as soon as I go around to the back, people already look at me and conclude about me”

“We find empty bottles of medicines thrown away. Patients would rather put the drugs in their bags without their actual containers because they feel people will know they went to collect their drugs…three quarters you will find that they go into private rooms to remove the drugs from their containers…others remove their drugs [to put] in plastic bags, for the fear that maybe even family members might see the bottle”


Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is the coordinator of HIFA-Zambia and the HIFA campaign (Healthcare Information For All - www.hifa.org ) and current chair of the Dgroups Foundation (www.dgroups.info), which supports 700 communities of practice for international development, social justice and global health. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org