{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:11:30Z","timestamp":1791558690232,"version":"4.3.4"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T00:00:00Z","timestamp":1697155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R34MH122323"],"award-info":[{"award-number":["R34MH122323"]}],"id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>South Africa rolled out Universal Test-and-Treat (UTT) in 2016, extending treatment eligibility to all persons living with HIV (PLHIV). We sought to understand how PLHIV in Johannesburg, South Africa, interpret and experience their HIV status, five years into the UTT era. In May 2021, we conducted in-depth interviews (IDI) (N = 27) with adult (\u226518 years) PLHIV referred by HIV counsellors at three peri-urban primary healthcare clinics. We also conducted three focus group discussions (FGDs) (N = 27) with adult PLHIV recruited from clinics or from civil society organisations through snowball sampling. Follow-up interviews were conducted with 29 IDI and FGD participants. Participants were asked to reflect on their HIV diagnosis, what their HIV status meant to them and how, if at all, being HIV-positive affected their lives. Interviews and focus group discussions were audio-recorded, transcribed, translated to English, and analysed using a grounded theory approach. Participants perceived that HIV was common, that PLHIV could live a normal life with antiretroviral therapy (ART), and that ART was widely accessible. However, HIV elicited feelings of guilt and shame as a sexually transmitted disease. Participants used the language of \u201cblame\u201d in discussing HIV transmission, citing their own reckless behaviour or blaming their partner for infecting them. Participants feared transmitting HIV to others and felt responsible for avoiding transmission. To manage transmission anxiety, participants avoided sexual relationships, chose HIV-positive partners, and\/or insisted on using condoms. Many participants feared\u2013or had previously experienced\u2013rejection by partners due to their HIV status and reported hiding their medication, avoiding disclosure, or avoiding relationships altogether. Most participants were not aware that undetectable HIV is untransmittable (U = U). Participants who were aware of U = U expressed less anxiety about transmitting HIV to others and greater confidence in having relationships. Despite perceiving HIV as a manageable chronic condition, PLHIV still faced transmission anxiety and fears of rejection by their partners. Disseminating information on U = U could reduce the psychosocial burdens of living with HIV, encourage open communication with partners, and remove barriers to HIV testing and treatment adherence.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000829","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T17:22:00Z","timestamp":1697217720000},"page":"e0000829","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["\u201cI was scared dating\u2026 who would take me with my status?\u201d\u2014Living with HIV in the era of UTT and U = U: A qualitative study in Johannesburg, South Africa"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1856-6358","authenticated-orcid":true,"given":"Tembeka","family":"Sineke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorina","family":"Onoya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8054-0116","authenticated-orcid":true,"given":"Idah","family":"Mokhele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Refiloe","family":"Cele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7842-6955","authenticated-orcid":true,"given":"Shubhi","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patience","family":"Sigasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandisa","family":"Dukashe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laila","family":"Hansrod","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Inglis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5112-8536","authenticated-orcid":true,"given":"Jacob","family":"Bor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,13]]},"reference":[{"key":"pgph.0000829.ref001","first-page":"232","article-title":"AIDS and its metaphors","author":"S. Sontag","year":"1997","journal-title":"The disability studies reader"},{"issue":"3","key":"pgph.0000829.ref002","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1177\/1359105307076229","article-title":"Dying Twice\u2019 A Multi-level Model of the Roots of AIDS Stigma in Two South African Communities","volume":"12","author":"C Campbell","year":"2007","journal-title":"Journal of health psychology"},{"issue":"1","key":"pgph.0000829.ref003","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jana.2004.11.002","article-title":"Suffering, shame, and silence: The stigma of HIV\/AIDS","volume":"16","author":"L Duffy","year":"2005","journal-title":"Journal of the Association of Nurses in AIDS Care"},{"issue":"6","key":"pgph.0000829.ref004","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1002\/casp.897","article-title":"Church leaders confront HIV\/AIDS and stigma: a case study from Tanzania.","volume":"16","author":"KA Hartwig","year":"2006","journal-title":"Journal of Community & Applied Social Psychology"},{"issue":"1","key":"pgph.0000829.ref005","first-page":"55","article-title":"Examining the actions of faith-based organizations and their influence on HIV\/AIDS-related stigma: a case study of Uganda","volume":"7","author":"E Otolok-Tanga","year":"2007","journal-title":"African health sciences"},{"issue":"9","key":"pgph.0000829.ref006","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1016\/j.socscimed.2007.01.006","article-title":"Internalized stigma, discrimination, and depression among men and women living with HIV\/AIDS in Cape Town, South Africa.","volume":"64","author":"LC Simbayi","year":"2007","journal-title":"Social Science & Medicine"},{"issue":"3","key":"pgph.0000829.ref007","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1548-1387.2008.00023.x","article-title":"Coded talk, scripted omissions: The micropolitics of AIDS talk in an affected community in South Africa","volume":"22","author":"K Wood","year":"2008","journal-title":"Medical Anthropology Quarterly"},{"issue":"2","key":"pgph.0000829.ref008","first-page":"49","article-title":"Fear of stigmatization as barrier to voluntary HIV counselling and testing in South Africa","volume":"5","author":"AER Bos","year":"2008","journal-title":"East Afr J Public Health"},{"issue":"4","key":"pgph.0000829.ref009","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1080\/09540120701203931","article-title":"HIV testing and disclosure: a qualitative analysis of TB patients in South Africa","volume":"19","author":"A Daftary","year":"2007","journal-title":"AIDS care"},{"issue":"10","key":"pgph.0000829.ref010","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1080\/09540120701854634","article-title":"Factors facilitating and challenging access and adherence to antiretroviral therapy in a township in the Zambian Copperbelt: a qualitative study","volume":"20","author":"E Grant","year":"2008","journal-title":"AIDS care"},{"issue":"3","key":"pgph.0000829.ref011","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1080\/14681810903059078","article-title":"Male youth and Voluntary Counseling and HIV-Testing: the case of Malawi and Uganda","volume":"9","author":"CO Izugbara","year":"2009","journal-title":"Sex Education"},{"key":"pgph.0000829.ref012","doi-asserted-by":"crossref","first-page":"18640","DOI":"10.7448\/IAS.16.3.18640","article-title":"Impact of HIV\u2010related stigma on treatment adherence: systematic review and meta\u2010synthesis","volume":"16","author":"IT Katz","year":"2013","journal-title":"Journal of the International AIDS Society"},{"issue":"1","key":"pgph.0000829.ref013","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1177\/1043659605281978","article-title":"Voluntary HIV counseling and testing: knowledge and practices in a rural South African village","volume":"17","author":"G. Mabunda","year":"2006","journal-title":"Journal of Transcultural Nursing"},{"issue":"7","key":"pgph.0000829.ref014","doi-asserted-by":"crossref","first-page":"e261","DOI":"10.1371\/journal.pmed.0030261","article-title":"Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns","volume":"3","author":"SD Weiser","year":"2006","journal-title":"PLoS medicine"},{"issue":"4","key":"pgph.0000829.ref015","doi-asserted-by":"crossref","first-page":"e1001418","DOI":"10.1371\/journal.pmed.1001418","article-title":"Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies","volume":"10","author":"LF Johnson","year":"2013","journal-title":"PLoS medicine"},{"issue":"7","key":"pgph.0000829.ref016","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1377\/hlthaff.2012.0407","article-title":"In a study of a population cohort in South Africa, HIV patients on antiretrovirals had nearly full recovery of employment","volume":"31","author":"J Bor","year":"2012","journal-title":"Health affairs"},{"issue":"12","key":"pgph.0000829.ref017","doi-asserted-by":"crossref","first-page":"e25647","DOI":"10.1002\/jia2.25647","article-title":"Pathways for reduction of HIV\u2010related stigma: a model derived from longitudinal qualitative research in Kenya and Uganda","volume":"23","author":"CS Camlin","year":"2020","journal-title":"Journal of the International AIDS Society"},{"key":"pgph.0000829.ref018","unstructured":"UNAIDS. Country factsheets South Africa 2020 [Available from: https:\/\/www.unaids.org\/en\/regionscountries\/countries\/southafrica."},{"key":"pgph.0000829.ref019","unstructured":"Forum SAPP. Quality of HIV care higher in clinics than hospitals 2021 [Available from: https:\/\/sappf.co.za\/news\/413964."},{"key":"pgph.0000829.ref020","unstructured":"NDoH. National Policy on HIV Pre-exposure Prophylaxis (PrEP) and Test and Treat (T&T). Pretoria: National Department of Health. 2016."},{"key":"pgph.0000829.ref021","unstructured":"NDOH. Fast tracking implementation of the 90-90-90 strategy for HIV, through implementation of the test and treat (TT) policy and same-day anti-retroviral therapy (ART) initiation for positive patients. Pretoria, South Africa: National Department of Health (NDOH) 2017."},{"issue":"5","key":"pgph.0000829.ref022","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1097\/QAI.0000000000001011","article-title":"HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003\u20132013","volume":"72","author":"BT Chan","year":"2016","journal-title":"JAIDS Journal of Acquired Immune Deficiency Syndromes"},{"issue":"1","key":"pgph.0000829.ref023","doi-asserted-by":"crossref","first-page":"27","DOI":"10.2989\/16085906.2018.1552163","article-title":"I don\u2019t want them to know\u201d: how stigma creates dilemmas for engagement with treat-all HIV care for people living with HIV in Eswatini","volume":"18","author":"S Horter","year":"2019","journal-title":"African Journal of AIDS Research"},{"issue":"4","key":"pgph.0000829.ref024","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1177\/0956462418813047","article-title":"Treatment adherence in HIV stigmatized environments in South Africa: stigma avoidance and medication management.","volume":"30","author":"SC Kalichman","year":"2019","journal-title":"International journal of STD & AIDS"},{"issue":"5","key":"pgph.0000829.ref025","first-page":"1583","article-title":"Is HIV Post-test Counselling Aligned with Universal Test and Treat Goals?","volume":"25","author":"T Mabuto","year":"2021","journal-title":"A Qualitative Analysis of Counselling Session Content and Delivery in South Africa. AIDS and Behavior"},{"issue":"8","key":"pgph.0000829.ref026","first-page":"596","article-title":"Perceived efficacy of HIV treatment-as-prevention among university students in Johannesburg, South Africa. Sexually transmitted infections","volume":"97","author":"J Bor","year":"2021"},{"issue":"12","key":"pgph.0000829.ref027","doi-asserted-by":"crossref","first-page":"4209","DOI":"10.1007\/s10461-021-03296-8","article-title":"Changing knowledge and attitudes towards HIV treatment-as-prevention and \u201cUndetectable = Untransmittable\u201d: A systematic review","volume":"25","author":"J Bor","year":"2021","journal-title":"AIDS and Behavior"},{"key":"pgph.0000829.ref028","unstructured":"RePORT N. Integrating U = U into HIV counseling in South Africa (INTUIT-SA) 2020 [Available from: https:\/\/reporter.nih.gov\/search\/Ek4tFJQaLE6aKgl6hX1l_g\/project-details\/10082738."},{"key":"pgph.0000829.ref029","unstructured":"RePORT N. Integrating U = U into HIV counseling in South Africa (INTUIT-SA) 2021 [Available from: https:\/\/reporter.nih.gov\/search\/Ek4tFJQaLE6aKgl6hX1l_g\/project-details\/10227801"},{"issue":"2","key":"pgph.0000829.ref030","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qual Res Psychol"},{"issue":"8","key":"pgph.0000829.ref031","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.2105\/AJPH.2015.302716","article-title":"HIV Treatment Scale-Up and HIV-Related Stigma in Sub-Saharan Africa: A Longitudinal Cross-Country Analysis","volume":"105","author":"BT Chan","year":"2015","journal-title":"American journal of public health"},{"issue":"1","key":"pgph.0000829.ref032","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1080\/17441692.2020.1851743","article-title":"The end of AIDS? HIV and the new landscape of illness in rural South Africa","volume":"17","author":"SA Mojola","year":"2022","journal-title":"Global Public Health"},{"issue":"1","key":"pgph.0000829.ref033","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/1467-9566.13208","article-title":"Universal HIV testing and treatment and HIV stigma reduction: a comparative thematic analysis of qualitative data from the HPTN 071 (PopART) trial in South Africa and Zambia","volume":"43","author":"L Viljoen","year":"2021","journal-title":"Sociology of Health & Illness"},{"issue":"14","key":"pgph.0000829.ref034","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1097\/QAD.0000000000002658","article-title":"The effect of universal testing and treatment on HIV stigma in 21 communities in Zambia and South Africa","volume":"34","author":"AL Stangl","year":"2020","journal-title":"AIDS (London, England)"},{"key":"pgph.0000829.ref035","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jad.2021.03.027","article-title":"The Association between HIV-Stigma and Depressive Symptoms among People Living with HIV\/AIDS: A Systematic Review of Studies Conducted in South Africa","volume":"287","author":"JR MacLean","year":"2021","journal-title":"Journal of Affective Disorders"},{"issue":"2","key":"pgph.0000829.ref036","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1080\/09540121.2012.689810","article-title":"Changing patterns in HIV\/AIDS stigma and uptake of voluntary counselling and testing services: the results of two consecutive community surveys conducted in the Western Cape, South Africa","volume":"25","author":"S Mall","year":"2013","journal-title":"AIDS care"},{"issue":"11","key":"pgph.0000829.ref037","doi-asserted-by":"crossref","first-page":"6597","DOI":"10.3390\/ijerph19116597","article-title":"Voluntary Counseling and Testing, Antiretroviral Therapy Access, and HIV-Related Stigma: Global Progress and Challenges","volume":"19","author":"EA Armstrong-Mensah","year":"2022","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"pgph.0000829.ref038","author":"Assembly UG","year":"2016"},{"issue":"2","key":"pgph.0000829.ref039","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s10461-007-9307-7","article-title":"Processes and outcomes of HIV serostatus disclosure to sexual partners among people living with HIV in Uganda","volume":"12","author":"R King","year":"2008","journal-title":"AIDS and Behavior"},{"issue":"4","key":"pgph.0000829.ref040","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s10508-006-9043-5","article-title":"Diminished sexual activity, interest, and feelings of attractiveness among HIV-infected women in two eras of the AIDS epidemic","volume":"35","author":"K Siegel","year":"2006","journal-title":"Arch Sex Behav"},{"key":"pgph.0000829.ref041","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1186\/1471-2458-11-633","article-title":"Changes in sexual desires and behaviours of people living with HIV after initiation of ART: implications for HIV prevention and health promotion","volume":"11","author":"J Wamoyi","year":"2011","journal-title":"BMC Public Health"},{"issue":"1","key":"pgph.0000829.ref042","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1136\/sti.2006.019893","article-title":"Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa","volume":"83","author":"LC Simbayi","year":"2007","journal-title":"Sexually transmitted infections"},{"issue":"1","key":"pgph.0000829.ref043","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-6963-14-276","article-title":"HIV\/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda","volume":"14","author":"LM Atuyambe","year":"2014","journal-title":"BMC Health Services Research"},{"issue":"25","key":"pgph.0000829.ref044","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.1056\/NEJMp2113118","article-title":"A Failure to Disseminate Transformative Science-HIV Treatment as Prevention, 10 Years On","volume":"385","author":"J Bor","year":"2021","journal-title":"The New England journal of medicine"},{"issue":"1","key":"pgph.0000829.ref045","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1080\/09540121.2021.1956415","article-title":"Investigating the effect of undetectable\u2009 = \u2009untransmittable message frames on HIV stigma: an online experiment","volume":"34","author":"R Coyne","year":"2022","journal-title":"AIDS Care"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000829","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T17:22:29Z","timestamp":1697217749000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000829"}},"subtitle":[],"editor":[{"given":"Sarah E.","family":"Brewer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,10,13]]},"references-count":45,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0000829","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,13]]}}}