STIGMA AND DELAYED CARE-SEEKING IN HIV IN UKUM LOCAL GOVERNMENT AREA, NIGERIA

Abstract

HIV-related stigma remains a pervasive barrier to timely care engagement in Nigeria, contributing to late presentation, advanced disease progression, and increased mortality risk among people living with HIV (PLHIV). Despite Nigeria's substantial HIV burden, empirical evidence quantitatively linking stigma to delayed care-seeking remains limited in rural local government areas, including Ukum LGA, Benue State one of Nigeria's highest-burden states. This study examined the relationship between HIV-related stigma and delayed care-seeking among adult PLHIV in Ukum LGA. Specific objectives were to determine the level and pattern of perceived, internalised, and enacted stigma; assess the extent and duration of delayed careseeking; examine the association between stigma and delay while controlling for sociodemographic and health-system factors; and explore the lived experience and decision-making pathway shaping care-seeking behaviour. The study was guided by the Health Stigma and Discrimination Framework, integrated with Andersen's Behavioural Model of Health Services Use. A mixed-methods, explanatory sequential design was employed, combining a crosssectional survey of 422 adult PLHIV, clinical record abstraction (CD4 count, WHO clinical stage), and complemented by qualitative in-depth interviews with 12 purposively selected interview participants. Findings revealed that stigma was widespread, with internalised and perceived stigma exceeding enacted stigma. Approximately two-fifths of respondents delayed care-seeking, corroborated by lower CD4 counts and advanced clinical staging among this group. Multivariable analysis confirmed stigma as an independent predictor of delay, alongside non-disclosure and facility distance, while qualitative findings highlighted fear of exposure and anticipated rejection as key mechanisms. The study concludes that stigma is a modifiable, clinically consequential barrier requiring integrated psychosocial and structural responses, and recommends provider training, community-based service delivery, and strengthened peersupport networks in rural Nigerian LGAs.