Exploring HIV Care Services within the Framework of Universal Health Coverage in a Low-Resource Setting of Zimbabwe

Abstract

Universal Health Coverage (UHC) is celebrated for expanding access to comprehensive, quality healthcare without financial hardship; however, its effectiveness in reducing health disparities in Africa depends on the equity and quality of care delivery. This study explored the lived experiences of rural women living with HIV in Zimbabwe, examining how health system design and provider practices influence well-being, stigma, and health equity. A qualitative, exploratory design was employed, using purposive sampling for in-depth semi-structured interviews and focus group discussions (FGDs). Forty participants were recruited (16 interviews and 24 FGDs), with data saturation achieved. Data were analysed thematically following Braun and Clarke’s six-phase framework. Findings reveal persistent gaps between service availability and patient-centredness. While community-based support groups for people living with HIV (PLHIV) foster resilience, dignity, and social solidarity, institutional care often fails to safeguard patient confidentiality and respect. Public disclosure of HIV status in hospital settings exemplifies these breaches, undermining trust and perpetuating stigma and structural inequities within the health system. Three key themes emerged: (1) Breaches of Confidentiality and Compromised Privacy; (2) Resilient Sources of Dignity and Psychosocial Support; and (3) Loss of Dignity and Respect in Patient Care. The study concludes that achieving UHC requires integrating privacy, personalisation, and respect for patient agency into the design and delivery of health services. Strengthening these person-centred elements is crucial for developing resilient, equitable, and genuinely patient-centred health systems.