Every afternoon, the aroma of roasted yam and plantain draws a small crowd to the corner of the street where Mama Ijeoma sets up her bole stand. Her hands move swiftly, flipping plantains with the same care she has used to raise her three children.
To her customers, she is cheerful and dependable. But a quiet silence had begun to grow where her voice once rang, especially at the local health center.
Weeks passed, and the team noticed that Mama Ijeoma had stopped coming in for her regular antiretroviral (ARV) treatment. At first, it seemed like a scheduling error. But as her file gathered dust, concern deepened.
A community health worker decided to follow up and trace her to her home. There, behind the walls she rarely let others into, Mama Ijeoma opened up.
“The health center is too open,” she said quietly, eyes avoiding contact. “I know people around there. What if someone sees me? My customers may stop coming.”
Fear, not of her condition but of being recognised, had driven her away. Each skipped dose was a silent act of self-preservation.
She had reverted to trying her luck with private pharmacies, although the results were often inconsistent and costly. Her silence was not negligence. It was stigma in slow motion.
She had never spoken her fears aloud, not until that visit. It changed something, but this time, she was not left to figure it out alone.
Two flexible options were offered to help her stay on treatment. She could either pick up her medications before the health center opened or quietly receive them through a partnered outreach initiative under the Private Refill Access Program (PRAP) that was provided by RVS (Retroviral Solutions).
She chose the second option. Even early-morning pickups at the clinic still felt too exposed. With PRAP, she now collects her refills discreetly and safely without risking recognition. Since then, she has not missed a single refill.
In a world where silence can cost lives, sometimes all it takes is a quiet, respectful option and someone to ask.
“Now I serve my customers and protect my health without fear,” she said one afternoon, her fingers dusted with ash and her face calm. “It feels like I got my balance back.”
Behind every missed appointment is a story, and often it is not about forgetfulness. It is fear. Shame. The quiet burden of being seen.
Mama Ijeoma’s story is a reminder that health is not just about pills or clinics. It is about feeling safe enough to show up.
When stigma stands in the way, people find ways to disappear quietly. But small changes like private pickups or discreet delivery can bring them back.
This is not just one woman’s experience. It is the reality for many. Structural stigma continues to reduce retention in ART programs, especially among female entrepreneurs in informal markets.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) reports have consistently shown that fear of disclosure remains a top barrier to care retention.
How many others are missing appointments not out of neglect, but fear?
What would healthcare look like if dignity were built into every delivery channel?
Sometimes, helping someone stay on treatment starts with simply protecting their dignity.