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This scares some people away from HIV health care. Patients take the whole day there [at the clinic]; one may go there at am and come back at pm. This has not encouraged me to go to the clinic. Many clients complain about the time they spend at Suubi. I feel strong and sometimes doubt the positive HIV test results. I also have a friend who told me yesterday that he has never had any sign or feeling of being unhealthy.
He has been strong all the time, but the health workers say he has HIV. I feel reluctant after I doubt my HIV status. I did not feel sick. That is the main reason why I did not enroll. I will enroll at the clinic when I start falling sick or if I see any sign.
HIV/AIDS in South Africa | Publish your master's thesis, bachelor's thesis, essay or term paper
In a program which provided free access to community-based HIV care, Thus, underutilization of HIV services among the young people remains a substantial problem in this rural setting. Perceived barriers to using HIV care services included social concerns like the fear of stigma or the negative consequences of HIV status disclosure and economic barriers like long distance to the clinic and the high transport costs, long clinic waiting time, and fear of medication.
These mainly related to lack of money to meet transport costs to the clinic and time and money lost during the long waiting hours at the clinic. These findings are similar to other studies that have shown that people with HIV frequently experience severe economic barriers to health care, which can prevent or delay diagnosis and treatment outcome Richter et al.
Transport is a known barrier for poor people to access HIV treatment and care Mshana et al. In another study, among TB-infected patients, indirect cost of care constituted important determinants of poor treatment adherence, contributing to low cure rates and high risk of death among poor and vulnerable groups Munro et al. Although information on impact of economic strengthening on uptake of HIV care services is lacking, improved uptake of HIV screening and treatment and improved treatment outcomes have been reported in some social protection interventions, such as cash transfers Boccia et al.
Findings from this study strongly highlight the importance of economic barriers to utilization of HIV care services and suggest the need to promote economic empowerment for HIV-infected young people, so as to promote access and adherence to HIV care. However, since the study was exploratory, the findings may not be generalizable. Also, due to logistical constraints, we interviewed 30 18 non-users of care and 12 providers participants who could be located and these may differ from those that were difficult to locate.
Economic barriers, particularly lack of transport money and loss of work hours due to long waiting time at the clinic, are highly prevalent as obstacles to utilization of care by this population, suggesting the need for economic strengthening for young persons living with HIV, so as to promote utilization of HIV care services. Stigma also remains a key barrier, and there is a need to provide youth-friendly services. Skip to main content Skip to sections.
Advertisement Hide. Download PDF. Article First Online: 01 May Conclusion Economic barriers are highly prevalent as obstacles to utilization of care by young people, suggesting the role of economic strengthening for young persons living with HIV, so as to promote utilization of HIV care services.
HIV/AIDS in South Africa
Interviewers were acquainted with the study geographical locations and, hence, able to trace addresses of participants. When in doubt, they utilized the services of community field guides.
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Participant tracing and interview continued until the intended sample size of 18 was complete. Twenty-three of 30 attempts to locate participants were successful. Of the 23, two individuals refused to participate due to lack of time for the interview and three had no guardian available to provide written informed consent Fig.
Open image in new window. The HBM The health belief model HBM is a psychological model that attempts to explain and predict health behaviors, by focusing on the attitudes and beliefs of individuals. Informant Characteristics In the previous study examining non-enrollment into care, 86 out of the Stigma, defined as a social process, experienced or anticipated, characterized by exclusion, rejection, blame, or devaluation that results from experience, perception, or anticipation of an adverse social judgment about a person or group Weiss et al.
In these participants, stigma manifested as expressions of fear of being seen by other people at the HIV clinic, hence unintentionally disclosing their HIV status. Participants anticipated disrespect, ill treatment, or social isolation by their peers or the community, if known to be HIV infected, as shown by the quotes below. Majority of these related to failure to find money to meet transport costs to the HIV care service points. Although services were provided free of cost to the patient at the clinics, some patients needed to travel long distances to the health unit.
The long distance, coupled with lack of transport money, posed a major barrier to entry into HIV care. The participants referred to long distance to the clinics and high transport costs as the main barriers to entry into care. Below, we highlight some of the study participant economic barriers to care seeking. IDI, Male, 20 I failed to keep the clinic appointment because I am already sick and weak yet I do not have money to take me to the clinic neither do I have a relative to help them out of any problems.
IDI, Female, 22 Some clients have failed because of the distance. One orphaned male student attending a boarding school and taken care of by non-relatives who were unaware of his positive HIV status expressed his difficulty in accessing care: I was not able to meet my appointment at the clinic because of lack of time and transport since I was far away at school.
The fear of life-long HIV medication and its side effects prevented some individuals from entering care. The need for strict drug dosing schedules created a fear of failure to adhere to health worker recommendations. One participant and one provider reported that the long waiting hours at the clinic were a barrier to entry into care.
One participant narrated how the length of time spent at the clinic by some of his HIV-positive colleagues had dissuaded him from entering HIV care. The long waiting hours translated into lost work time and money. One study participant and one provider reported that doubts about the accuracy of HIV status were a barrier to enrollment for HIV care. One HIV-positive person had received HIV testing and been counseled but doubted his status because he was still in good health and physically strong, as reported below. Feeling healthy was raised as a major reason for not seeking HIV medical care.
The absence of physical symptoms diminished the need to seek care. Althoff, K. Late presentation for human immunodeficiency virus care in the United States and Canada. Clinical Infectious Diseases, 50 11 , — CrossRef Google Scholar. Amuron, B. Mortality and loss-to follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda. BMC Public Health, 9 , Bassett, I. Loss to care and death before antiretroviral therapy in Durban, South Africa.
Journal of Acquired Immune Deficiency Syndromes, 51 2 , — Boccia, D. Cash transfer and microfinance interventions for tuberculosis control: review of the impact evidence and policy implications. Market-oriented, demand-driven health care reforms and equity in health and health care utilization in Sweden. International Journal of Health Services, 39 , — Fagan, J.
Understanding people who have never received HIV medical care: a population-based approach. Public Health Reports, 4 , — Google Scholar. Graham, S. Antiretroviral adherence and development of drug resistance are the strongest predictors of genital HIV-1 shedding among women initiating treatment. Journal of Infectious Diseases, 10 , — Granich, R. Highly active antiretroviral treatment for the prevention of HIV transmission.
beamaconsoft.ga Janz, N. The health belief model: a decade later. Health Education Quarterly, 11 1 , 1— Kamali, A. AIDS Care, 8 5 , — Losina, E. PloS One, 5 3 , e Marks, G.
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Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis. AIDS, 24 17 , — Mermin, J. Effect of co-trimoxazole prophylaxis, antiretroviral therapy, and insecticide treated bednets on the frequency of malaria in HIVinfected adults in Uganda: a prospective cohort study. The Lancet, , — Mkanta, W. Theoretical and methodological issues in conducting research related to health care utilization among individuals with HIV infection. Mshana, G. University of Tennessee Honors Thesis Projects. Ve the HIV virus, and Outline on Informative Speech.
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