Non-use of Antiretroviral Therapy by eligible HIV infected persons in Uganda: a case study of Kampala District
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Antiretroviral Therapy has become more universally accessible in Uganda mainly because of the recent national roll-out of free ARVs in all regional referral hospitals, level IV health centers (mini-hospitals) as well as other missionary hospitals. Before the roll-out of ART, concerns were about access to treatment, but that has dramatically changed with the MOH ART roll-out strategy. Concerns are now much more on ART uptake and adherence. This study is therefore about non-use of antiretroviral therapy by eligible HIV infected persons in Uganda amidst increased ARV availability. The principal objective of this study is to examine non use of ART by eligible PLWHA in Kampala district. Given the importance of ARVs in the fight against HIV/AIDS, this study attempted to find out the factors which were responsible for the low user rates of ART services among eligible persons despite availability and eased access to HIV treatment. A sample of 60 respondents and informants was purposively selected. ART Non users were 25, ART users 20, 10 were caretakers and 5 were service providers. Interview guides were used to collect data for the study and this data was analyzed using themes and coding categories and later reported using quotations and vivid descriptions. Findings show that although 26 ART eligible women were in need of ARVs, only 8 were utilizing ART services and the opposite was true for their male counterparts who positively utilized ARVs and reasons ranged from fear of spouse dissertation on disclosure or mere lack of empowerment whereby some women did not use ART because their husbands had forbidden them. Knowledge about ART varied from person to person although importantly, all respondents had reasonable information; general awareness about ART to enable them to start treatment. Notably, there were gaps in information dissemination systems with Service providers being the principal information dissemination source. PLWHA advanced various reasons for non use or delayed ART use. Among these were fear of ARV side effects sighting physical weaknesses, adverse skin reactions, and eventual death experienced by people known to them. Dietary/nutrition restrictions also came out strongly with a bias towards inability to afford at least two meals a day and failure to do away with toxic/alcohol consumption as advised by health providers when dozing with ARVs. Fear of pill burden was advanced as well – the administration of multiple pills a day for life was considered unthinkable for one particular lady therefore her decline of ARVs as HIV treatment. Efficacy of ARVs was questioned; many non users advising that ARVs do not work therefore the resort to alternative treatments like spiritual healing and herbal / traditional medicine. Other factors advanced for ART non-use among eligible PLWHA were considered to be social; factors like fear of social consequences of ART; these being: fear of being discriminated against as an HIV patient, fear of rejection by loved ones, fear of being stereotyped among other reasons. Insufficient social support received from family members and communities also came out strongly. Some service related factors were echoed, factors like rudeness of service providers, insufficient time accorded to patients and proximity or long distances to health units that culminated into high transport fares not affordable for some PLWHA. PLWHA were found to have general awareness of HIV treatment and therefore equipped with sufficient information on where to access ARVs. However, despite this awareness, many had not yet enrolled for treatment and reasons mainly revolved around social issues; emphasizing the social dimensional nature of HIV/AIDS and ART. Recommendations therefore focused on addressing social constraints to HIV treatment as viewed by PLWHA and among these are: Campaigns to bring men on board, continuous sensitization of masses on HIV/AIDS addressing social burdens like stigma and discrimination, disclosure - loss of confidentiality fears, spouse desertion, rejection by loved ones and domestic violence. Also bringing HIV/AIDS services closer to people through extending ART services to HCIII would go a long way in addressing transport and proximity problems. Continuous provision of refresher courses for service providers and training all Maternal and Child Health (MCH) staff in essential ART related services would also greatly reduce the doctor workload and increase doctor patient ratio in ART service provision.