Barriers to antiretroviral therapy : a case study of person`s living with HIV/AIDs in Nairobi, Kenya
Wasonga, John Gregory
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Context: An estimated 5 million people became infected with HIV worldwide in 2003, and 700,000 of these were children. Over the next decade, without effective treatment and care, UNAIDS predicts that these people will join the ranks of the more than 20 million people who have died of AIDS since the first clinical evidence of the disease was reported in 1981. By the end of 2003, Kenya had lost 1.5 million people to AIDS, and population-based national HIV prevalence rates stood at 7%. Between 300 and 500 Kenyans were dying daily due to AIDS in 2003, with the number eligible for HIV treatment some 180,000 adults and children. The steep increases in HIV / AIDS caseloads in Kenya in the last two decades occurred on the background of crumbling health infrastructure, demoralised health workers, perennial shortages of essential medical supplies, persistent HIV stigma, and increasing poverty in the population. The Government of Kenya inaugurated a public sector HIV treatment program in September 2003. However, despite the apparent improved access, only some 10,000 Kenyans were on antiretroviral therapy at the end of 2003. It was against this background that a descriptive cross-sectional study was conducted among PL WHA in Nairobi in January and February 2004 to investigate their felt barriers to antiretroviral therapy. Objective: The purpose of this study was to investigate and document client-felt barriers to antiretroviral therapy and suggest ways of overcoming the barriers based on these experiences. Materials and Methods: This was a descriptive cross-sectional survey targeting PL WHA, both on ARVs and not on ARVs, living in informal settlements and those presenting for .care at selected health facilities within Nairobi. Purposive sampling was used to select study sites. Data collection methods used were structured interviews, focus group discussions and key informant interviews. Results: A total of 484 respondents were included in the study, comprising 397 structured interviews, 76 participants in FGDs and 11 key informant interviews. Females comprised 71 % of ail respondents interviewed. Mean age of respondents was 36.2 years, and 37.5% were married. About 45% had secondary education or higher, with 60% reporting incomes below KShs 5000 a month (1 US$ = 80 KShs). Only 90 out of 397 (22.7%) respondents were on ARVs, and of these, 52 were women. Thirty three percent of men interviewed were on ARVs (n=114), as compared to only 18% of the women who were on ARVs (n=283). The main client-felt barriers to HN care were long waiting times (24.7%), frequent shortage of medical supplies (22%) and high cost of medical care (21.4%). Qualitative methods revealed stigma and fear of HN disclosure as key barriers to medical care. Seventy seven percent of respondents were not on HAART. Specific barriers to HAART reported were high cost of treatment (57.8%), lack of adequate information on ART benefits (33%) and fear of side effects (25.9%). About 13% said they didn't know where to get ARVs while 10% were on alternative (herbal) medicine. From qualitative methods, the main barriers reported were cost of drugs and laboratory monitoring, an exaggerated fear of ARV side effects, stigma and discrimination against PL WHA, and information gaps and myths surrounding ARVs. Conclusions: PL WHA in Nairobi, Kenya, face multiple barriers to antiretroviral therapy. The study revealed a gender disparity in accessing HAART, which tended to favour males over females. From the WTP analysis, PL WHA in Nairobi, Kenya, are willing to pay for HAART with a mean ofKShs 428 or US$ 5.28 a month. Recommendations: The study findings call for an increase in the number of centres offering HIV care and treatment, and constant availability of medical supplies. The current co¬payment system in Kenya should be revised to increase access to HN care for vulnerable groups. Also needed at national level are HN stigma reduction programmes and treatment literacy initiatives on antiretroviral therapy.