A Social-Ecological Framework to Understand Barriers to HIV Clinic Attendance in Nakivale Refugee Settlement in Uganda: a Qualitative Study

• Published in: AIDS and behavior Vol. 25; no. 6; pp. 1729 - 1736
• Main Authors: O’Laughlin, Kelli N., Greenwald, Kelsy, Rahman, Sarah K., Faustin, Zikama M., Ashaba, Scholastic, Tsai, Alexander C., Ware, Norma C., Kambugu, Andrew, Bassett, Ingrid V.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2021; Springer Nature B.V
• Subjects: Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Barriers; Community involvement; Constraints; Ecological effects; Ecological models; Health behavior; Health care expenditures; Health Psychology; Health services; HIV; HIV Infections - drug therapy; HIV Infections - prevention & control; Human immunodeficiency virus; Human settlements; Humans; Infectious Diseases; Medical appointments; Medicine; Medicine & Public Health; Original Paper; Public Health; Qualitative Research; Refugees; Social Environment; Social interactions; Social Stigma; Social support; Uganda - epidemiology; Unemployment; Uganda; Refugee; Linkage; HIV; Qualitative
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-020-03102-x

The social-ecological model proposes that efforts to modify health behaviors are influenced by constraints and facilitators at multiple levels. We conducted semi-structured interviews with 47 clients in HIV care and 8 HIV clinic staff to explore how such constraints and facilitators (individual, social environment, physical environment, and policies) affect engaging in HIV clinical care in Nakivale Refugee Settlement in Uganda. Thematic analysis revealed that participants were motivated to attend the HIV clinic because of the perceived quality of services and the belief that antiretroviral therapy improves health. Barriers to clinic attendance included distance, cost, unemployment, and climate. Those that disclosed their status had help in overcoming barriers to HIV care. Nondisclosure and stigma disrupted community support in overcoming these obstacles. Interventions to facilitate safe disclosure, mobilize social support, and provide more flexible HIV services may help overcome barriers to HIV care in this setting.