Abstract
BackgroundRefugees living with HIV in sub-Saharan Africa suffer unique hardships that may increase their vulnerability to interruptions in antiretroviral therapy (ART).MethodsTo investigate refugees’ experiences adhering to ART, we conducted inperson interviews with refugees on ART (n = 73) and HIV clinic staff (n = 4) in Nakivale Refugee Settlement in southwest Uganda from March to July 2011. Three analysts used a conventional content analysis approach to evaluate these data.ResultsRefugees described profound motivation to adhere to ART and employed adherence strategies to facilitate success despite the austere setting. However, refugees spoke of specific hardships living in Nakivale that served as barriers to ART adherence, including difficulty accessing clinic when ill, food insecurity, drug stockouts, and violence and unrest in the settlement. For some refugees, need for ART inextricably linked them to the HIV clinic and prevented them from transitioning permanently away from the settlement.ConclusionsBy learning about refugees’ experiences we can design informed interventions to enhance ART adherence, thus minimizing morbidity and mortality, preventing transmission of HIV, and supporting refugees’ abilities to move freely toward repatriation, resettlement or integration in their host country.
Highlights
Refugees living with HIV in sub-Saharan Africa suffer unique hardships that may increase their vulnerability to interruptions in antiretroviral therapy (ART)
A study comparing experiences of refugees on ART in a camp-based HIV clinic in Kenya and an urban HIV clinic in Malaysia found that in both settings, the main threats to ART adherence were migration and insecurity [17]; this is the single study on barriers to ART adherence among a refugee population in sub-Saharan Africa to date
Ensuing research at this site including refugees and Ugandan nationals that participated in HIV screening demonstrated that HIV prevalence was lower among refugees than Uganda nationals (2% vs 9% respectively) [24] and that 54% (CI: 47–60%) of newly diagnosed HIV-positive individuals link to HIV clinical care in the settlement [25]
Summary
Refugees living with HIV in sub-Saharan Africa suffer unique hardships that may increase their vulnerability to interruptions in antiretroviral therapy (ART). People living in sub-Saharan Africa face poverty-related barriers (i.e. competing demands, transport costs, food insecurity), institutional barriers (i.e. overburdened healthcare facilities, limited access to mental health care), and political/cultural barriers A study comparing experiences of refugees on ART in a camp-based HIV clinic in Kenya and an urban HIV clinic in Malaysia found that in both settings, the main threats to ART adherence were migration and insecurity (food, health system and emotional insecurity) [17]; this is the single study on barriers to ART adherence among a refugee population in sub-Saharan Africa to date
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