A socio-ecological analysis of factors influencing HIV treatment initiation and adherence among key populations in Papua New Guinea

Elke Mitchell,Somu Nosi,Michelle Redman-Maclaren,Ruthy Boli-Neo,Sophie Ase,Parker Hou,John M Kaldor,Barne Willie,Steven G Badman,Rebecca Narokobi,Herick Aeno,Martha Kupul,Angelyn Amos,Angela Kelly-Hanku,Avi Hakim,Andrew J Vallely

doi:10.1186/s12889-021-12077-w

Abstract

BackgroundIn Papua New Guinea (PNG) members of key populations, including female sex workers (FSW), men who have sex with men (MSM) and transgender women (TGW), have higher rates of HIV compared to the general adult population and low engagement in HIV care. This paper examines the socio-ecological factors that encourage or hinder HIV treatment initiation and adherence among HIV positive members of key populations in PNG.MethodsAs part of a larger biobehavioural survey of key populations in PNG, 111 semi-structured interviews were conducted with FSW, MSM and TGW, of whom 28 identified as living with HIV. Interviews from 28 HIV positive participants are used in this analysis of the influences that enabled or inhibited HIV treatment initiation and treatment adherence.ResultsEnablers included awareness of the biomedical benefits of treatment; experiences of the social, familial and health benefits of early treatment initiation and adherence; support provided by family and friends; and non-judgmental and supportive HIV service provision. Factors that inhibited treatment initiation and adherence included perception of good health and denial of HIV diagnosis; poor family support following positive diagnosis; and anonymity and stigma concerns in HIV care services.ConclusionExploring health promotion messages that highlight the positive health impacts of early treatment initiation and adherence; providing client-friendly services and community-based treatment initiation and supply; and rolling out HIV viral load testing across the country could improve health outcomes for these key populations.

Highlights

In Papua New Guinea (PNG) members of key populations, including female sex workers (FSW), men who have sex with men (MSM) and transgender women (TGW), have higher rates of Human immunodeficiency virus (HIV) compared to the general adult population and low engagement in HIV care
In a national context where sex work and male-to-male sex are illegal and highly stigmatised and HIV prevalence is concentrated among key populations, our findings demonstrate a range of socio-ecological influences that can either encourage or inhibit HIV treatment initiation and adherence among these populations in PNG
Several qualitative studies have examined living with HIV, including treatment beliefs and experiences, in PNG, to our knowledge, our analysis is the first to solely focus on and explore the experiences of key populations relating to antiretroviral therapy (ART) and adherence in this setting

Summary

Introduction

In Papua New Guinea (PNG) members of key populations, including female sex workers (FSW), men who have sex with men (MSM) and transgender women (TGW), have higher rates of HIV compared to the general adult population and low engagement in HIV care. Key populations, including female sex workers (FSW), men who have sex with men (MSM) and transgender women (TGW), have increased risk of acquiring HIV and experience a greater burden of disease compared to the general adult population [1,2,3]. In Papua New Guinea (PNG), sex work and male-tomale sex are illegal and highly stigmatised [16] In this setting key populations including FSW, MSM and TGW are vulnerable to HIV due to high prevalence of HIV-related risk behaviours, including concurrent sexual partnerships, low condom use and high prevalence of sexually transmissible infections [17, 18]. For a detailed description of the methodology used, including reasons for combining MSM and TGW into a single survey, see the Kauntim mi tu study report [17]

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