Abstract
BackgroundThe provision of effective health care to people with HIV and those from usually marginalised backgrounds, such as drug users and sex workers is a growing concern in Nepal, because these populations often do not seek health care, as willingly as the general population. Exploration of the factors, which hinder them seeking health care is crucial. The 'lived' experiences of the usually marginalized participants in this research will reflect on the constraining factors, and contribute to the development of appropriate strategies, which will facilitate people with HIV and other marginal populations to seek more readily appropriate health services.MethodsThis study explored the healthcare-seeking experiences of 20 HIV-positive participants in Nepal, as well as 10 drug-using participants who had never had an HIV test and did not know their HIV status. Using grounded theory, this study investigated the perceptions and experiences of HIV-positive persons, or those perceived to be at risk for HIV, as they sought health care services in locations around Kathmandu Valley.ResultsHealth professionals were perceived to lack knowledge and sensitivity in providing health care to often marginalized and stigmatized injecting drug users, sex workers and HIV-positive people. Stigma and marginalization seem to interfere with doctors' and other health professionals' decisions to voluntarily treat persons who they perceive to be at high risk for HIV infections. Doctors and other health professionals appear suspicious, even unaware, of contemporary biomedical knowledge as it relates to HIV. The fear that certain marginalized groups, such as injecting drug users and sex workers, would be infected with HIV has further intensified stigma against these groups.ConclusionThe study identified the beginning of a change in the experiences of HIV-positive people, or those at risk of HIV, in their seeking of health care. With focused, contemporary HIV education and training, the beginning of positive changes in the knowledge base and attitude of health providers seemed to be apparent to some participants of this study.
Highlights
The provision of effective health care to people with HIV and those from usually marginalised backgrounds, such as drug users and sex workers is a growing concern in Nepal, because these populations often do not seek health care, as willingly as the general population
The literature reveals that many health care providers still hesitate to provide care to people at high risk of HIV due to a fear of contracting HIV themselves [1,2,3,4]
Was the experience and phenomenon described by people with HIV similar or different from other people at risk for HIV infection, such as drug users or sex workers? the interview process included at-risk informants to enrich the emerging themes [35,38,40]
Summary
The provision of effective health care to people with HIV and those from usually marginalised backgrounds, such as drug users and sex workers is a growing concern in Nepal, because these populations often do not seek health care, as willingly as the general population. The literature reveals that many health care providers still hesitate to provide care to people at high risk of HIV due to a fear of contracting HIV themselves [1,2,3,4] Due to this fear, some doctors continue to refer people at high risk to other health facilities [1], transferring the perceived risk to other health professionals. Other studies [10,12,13,14] report that people with HIV, admitted to health institutions for treatment, are isolated, even when it involves the use of eating utensils Such experiences discourage people with HIV from seeking care from health providers
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