Testing experiences of HIV positive refugees in Nakivale Refugee Settlement in Uganda: informing interventions to encourage priority shifting

Kelli N O’Laughlin,Norma C Ware,Shada A Rouhani,Zikama M Faustin

doi:10.1186/1752-1505-7-2

Kelli N O’Laughlin, Norma C Ware + Show 2 more

Open Access

https://doi.org/10.1186/1752-1505-7-2

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Abstract

BackgroundRecent initiatives by international health and humanitarian aid organizations have focused increased attention on making HIV testing services more widely available to vulnerable populations. To realize potential health benefits from new services, they must be utilized. This research addresses the question of how utilization of testing services might be encouraged and increased for refugees displaced by conflict, to make better use of existing resources.MethodsOpen-ended interviews were conducted with HIV-infected refugees (N=73) who had tested for HIV and with HIV clinic staff (N=4) in Nakivale Refugee Settlement in southwest Uganda. Interviews focused on accessibility of HIV/AIDS-related testing and care and perspectives on how to improve utilization of testing services. Data collection took place at the Nakivale HIV/AIDS Clinic from March to July of 2011. An inductive approach to data analysis was used to identify factors related to utilization.ResultsIn general, interviewees report focusing daily effort on tasks aimed at meeting survival needs. HIV testing is not prioritized over these responsibilities. Under some circumstances, however, HIV testing occurs. This happens when: (a) circumstances realign to trigger a temporary shift in priorities away from daily survival-related tasks; (b) survival needs are temporarily met; and/or (c) conditions shift to alleviate barriers to HIV testing.ConclusionHIV testing services provided for refugees must be not just available, but also utilized. Understanding what makes HIV testing possible for refugees who have tested can inform interventions to increase testing in this population. Intervening by encouraging priority shifts toward HIV testing, by helping ensure survival needs are met, and by eliminating barriers to testing, may result in refugees making better use of existing testing services.

Highlights

Recent initiatives by international health and humanitarian aid organizations have focused increased attention on making human immunodeficiency virus (HIV) testing services more widely available to vulnerable populations
Sub-Saharan Africa is home to 68% of the global population living with HIV/acquired immune deficiency syndrome (AIDS), and to two million refugees displaced by conflict [1,2,3]
This paper provides information from a qualitative study to inform development of interventions to improve HIV testing service utilization in refugee settlements

Summary

Introduction

Recent initiatives by international health and humanitarian aid organizations have focused increased attention on making HIV testing services more widely available to vulnerable populations. This research addresses the question of how utilization of testing services might be encouraged and increased for refugees displaced by conflict, to make better use of existing resources. AIDS (UNAIDS), and the United Nations High Commissioner for Refugees (UNHCR), have set goals to scale up HIV testing and comprehensive services for all people, including vulnerable populations facing humanitarian crisis [10,11,12,13,14,15]. Widespread programmatic response has resulted in increased availability of HIV testing and care services for refugees. UNHCR data show that, despite regional variations, many internally displaced peoples and refugees have access to HIV testing and other comprehensive services [20]. Behavioral surveillance surveys conducted by UNHCR in Kenya, Tanzania and Uganda in 2004/2005 and again in 2010, show that the percentage of participants who have had an HIV test and received results in the previous 12 months increased considerably over the study period [21]

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