“I attend at Vanguard and I attend here as well”: barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases

Abstract

BackgroundHIV and non-communicable disease (NCD) are syndemic within sub-Saharan Africa especially among older persons. The two epidemics interact with one another within a context of poverty, inequality and inequitable access to healthcare resulting in an increase in those aged 50 and older living with HIV and experiencing an NCD co-morbidity. We explore the challenges of navigating healthcare for older persons living with HIV and NCD co-morbidity.MethodsIn-depth semi-structured interviews were conducted with a small sample of older persons living with HIV (OPLWH). The perspectives of key informants were also sought to triangulate the evidence of OPLWH. The research took place in two communities on the outskirts of Cape Town, South Africa. All interviews were conducted by a trained interviewer and transcribed and translated for analysis. Thematic content analysis guided data analysis.ResultsOPLWH experienced an HIV-NCD syndemic. Our respondents sought care and accessed treatment for both HIV and other chronic (and acute) conditions, though these services were provided at different health facilities or by different health providers. Through the syndemic theory, it is possible to observe that OPLWH and NCDs face a number of physical and structural barriers to accessing the healthcare system. These barriers are compounded by separate appointments and spaces for each condition. These difficulties can exacerbate the impact of their ill-health and perpetuate structural vulnerabilities. Despite policy changes towards integrated care, this is not the experience of OPLWH in these communities.ConclusionsThe population living with HIV is aging increasing the likelihood that those living with HIV will also be living with other chronic conditions including NCDs. Thus, it is essential that health policy address this basic need to integrate HIV and NCD care.

Challenges with seeking HIV care services: perspectives of older adults infected with HIV in western Kenya

“…The cost of seeking care for multiple conditions, often offered by different healthcare providers and likely on different days was not only expressed as being expensive but also hinders continuous HIV care seeking. Our findings concur with previous studies [36,[38][39][40][41][42] conducted in developing countries including studies done by researchers in Uganda's MRC/UVRI that indicate continuous struggle faced by older adults managing HIV and other chronic diseases. Distance to the facility, cost of traveling to access care, and time [36,42] have all been cited as barriers to accessing HIV care services among HIV infected older adults.…”

“…Our findings concur with previous studies [36,[38][39][40][41][42] conducted in developing countries including studies done by researchers in Uganda's MRC/UVRI that indicate continuous struggle faced by older adults managing HIV and other chronic diseases. Distance to the facility, cost of traveling to access care, and time [36,42] have all been cited as barriers to accessing HIV care services among HIV infected older adults. These barriers have been exacerbated by persistent verticalization [42,43] of HIV care provision.…”

Older People, Mobility and Transport in Low- and Middle-Income Countries: A Review of the Research

“…A study in rural Kyrgyzstan, for example, found that one in five older people lived more than a 30-minute travel away from a health facility, with access particularly problematic for those with a limiting longstanding illness or disability [39]. The structure of health care provision is also problematic, noted by a study in South Africa of care and treatment for older people (50+) living with both HIV and other chronic conditions, which found that services were typically provided at different health facilities or by different health providers, necessitating multiple patient journeys [40].…”

Assessing the feasibility of a life history calendar to measure HIV risk and health in older South Africans

“…A final advantage of the TRHC approach is that we expected it would add more information on the social context surrounding testing decisions that is lacking in existing survey data, such as the dynamism of sexual relationships over time [7,32], the potential importance of sexual and marital histories [8], and personal health and wellness [18]. The TRHC demonstrated the distinct advantage of being less structured and more informal than a standard survey interview, but not as free form as a qualitative in-depth interview.…”

“…Currently, there are limited data on HIV testing and its correlation to health status and sexual relationships for adults transitioning to old age in HIV-endemic, African contexts. Although the HIV epidemic is aging, the focus of HIV data collection, interventions, and programming in Africa has centered on those aged 15-49 [14,15], with only a modest recent increased interest in populations outside this age range [16][17][18]. Overall, studies remain focused on younger adults (e.g., [19,20]).…”