Barriers and facilitators of linkage to HIV care among HIV-infected young Chinese men who have sex with men: a qualitative study

Abstract

BackgroundThe Four Free and One Care Policy (HIV/AIDS-related free services) has been in place in China since 2004. However, linkage to human immunodeficiency virus (HIV) care is not yet achieved very well among people living with HIV. We conducted a qualitative study to explore individual and contextual factors that may influence a linkage to HIV care from the perspective of young HIV-infected men who have sex with men (MSM) in a highly centralized HIV care context of China.MethodsPurposive sampling was used to recruit 21 HIV-infected MSM in Shandong Province, with in-depth interviews conducted between March and July 2015. Thematic content analysis was subsequently used for data analysis.ResultsKey barriers and facilitators related to a linkage to HIV care emerged from participants’ narratives. The barriers included perceived healthy status, low health literacy, and stigma associated with receiving HIV care. The facilitators included an awareness of responsibility, knowledge associated with health literacy, social support, and trusting and relying on services provided by the Center for Disease Control and Prevention (CDC) and the government. These were related to the quality of current HIV counselling and testing, service promotion, and the cost and placement of these HIV services.ConclusionsIn order to improve the MSM linkage to HIV care in China, it is imperative to improve the quality of the current on-going counselling and testing. Further critical linkage support includes increasing supportive services among local CDC systems, designated hospitals and community-based organizations (CBOs), and more financial support for HIV/AIDS related testing, medical checkups and treatments.

Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making

“…37 Support from family and friends was important for care engagement in this study, and has also been recognized as a facilitator to care engagement in other settings. 14,38,39 Similarly, lack of knowledge regarding HIV care has been cited as a barrier to care in other studies, and was associated with delays in care engagement in Latinos living along the US/Mexico border. 40,41 However, several findings in this study offer new insights into the challenge of care engagement not previously described in the literature.…”

“…HIV-related stigma is a wellacknowledged barrier to care throughout the globe, found commonly in communities of color and social and gender minorities. 13,35,[37][38][39][40]42 The vast majority of patients interviewed for this study, regardless of Missed or Arrived initial visit status, described experiences with stigma and the pro-found impact that living with HIV had on their personal and professional relationships. In this study, the structured sample design allowed for comparison of perspectives between Missed and Arrived groups and revealed distinct differences in their descriptions of stigma.…”

“Our Tradition Our Enemy”: A Qualitative Study of Barriers to Women’s HIV Care in Jimma, Southwest Ethiopia

“…Evidence shows that reasons for the high burden of HIV among women included personal factors (e.g., denial, mental illness, drug use, lack of trust, perceived health status, misconception) [10][11][12][13][14], social factors (e.g., stigma and discrimination, preference for traditional medicine) [10,[15][16][17][18][19][20][21][22], financial factors (e.g., cost for medications for opportunistic infections, visiting health care facilities) [10,11,16,23], geographic and transportation factors (e.g., distance, transportation availability) [10,[24][25][26][27][28], and barriers within the health system (e.g., length of appointments, waiting time) [10,[29][30][31]. In addition, global literature revealed that socio-cultural issues such as gender roles, norms, and disempowerment appeared to be leading factors both in potential risk of HIV infection and against effective HIV care and treatment in women [32].…”

HIV-related stigma among people living with HIV/AIDS in rural Central China

“…Numerous studies have shown that stigma is associated with poor adherence to antiretroviral therapy (ART) [ 2 ], mental health disorders such as loneliness, depression and anxiety [ 3 ], non-disclosure of HIV status, and overall poor health outcomes [ 4 , 5 ]. Because stigma continues to be a major barrier to seeking HIV testing, care, and treatment services [ 6 , 7 ], it is recognized as a priority for both primary and secondary prevention of HIV and AIDS [ 8 , 9 ]. Definitions and discussion of different forms of HIV related stigma have been described previously [ 10 ].…”