Determinants of unequal HIV care access among people living with HIV in Peru

Abstract

BackgroundEquity in access to health care among people living with HIV (PLHA) has not been extensively studied in Peru despite the fact there is significant social diversity within this group. We aimed to assess the extent to which health care provision to PLHA, including ARVT, was equitable and, if appropriate, identify factors associated with lower access.MethodsWe conducted a survey among adult PLHA in four cities in Peru, recruited through respondent-driven sampling (RDS), to collect information on socio-demographic characteristics, social network size, household welfare, economic activity, use of HIV-related services including ARV treatment, and health-related out-of-pocket expenses.ResultsBetween September 2008 and January 2009, 863 individuals from PLHA organizations in four cities of Peru were enrolled. Median age was 35 (IQR = 29–41), and mostly male (62%). Overall, 25% reported to be gay, 11% bisexual and 3% transgender. Most PLHA (96%) reported access to some kind of HIV-related health service, and 84% were receiving those services at a public facility. Approximately 85% of those reporting access to care were receiving antiretroviral treatment (ARV), and 17% of those not in treatment already had indication to start treatment. Among those currently on ARV, 36% percent reported out-of-pocket expenses within the last month. Transgender identity and age younger than 35 years old, were associated with lower access to health care.ConclusionsOur findings contribute to a better social and demographic characterization of the situation of PLHAs, their access to HIV care and their source of care, and provide an assessment of equity in access. In the long term, it is expected that HIV care access, as well as its social determinants, will impact on the morbidity and mortality rates among those affected by the HIV/AIDS epidemic. HIV care providers and program managers should further characterize the barriers to healthcare access and develop strategies to resolve them by means of policy change, for the benefit of the health service users and as part of the national response to the HIV/AIDS epidemic within a human rights framework.

Partner-Level Factors Associated with Insertive and Receptive Condomless Anal Intercourse Among Transgender Women in Lima, Peru

“…TW who are unaware of their HIV status may have lower access to HIV testing due to inadequate access to the formal health care system. TW in Peru have described denial of health care on the basis of their gender identity as well as stigma and discrimination when accessing HIV testing services [16, 37]. US studies have found a higher burden of stigma among TW who do not “pass,” or are not perceived by others as female without suspicion or judgment, and a better quality of life among transgender individuals who do pass [19, 38, 39].…”

Men Who Have Sex With Men in Peru: Acceptability of Medication-Assisted Therapy for Treating Alcohol Use Disorders

“…HIV prevalence has been reported to be as high as 12.4% (Ministerio de Salud, 2012) and 22% (Beyrer et al, 2013; Sanchez et al, 2007) in the capital city of Lima, compared to 0.2% in the general population (Garcia et al, 2012). TGW are markedly vulnerable to HIV/AIDS (Silva-Santisteban et al, 2012) and among PLH, age <35 years and being a TGW are associated with reduced healthcare access (Silva-Santisteban et al, 2013). HIV transmission among MSM/TGW in Peru is driven by unknown HIV status (Goodreau et al, 2012; Vagenas et al, 2014) and sexual risk behavior (Goodreau, Goicochea, & Sanchez, 2005), which is also correlated with AUDs and drug use (Ludford et al, 2013).…”

Coinfecciones transmitidas por sexo en transfemeninas VIH positivas en Managua octubre 2017 a abril 2018

“…MacCarthy et al, 2017y Socías et al, 2014 encontraron que a nivel mundial la presencia de ITS y VIH es mayor en las trans femeninas que en el resto de la población y los HSH. La creciente evidencia mundial indica que las poblaciones transgénero sufren por el VIH y otras infecciones de transmisión sexual (ITS); en particular, las mujeres transgénero que tienen Sexo con hombres y trabajadoras sexuales transgénero (Silva-Santisteban et al 2013).…”

“…La información sobre la coinfección por VIH e ITS a nivel mundial y en la región centroamericana es limitada, sin embargo, determinar la coinfección entre las trans femeninas es clave para reducir la posibilidad que éstas tienen de morir por la asociación de estas patologías (Socías et al, 2014) y (Silva-Santisteban et al 2013). Nicaragua actualmente no cuenta con registros oficiales que permitan establecer la coinfección por ITS y VIH en trans femeninas VIH positivo únicamente (Morales-Miranda et al 2014, & Sánchez, Ibarra , Tallada , Saleh-Ramírez 2013 , además éste grupo dentro de la diversidad sexual está ubicado dentro de la población de HSH, es muy disperso, no organizado lo que representa una importante limitación para la toma de decisiones en la planificación de una respuesta nacional para enfrentar el avance de la epidemia del sida a partir de las infecciones por ITS y VIH.…”