College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
Department of Infectious Diseases, Regional Hospital of Loreto, Iquitos, Peru.
BMC Public Health. 2020 May 19;20(1):728. doi: 10.1186/s12889-020-08745-y.
HIV-related incidence and mortality is increasing across Peru, with highest mortality rates recorded in the Amazonian region of Loreto. This epidemic is concentrated in men who have sex with men, a population with 14% HIV treatment adherence despite free national provision. This study investigates barriers and facilitators to following healthcare advice through experiences and perceptions of HIV-positive men who have sex with men and healthcare professionals in Loreto.
Twenty qualitative interviews with HIV-positive men who have sex with men and one focus group with HIV-specialist healthcare professionals were conducted in Loreto, January-February 2019. Interviews were transcribed per verbatim. Thematic content analysis and deviant case analysis were used.
A culture of isolation and discrimination was identified, propagated by poor public knowledge surrounding HIV transmission and treatment. Employment potential was hampered and 7/20 patients had suicidal thoughts post-diagnosis. Barriers to care included: shame, depression, travel cost/times, a preference for traditional plant-based medicine and side-effects of antiretroviral therapy. Facilitators included: education, family and clinic support, disease acceptance and lifestyle changes.
More effective, focussed community education and workplace discrimination investigations are recommended to reduce stigma and increase adherence to treatment in this population.
秘鲁的艾滋病毒相关发病率和死亡率正在上升，死亡率最高的地区是亚马逊州的洛雷托地区。这一流行病主要集中在男男性行为者中，尽管国家免费提供，但这一人群的艾滋病毒治疗依从率仅为 14%。本研究通过洛雷托艾滋病毒阳性男男性行为者和艾滋病毒专业医疗保健专业人员的经验和看法，调查了他们遵循医疗建议的障碍和促进因素。
2019 年 1 月至 2 月，在洛雷托进行了 20 次与艾滋病毒阳性男男性行为者的定性访谈和一次与艾滋病毒专家医疗保健专业人员的焦点小组访谈。访谈内容逐字逐句记录下来。采用主题内容分析和异常案例分析。
发现存在一种孤立和歧视的文化，这是由于公众对艾滋病毒传播和治疗的知识不足所导致的。就业潜力受到阻碍，7/20 名患者在诊断后有自杀念头。护理障碍包括：羞耻感、抑郁、旅行费用/时间、对传统植物药的偏好以及抗逆转录病毒治疗的副作用。促进因素包括：教育、家庭和诊所支持、对疾病的接受和生活方式的改变。
建议开展更有效、有针对性的社区教育和工作场所歧视调查，以减少这一人群的污名化并提高治疗依从性。
