Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Department of Health Behavior and Health Education, University of Michigan, Michigan, USA.
Afr J AIDS Res. 2023 Jul;22(2):71-84. doi: 10.2989/16085906.2023.2197879. Epub 2023 Jun 20.
Adolescent girls and young women (AGYW) in sub-Saharan Africa experience delayed linkage to and poor retention in HIV care. Identifying and addressing specific barriers in HIV care programming is important to achieving the upgraded UNAIDS 95-95-95 targets and epidemic control. We examined these challenges among 103 HIV-positive AGYW in and out of HIV care in communities around Lake Victoria in western Kenya as part of a larger qualitative study to identify drivers of HIV testing and HIV care utilisation in key populations. We used the social-ecological model to guide development of interview guides. Individual-level barriers included denial and forgetfulness and gendered household responsibilities, medication side effects, especially if taken without food, pills being too big and difficult to swallow and the burden of a daily medication-taking regimen. Interpersonal barriers included troubled family relationships and pervasive fears of stigma and discrimination by friends and family. Communitylevel barriers were stigmatising attitudes toward people living with HIV. Health-system barriers included negative provider attitudes and confidentiality breaches. At the structural level, participants noted high costs due to long travel times to facilities, long clinic waiting times, household food insecurity and school and work commitments. AGYW's limited decision-making autonomy due to age and gender norms, including their reliance on the authority of older adults, makes these barriers especially troubling. Innovative treatment approaches that take into account the unique vulnerabilities of AGYW are urgently needed.
撒哈拉以南非洲的青少年女孩和年轻女性（AGYW）在 HIV 护理中存在延迟联系和保留率低的问题。确定和解决 HIV 护理规划中的具体障碍对于实现升级后的 UNAIDS 95-95-95 目标和控制艾滋病疫情至关重要。我们在肯尼亚维多利亚湖周围社区中对 103 名 HIV 阳性的 AGYW 进行了调查，这些人正在接受 HIV 护理或已经脱离 HIV 护理，这是一项更大规模的定性研究的一部分，旨在确定关键人群中 HIV 检测和 HIV 护理利用的驱动因素。我们使用社会生态学模型来指导访谈指南的制定。个人层面的障碍包括否认和健忘以及性别化的家庭责任、药物副作用，尤其是在空腹服用药物时、药物太大且难以吞咽以及每天服用药物的负担。人际层面的障碍包括家庭关系问题以及对朋友和家人的污名化和歧视的普遍恐惧。社区层面的障碍是对艾滋病毒感染者的污名化态度。卫生系统层面的障碍包括提供者的负面态度和保密性的破坏。在结构层面，参与者指出由于前往医疗机构的时间长、诊所等待时间长、家庭粮食不安全以及学校和工作的承诺，导致费用高昂。由于年龄和性别规范，AGYW 的决策自主权有限，包括他们对成年人权威的依赖，这使得这些障碍更加令人困扰。迫切需要采取创新的治疗方法，考虑到 AGYW 的独特脆弱性。
