University of Strathclyde, Glasgow, Scotland, UK.
Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK.
BMC Public Health. 2024 Jan 6;24(1):105. doi: 10.1186/s12889-023-17271-6.
Access to antiretroviral therapy (ART) helps to improve quality of life and reduces the spread of HIV. However, while a lot of studies focus on supply factors, such as resources for the purchase of antiretroviral drugs, demand and structural forces are not given much emphasis. In this paper it is argued that structural forces shape the way people access antiretroviral therapy in Nigeria.
A Grounded Theory methodology was undertaken in the research. Semi structured qualitative interviews were administered to select people living with HIV/AIDS in Nigeria. This was facilitated by the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) to understand their perspectives with regard to barriers and enablers to ART access in Nigeria. Thirty persons living with HIV/AIDS were interviewed and recorded. The interview recordings were transcribed and coded using a constructionist epistemological approach. This was triangulated with results of preliminary and secondary literature review analysis.
In this research, the participants discussed structural forces (barriers and enablers) that influenced how they accessed ART. These included economic factors such as poverty that enabled transactional sex. Unequal gender relations and perceptions influenced how they accessed ART. The participants' belief in 'God' and religious activities such as 'prayer' and the use of 'traditional medicine' had an impact on how and when they accessed ART. Political activity at the international, national, and local levels influenced access to ART as well as resources. The individual's familial, social, and organisational connections also influenced their ease of accessing ART.
This study identifies structural forces that affect access to antiretroviral therapy and provides recommendations on how they can be harnessed to enable improved access to ART and consequently improved health.
获得抗逆转录病毒疗法（ART）有助于提高生活质量并减少 HIV 的传播。然而，尽管许多研究都集中在供应因素上，例如购买抗逆转录病毒药物的资源，但需求和结构力量并没有得到太多重视。本文认为，结构力量塑造了人们在尼日利亚获得抗逆转录病毒疗法的方式。
本研究采用扎根理论方法。通过尼日利亚艾滋病毒/艾滋病感染者网络（NEPWHAN）对尼日利亚的艾滋病毒感染者进行半结构化定性访谈，以了解他们对尼日利亚获得抗逆转录病毒治疗的障碍和促进因素的看法。共访谈并记录了 30 名艾滋病毒感染者。使用建构主义认识论方法对访谈录音进行转录和编码，并与初步和二级文献综述分析的结果进行三角验证。
在这项研究中，参与者讨论了影响他们获得 ART 的结构力量（障碍和促进因素）。这些因素包括经济因素，如贫困，导致了性交易。不平等的性别关系和观念影响了他们获得 ART 的方式。参与者对“上帝”的信仰以及宗教活动，如“祈祷”和使用“传统医学”，也对他们获得 ART 的方式和时间产生了影响。国际、国家和地方各级的政治活动以及资源也影响了获得 ART 的机会。个人的家庭、社会和组织关系也影响了他们获得 ART 的便利性。
本研究确定了影响获得抗逆转录病毒疗法的结构力量，并就如何利用这些力量来改善获得抗逆转录病毒疗法的机会，从而改善健康状况提出了建议。
