Apuulison David Friday, Nabawanuka Brenda, Muhoozi Michael, Aryampa Julian, Irumba Pauline, Katsomyo Edson, Asiimwe Moses, Epuitai Joshua, Akugizibwe Pardon, George Wasswa, Rubaihayo John
Department of Nursing, Faculty of Heath Sciences, Mountains of the Moon University, P.O. Box 837, Fort Portal City, Uganda.
Research Department, Makerere University Center for Health and Population Research, Kampala City, Uganda.
AIDS Res Ther. 2025 Jan 8;22(1):4. doi: 10.1186/s12981-025-00698-9.
Female sex workers (FSWs) in Uganda experience numerous barriers to antiretroviral therapy (ART) adherence. We used the planned behavior theory to help explore the enablers and barriers to ART adherence among FSWs. Understanding the barriers to ART adherence may help contribute to the development of interventions to improve ART adherence among the FSWs.
A descriptive qualitative study was conducted in Fort portal City. We conducted 30 in-depth interviews among FSWs who had been taking ART for at least six months. Furthermore, six key informant interviews were conducted with healthcare workers and leaders of the FSWs initiative. Data collection lasted for two months. Thematic deductive analysis was applied to analyse the data through the lens of the theory of planned behavior.
The attitudes, subjective norms, and perceived behavioral control influenced adherence to ART. Positive attitudes including perceived benefits of ART, and experiencing positive outcomes from taking ART were seen to enable its adherence. Subjective norms such as social support, disclosure of HIV status, seeing others take ART, and aspirations of longer life enabled ART adherence. Taking ART in the morning, responsive and respectful healthcare workers, and availability of food/basic needs facilitated compliance with ART adherence. Negative attitudes such as misconceptions and fear of side effects hindered ART adherence. Social disapproval of sex work and or HIV, lack of social support, gender-based violence, non-disclosure, stigma, and abandonment hindered the use of ART among FSWs. Socio-economic constraints (e.g., food scarcity), and occupation-related factors (substance use, incarceration, busy and predictable schedules, and abrupt migrations) were the additional barriers to ART adherence.
ART adherence among FSWs was influenced by attitudes, subjective norms, and perceived behavioral control. Addressing these barriers in ART adherence through targeted interventions could facilitate ART adherence and improve health outcomes among FSWs.
乌干达的女性性工作者在坚持抗逆转录病毒疗法（ART）方面面临诸多障碍。我们运用计划行为理论来探究女性性工作者坚持ART的促进因素和障碍。了解ART坚持的障碍可能有助于制定干预措施，以提高女性性工作者对ART的依从性。
在福特portal市开展了一项描述性定性研究。我们对至少接受ART治疗六个月的女性性工作者进行了30次深入访谈。此外，还对医护人员和女性性工作者倡议组织的领导人进行了6次关键信息访谈。数据收集持续了两个月。运用主题演绎分析法，通过计划行为理论的视角对数据进行分析。
态度、主观规范和感知行为控制影响了对ART的坚持。积极态度包括认识到ART的益处以及服用ART后有积极效果，这些被视为有助于坚持ART。主观规范如社会支持、HIV感染状况的披露、看到他人服用ART以及对长寿的期望有助于坚持ART。早上服用ART、反应迅速且尊重他人的医护人员以及食物/基本需求的可得性促进了对ART坚持的依从性。负面态度如误解和对副作用的恐惧阻碍了ART坚持。社会对性工作和/或HIV的不认可、缺乏社会支持、基于性别的暴力、不披露、耻辱感和被抛弃阻碍了女性性工作者使用ART。社会经济限制（如食物短缺）和与职业相关的因素（药物使用、监禁、忙碌且可预测的日程安排以及突然迁移）是ART坚持的额外障碍。
女性性工作者对ART的坚持受到态度、主观规范和感知行为控制的影响。通过有针对性的干预措施解决这些ART坚持的障碍，可促进女性性工作者对ART的坚持并改善其健康状况。
