The effects of enhanced access to antiretroviral therapy: a qualitative study of community perceptions in Kampala city, Uganda.
BACKGROUND
Since 2001, Antiretroviral Therapy (ART) has been integrated as part of the Uganda National Program for Comprehensive HIV/AIDS Care and Support. If patients take Antiretroviral drugs (ARVs) as prescribed, quality of life is expected to improve and patients become healthier. It is, however, postulated that scale up of ARVs could erode the previous achievement in behaviour change interventions. This study examined community perceptions and beliefs on whether enhanced access to ARVs increases risk behaviour. It also examined people's fears regarding HIV/AIDS infection and the use of ARVs.


METHODS
This was a qualitative study that utilized Focus Group Discussions (FGDs) and Key Informant (KI) interviews. Participants were purposefully sampled. Twenty FGDs comprising of 190 participants and 12 KI interviews were conducted. FGDs were conducted with adult men and women (above 25 years), and youth (male and female) while KI interviews were held with Kampala City Council officials, Kawempe Division Local Council officials, health workers and religious leaders. All data was tape recorded with consent from participants and transcribed thereafter. Typed data was analyzed manually using qualitative latent content analysis technique.


RESULTS
Most participants felt that enhanced access to ART would increase risky sexual behaviour; namely promiscuity, lack of faithfulness among couples, multiple partners, prostitution, unprotected sexual practices, rape and lack of abstinence as the risky sexual behaviours. A few FGDs, however, indicated that increased ART access and counselling that HIV-positive people receive promoted positive health behaviour. Some of the participants expressed fears that the increased use of ARVs would promote HIV transmission because it would be difficult to differentiate between HIV-positive and HIV-negative persons since they all looked healthy. Furthermore, respondents expressed uncertainty about ARVs with regard to adherence, sustainable supply, and capacity to ensure quality of ARVs on the market.


CONCLUSIONS
There are fears and misconceptions that enhanced access to ART will increase risky sexual behaviour and HIV transmission. Information Education and Communication (IEC) on ART use and availability should be enhanced among all people. Prevention programs which are modified and specific to the needs of the people living with HIV should be developed and implemented, and should include information on the ability of individuals to transmit HIV even when they are on ART.
Behavioural Surveillance Program, Academic Alliance for AIDS Care and Prevention in Africa, Makerere University School of Public Health, P.O. Box 7072, Kampala. atuyambe@musph.ac.ug
Lynn
L
Atuyambe
Stella
S
Neema
Erasmus
E
Otolok-Tanga
Gakenia
G
Wamuyu-Maina
Simon
S
Kasasa
Fred
F
Wabwire-Mangen
D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010465:Perception; D012309:Risk-Taking; D014454:Uganda
D044966:Anti-Retroviral Agents