title: Determinants of unequal HIV care access among people living with HIV in Peru.
abstract: BACKGROUND
  Equity in access to health care among people living with HIV (PLHA) has not been extensively studied in Peru despite the fact there is significant social diversity within this group. We aimed to assess the extent to which health care provision to PLHA, including ARVT, was equitable and, if appropriate, identify factors associated with lower access.
  
  
  METHODS
  We conducted a survey among adult PLHA in four cities in Peru, recruited through respondent-driven sampling (RDS), to collect information on socio-demographic characteristics, social network size, household welfare, economic activity, use of HIV-related services including ARV treatment, and health-related out-of-pocket expenses.
  
  
  RESULTS
  Between September 2008 and January 2009, 863 individuals from PLHA organizations in four cities of Peru were enrolled. Median age was 35 (IQR = 29-41), and mostly male (62%). Overall, 25% reported to be gay, 11% bisexual and 3% transgender. Most PLHA (96%) reported access to some kind of HIV-related health service, and 84% were receiving those services at a public facility. Approximately 85% of those reporting access to care were receiving antiretroviral treatment (ARV), and 17% of those not in treatment already had indication to start treatment. Among those currently on ARV, 36% percent reported out-of-pocket expenses within the last month. Transgender identity and age younger than 35 years old, were associated with lower access to health care.
  
  
  CONCLUSIONS
  Our findings contribute to a better social and demographic characterization of the situation of PLHAs, their access to HIV care and their source of care, and provide an assessment of equity in access. In the long term, it is expected that HIV care access, as well as its social determinants, will impact on the morbidity and mortality rates among those affected by the HIV/AIDS epidemic. HIV care providers and program managers should further characterize the barriers to healthcare access and develop strategies to resolve them by means of policy change, for the benefit of the health service users and as part of the national response to the HIV/AIDS epidemic within a human rights framework.
authors.affiliation: Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru. alfonsoss@upch.pe
authors.forename: Alfonso
authors.initials: A
authors.lastname: Silva-Santisteban
authors.forename: Eddy R
authors.initials: ER
authors.lastname: Segura
authors.forename: Clara
authors.initials: C
authors.lastname: Sandoval
authors.forename: Maziel
authors.initials: M
authors.lastname: Girón
authors.forename: Margarita
authors.initials: M
authors.lastname: Petrera
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Caceres
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D015658:HIV Infections / Q000628:therapy*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010568:Peru; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents