title: Barriers to access to care reported by women living with HIV across 27 countries.
abstract: Increased access to successful antiretroviral therapy (ART) is necessary in order to achieve an AIDS-free generation. Importantly, slightly over half of the people living with HIV are women. Small studies have described many barriers to accessing treatment and care among women living with HIV. This cross-sectional, non-interventional, epidemiological study assessed the prevalence of barriers to accessing care for women living with HIV across 27 countries, divided into four global regions. HIV-positive women attending routine clinical visits were offered the opportunity to participate in the study. Data describing the study sites and demographic characteristics of the participating women were collected. Participating women filled out questionnaires including the Barriers to Care Scale (BACS) questionnaire, on which they reported the extent to which they found each of the 12 potential barriers to accessing health care problematic. A total of 1931 women living with HIV were included in the study: 760 from Western Europe and Canada (WEC), 532 from Central and Eastern Europe (CEE), 519 from Latin America (LA), and 120 from China. The mean age of participating women was 40.1 ± 11.4 years. A total of 88.2% were currently taking ART. A total of 81.8% obtained HIV treatment under a government health plan. The most prevalent barrier to care was community HIV/AIDS stigma. Community HIV/AIDS knowledge, lack of supportive/understanding work environments, lack of employment opportunities, and personal financial resources were also highly prevalent barriers to accessing care. These findings indicate that, more than 30 years after the start of the AIDS epidemic, stigma is still a major issue for women living with HIV. Continued efforts are needed to improve community education on HIV/AIDS in order to maximize access to health care among women living with HIV.
authors.affiliation: a Royal Free Hospital NHS Trust , London , UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.affiliation: b Saint-Petersburg City HIV Centre , Petersburg , Russia.
authors.forename: Anna
authors.initials: A
authors.lastname: Samarina
authors.affiliation: c Guangzhou Eight People's Hospital , Yuexiu District , Guangzhou , China.
authors.forename: He
authors.initials: H
authors.lastname: Xi
authors.affiliation: d Centro de Referência e Treinamento DST/AIDS , Sã Paulo , Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Valdez Ramalho Madruga
authors.affiliation: e Centre Hospitalier Régional d'Orléans - La Source, Service des Maladies Infectieuses et Tropicales, Orléans , France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Hocqueloux
authors.affiliation: f Women's College Research Institute , University of Toronto, Toronto , Canada.
authors.forename: Mona
authors.initials: M
authors.lastname: Loutfy
authors.affiliation: g AbbVie, Inc ., North Chicago , IL , USA.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Fournelle
authors.affiliation: g AbbVie, Inc ., North Chicago , IL , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Norton
authors.affiliation: g AbbVie, Inc ., North Chicago , IL , USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Van Wyk
authors.affiliation: g AbbVie, Inc ., North Chicago , IL , USA.
authors.forename: Woodie
authors.initials: W
authors.lastname: Zachry
authors.affiliation: g AbbVie, Inc ., North Chicago , IL , USA.
authors.forename: Marisol
authors.initials: M
authors.lastname: Martinez
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015995:Prevalence; D057545:Social Stigma; D011795:Surveys and Questionnaires; D016387:Women's Health
keywords: HIV; HIV treatment; access to health care; barriers to care; stigma; women