title: Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia.
abstract: Russia has a large HIV epidemic, but medical care engagement is low. Eighty HIV-positive persons in St. Petersburg completed in-depth interviews to identify barriers and facilitators of medical HIV care engagement. The most commonly-reported barriers involved difficulties accessing care providers, dissatisfaction with the quality of services, and negative attitudes of provider staff. Other barriers included not having illness symptoms, life stresses, low value placed on health, internalized stigma and wanting to hide one's HIV status, fears of learning about one's true health status, and substance abuse. Care facilitators were feeling responsible for one's health and one's family, care-related support from other HIV-positive persons, and the onset of health decline and fear of death. Substance use remission facilitated care engagement, as did good communication from providers and trust in one's doctor. Interventions are needed in Russia to address HIV care infrastructural barriers and integrate HIV, substance abuse, care, and psychosocial services.
authors.affiliation: Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia.
authors.forename: Anna V
authors.initials: AV
authors.lastname: Kuznetsova
authors.affiliation: Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia.
authors.forename: Anastasia Y
authors.initials: AY
authors.lastname: Meylakhs
authors.affiliation: Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia. yuri@mcw.edu.|Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit Avenue, Milwaukee, WI, 53202, USA. yuri@mcw.edu.
authors.forename: Yuri A
authors.initials: YA
authors.lastname: Amirkhanian
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit Avenue, Milwaukee, WI, 53202, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kelly
authors.affiliation: Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia.|Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia.
authors.forename: Alexey A
authors.initials: AA
authors.lastname: Yakovlev
authors.affiliation: Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia.|Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia.
authors.forename: Vladimir B
authors.initials: VB
authors.lastname: Musatov
authors.affiliation: Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia.
authors.forename: Anastasia G
authors.initials: AG
authors.lastname: Amirkhanian
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012426:Russia / Q000453:epidemiology; D057545:Social Stigma; D012944:Social Support; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: HIV care linkage and retention; HIV medical care; HIV services; HIV-positive; Persons living with HIV (PLHIV); Russia