Access to HIV treatment and care for people who inject drugs in Kenya: a short report.
People who inject drugs (PWID) experience a range of barriers to HIV treatment and care access. The Kenyan government and community-based organisations have sought to develop HIV care for PWID. A principal approach to delivery in Kenya is to provide care from clinics serving the general population and for this to be linked to support from community-based organisations providing harm reduction outreach. This study explores accounts of PWID accessing care in Kenya to identify care barriers and facilitators. PWID accounts were collected within a qualitative longitudinal study. In-depth interviews with PWID living with HIV (n = 44) are combined with interviews with other PWID, care providers and community observation. Results show that some PWID are able to access care successfully, whilst other PWID report challenges. The results focus on three principal themes to give insights into these experiences: the hardship of addiction and the costs of care, the silencing of HIV in the community and then discrimination and support in the clinic. Some PWID are able to overcome, often with social and outreach support, barriers to clinic access; for others, the challenges of addiction, hardship, stigma and discrimination are too constraining. We discuss how clinics serving the general population could be further adapted to increase access. Clinic-based care, even with community links, may, however, be fundamentally challenging for some PWID to access. Additional strategies to develop stand-alone care for PWID and also decentralise HIV treatment and care to community settings and involve peers in delivery should be considered.
a Dept of Global Public Health , University of California San Diego , San Diego , CA , USA.|b Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine , London , UK.
Andy
A
Guise
b Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine , London , UK.
Tim
T
Rhodes
c Community Action on Harm Reduction Project, Kenya AIDS NGOs Consortium , Nairobi , Kenya.
James
J
Ndimbii
c Community Action on Harm Reduction Project, Kenya AIDS NGOs Consortium , Nairobi , Kenya.
Sylvia
S
Ayon
d Mount Sinai Hospital Services, Elmhurst Hospital Centre , Elmhurst , NY , USA.
Obiora
O
Nnaji
D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration; D001291:Attitude of Health Personnel; D003153:Community Health Services / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D040261:Harm Reduction; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D036301:Qualitative Research; D057545:Social Stigma; D012944:Social Support; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000628:therapy; D055815:Young Adult
ART; HIV; Kenya; People who inject drugs; community