title: A qualitative analysis of multi-level barriers to HIV testing among women in Lebanon.
abstract: While the number of HIV cases in the Middle East and North Africa region is low compared to other regions, recent studies show that incidence is increasing especially among high-risk populations; in particular, little is known about women and HIV in the region. Through semi-structured interviews with sexual healthcare providers and staff at non-governmental organisations, we sought to understand barriers to HIV testing among women in Lebanon. Using snowball sampling, key informants were recruited from greater Beirut (12 physicians, 9 non-governmental organisation staff). Data were analysed using a grounded theory framework. Findings identified barriers to HIV testing among women at each level of an adapted social-ecological model (i.e. social-cultural barriers, policy barriers, interpersonal healthcare provider barriers and intrapersonal barriers). Primary findings include the culture of sex as taboo; lack of sexual health education among women; fear of disclosing HIV testing and diagnosis; financial barriers linked to stigmatising insurance policies; and provider attitudes towards women. Findings can be used to inform HIV-related sexual health interventions at multiple levels for women in Lebanon and the greater region.
authors.affiliation: a Yale School of Public Health , New Haven , USA.
authors.forename: Kirsty A
authors.initials: KA
authors.lastname: Clark
authors.affiliation: a Yale School of Public Health , New Haven , USA.
authors.forename: Danya E
authors.initials: DE
authors.lastname: Keene
authors.affiliation: a Yale School of Public Health , New Haven , USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Pachankis
authors.affiliation: b Lebanese Medical Association for Sexual Health , Beirut , Lebanon.|c Department of Psychiatry , New York University , New York , USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Fattal
authors.affiliation: d Department of Internal Medicine , American University of Beirut , Beirut , Lebanon.
authors.forename: Nesrine
authors.initials: N
authors.lastname: Rizk
authors.affiliation: a Yale School of Public Health , New Haven , USA.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Khoshnood
mesh_terms: D015492:AIDS Serodiagnosis; D000328:Adult; D001291:Attitude of Health Personnel; D003469:Culture; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007861:Lebanon; D008297:Male; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D010820:Physicians / Q000523:psychology; D036301:Qualitative Research
keywords: HIV; HIV testing; Lebanon; barriers; stigma; women