The Effects of Enhanced Access to Antiretroviral Therapy : a Qualitative Study of Community Perceptions in Kampala city; Uganda

Introduction: Since 2001; Antiretroviral Therapy (ART) has been integrated as part of the Uganda National Program for Comprehensive HIV/AIDS Care and Support. If patients take Antiretroviral drugs (ARVs) as prescribed; quality of life is expected to improve and patients become healthier. It is; however; postulated that scale up of ARVs could erode the previous achievement in behaviour change interventions. This study examined community perceptions and beliefs on whether enhanced access to ARVs increases risk beha-viour. It also examined people's fears regarding HIV/AIDS infection and the use of ARVs. Methods: This was a qualitative study that utilized Focus Group Discussions (FGDs) and Key Informant (KI) interviews. Participants were purposefully sampled. Twenty FGDs comprising of 190 participants and 12 KI interviews were conducted. FGDs were conducted with adult men and women (above 25 years); and youth (male and female) while KI interviews were held with Kampala City Council officials; Kawempe Division Local Council officials; health workers and religious leaders. All data was tape recorded with consent from participants and transcribed thereafter. Typed data was analyzed manually using qualitative latent content analysis technique. Results: Most participants felt that enhanced access to ART would increase risky sexual behaviour; namely promiscuity; lack of faithfulness among couples; multiple partners; prostitution; unprotected sexual practices; rape and lack of abstinence as the risky sexual behaviours. A few FGDs; however; indicated that increased ART access and counselling that HIV-positive people receive promoted positive health behaviour. Some of the participants expressed fears that the increased use of ARVs would promote HIV transmission because it would be difficult to differentiate between HIV-positive and HIV-negative persons since they all looked healthy. Furthermore; respondents expressed uncertainty about ARVs with regard to adherence; sustainable supply; and capacity to ensure quality of ARVs on the market Con- clusions: There are fears and misconceptions that enhanced access to ART will increase risky sexual behaviour and HIV transmission. Information Education and Communi-cation (IEC) on ART use and availability should be enhanced among all people. Prevention programs which are modified and specific to the needs of the people living with HIV should be developed and implemented; and should include information on the ability of individuals to transmit HIV even when they are on ART

Examining the Actions of Faith-Based Organizations and their Influence on HIV/AIDS-Related Stigma: a Case Study of Uganda

Background: Stigma and discrimination are widely recognized as factors that fuel the HIV/AIDS epidemic. Uganda's success in combating HIV/AIDS has been attributed to a number of factors; including political; religious and societal engagement and openness - actors that combat stigma and assist prevention efforts. Objectives: Our study aimed to explore perceptions of Uganda-based key decision-makers about the past; present and optimal future roles of FBOs in HIV/AIDS work; including actions to promote or dissuade stigma and discrimination. Methods:We analyzed FBO contributions in relation to priorities established in the Global Strategy Framework on HIV/AIDS; a consensus-based strategy developed by United Nations Member States.Thirty expert key informants from 11 different sectors including faith-based organizations participated in a structured interview on their perceptions of the role that FBOs have played and could most usefully play in HIV/AIDS prevention; care and support. Results: Early on; FBOs were perceived by key informants to foster HIV/AIDS-related stigma and discrimination. Respondents attributed this to inadequate knowledge; moralistic perspectives; and fear relating to the sensitive issues surrounding sexuality and death. More recent FBO efforts are perceived to dissuade HIV/AIDS-related stigma and discrimination through increased openness about HIV status among both clergy and congregation members; and the leadership of persons living with HIV/AIDS. Conclusions: Uganda's program continues to face challenges; including perceptions among the general population that HIV/AIDS is a cause for secrecy. By virtue of their networks and influence; respondents believe that FBOs are well-positioned to contribute to breaking the silence about HIV/AIDS which undermines prevention; care and treatment efforts