It is now possible for antiretroviral therapy (ART) to reduce viral load of HIV to the point where an infected person is no longer, or much less, infectious to others. As a result, ‘treatment as prevention’ has become the cornerstone of UNAIDS’s post-2015 global strategy to end AIDS by 2030. As the expansion of treatment provision continues, and access improves, adherence becomes a determining factor in the impact of ART for both treatment and prevention. We’re conducting a number of small scoping studies on challenges to ART adherence in men who have sex with men (MSM) and lesbian, gay, bisexual, transgender, and intersex (LGBTI) communities living with HIV in East and Southern Africa (ESA), as key populations in the AIDS response.

A report presenting findings from a scoping study carried out in Kampala, Uganda, in December 2015 is now available. The findings suggest that (double) stigma and criminalisation of behaviour of people living with HIV (PLHIV) in MSM and LGBTI communities cut across almost every perceived challenge to ART adherence as a driving or contributory factor. As a result, indications suggest MSM and LGBTI experience challenges that are similar in type to the general population, but that these population groups experience the challenges more often, more acutely, and with less opportunity to overcome the challenges.

Summary of key findings in challenges to ART adherence for MSM and LGBTI populations:

  1. Inadequate access to food: Some ARVs must be taken with or after food consumption to support drug absorption to required levels. Doses can be delayed/ missed until people can afford food with which to take the pills.
  2. Stigma and a lack of social support: A lack of social support due to stigma resulting from a perceived or disclosed sexuality and HIV status is thought to contribute to worse adherence.
  3. Fear or experience of stigma at healthcare facilities: Both the fear 9of and the lived experience of stigma from healthcare workers on the basis of perceived sexuality breaks down trust in the relationship between health provider and patient.
  4. Inadequate counselling: A deficit of on-going counselling support was associated with a reduction in resilience to overcome challenges to adherence facing HIV positive MSM and LGBTI.
  5. Insufficient access to information: Information on side-effects, how to take pills, and the importance of adherence needs to become more accessible and relevant to MSM and LGBTI.
  6. Fears or perceptions of breaches in confidentiality by healthcare workers: Healthcare workers’ concern for confidentiality is driven by the perceived potential of stigma or criminal charges that could result in supporting MSM or LGBTI populations.
  7. Fear of or experience of ART side effects: Fears of or experience of negative ART side-effects. Psychosomatic, medication induced, or fears of side-effects can delay ART commencement or cause ART cessation.
  8. Fear of disclosure via pill taking and storage: Delaying/missing doses to reduce visibility of ART pill-taking so as to maintain HIV non-disclosure.
  9. Prohibitive travel costs to clinics: Public transport costs can be a barrier to collecting ART pills monthly for those living far away, especially to attend sensitised or dedicated healthcare for MSM and LGBTI.
  10. High pill burden: Daily regimens for life presents physical and psychological challenges. This can be worsened by TB-coinfection and regimen changes due to stock-outs.
  11. Alcohol and drug abuse: Abuse of drugs and alcohol is associated with worse adherence.
  12. ART stock outs: Stock-outs occur when clinics deplete their stocks of the regimens they prescribe. This can sometimes reflect a national shortage.
  13. Loss to follow up: Due to the necessity to maintain adherence, clinics follow up with patients that miss appointments.


  • 13 ART adherence challenges faced by MSM & LGBTI living with HIV in Kampala, Uganda | Download infographic |PDF|248 kB
  • Challenges to antiretroviral adherence among MSM and LGBTI living with HIV in Kampala, Uganda | Download report |PDF|758kB