The challenges to antiretroviral adherence among MSM and LGBTI living with HIV in east and southern Africa – A systematic literature review
The past decade has seen dramatic improvement in efficacy and reduction in side-effects of anti-retroviral drugs (ARVs). It is now possible for treatment to reduce viral load 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, the emerging large-scale challenge is how to ensure patient adherence to complex HIV treatments. Viral suppression requires >95% antiretroviral therapy (ART) adherence, but resource-poor countries average just 23%, and some much lower.
The East and Southern African (ESA) region bears the greatest burden of the global HIV and AIDS epidemic, including the largest number of people on ART. While there is some research on the challenges of adherence in the general population of PLHIV in ESA, there is very little research on adherence among key populations. This is problematic because key populations, including men who have sex with men (MSM) and lesbian, gay, bisexual, transsexual, intersex (LGBTI) communities, experience up to 19 times greater HIV prevalence globally (UNAIDS 2014: 20). Key populations also suffer human rights infringements that restrict their access to, and engagement with, HIV services.
In response, HEARD has conducted a systematic review of the literature on ART adherence of MSM PLHIV and LGBTI PLHIV in east and southern Africa, primarily to identify key knowledge gaps and guide further research. Only two studies met the above search parameters: (1) a qualitative global study which included views of one transgender person in South Africa on their HIV service needs; and (2) a clinical study of ART adherence outcomes of young men and women reporting high-risk behaviour, and MSM, in coastal Kenya. Neither study was sufficiently rigorous or representative to provide meaningful data or analysis. Consequently, the knowledge gap is all encompassing and suggests open and exploratory research to understand the linkages between criminalisation, discrimination, and (double) stigma experienced by (HIV positive) MSM and LGBTI communities, and their challenges to ART adherence.View full text