Working to Advance
Health Equity in Africa

Challenges to antiretroviral therapy adherence in LGBTI people living with HIV in East and Southern Africa

Challenges to antiretroviral therapy adherence in LGBTI people living with HIV in East and Southern Africa

Aims and objectives:

We conducted two 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. 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.

Project findings and/or results

Challenges to ART adherence in MSM and LGBTI PLHIV:

  • 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.
  • 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.
  • Both the fear of and lived experience of stigma from healthcare workers on the basis of perceived sexuality breaks down trust between health service provider and patient, discouraging patients in seeking support.
  • A deficit of on-going counselling support is associated with a reduction in resilience to overcome challenges to adherence facing HIV positive MSM and LGBTI.
  • Information on side-effects, how to take pills, and the importance of adherence is currently inadequate in terms of access and relevance to MSM and LGBTI.
  • Concern over health worker lack of confidentiality in the community or reporting LGBTI to the police can discourage LGBTI from seeking support ART-related support.
  • Psychosomatic, medication induced, or fears of side-effects can disrupt ART adherence.
  • Delaying/missing doses to reduce visibility of ART pill-taking so as to maintain HIV non-disclosure.
  • 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.
  • Daily regimens for life present physical and psychological challenges. This can be worsened by TB coinfection and regimen changes due to stock-outs.
  • Abuse of drugs and alcohol is associated with worse adherence.
  • ART stock outs disrupt adherence.

Project outputs and/or outcomes

  • Systematic literature review of ART adherence in LGBTI and MSM PLHIV in East and Southern Africa.
  • Scoping study report for Kenya
  • Scoping study report for Uganda.
  • Factsheet of key challenges