Antiretroviral treatment sharing among highly mobile Ugandan fisherfolk living with HIV: a qualitative study

Joseph G. Rosen, Neema Nakyanjo, Dauda Isabirye, Maria J. Wawer, Fred Nalugoda, Steven J. Reynolds, Gertrude Nakigozi, M. Kathryn Grabowski, Caitlin E. Kennedy

Research output: Contribution to journalArticle

Abstract

Antiretroviral treatment (ART) diversion from prescribed to non-prescribed users (i.e., sharing or selling) is an understudied dimension of HIV treatment adherence. We sought to explore ART diversion patterns in high-prevalence fishing communities on Lake Victoria, Uganda. We implemented a qualitative study in two fishing communities on Lake Victoria in south-central Uganda to identify facilitators of and pathways to ART diversion. We conducted 25 semi-structured interviews with HIV-positive fishermen (n = 25) and female sex workers (n = 10) covering personal and community experiences with ART selling/sharing, reasons for medication diversion, and potential solutions to reduce diversion. Data were analyzed using an adapted framework analysis approach. Participants reported frequent ART sharing within occupational networks, but no selling. Mobility was the principal driver of ART sharing and was associated with other barriers to treatment access including stigma, fear of negative health provider interactions, and transportation. ART sharing appears to emerge in response to short-term treatment interruptions in this setting. Future studies should explore characteristics and drivers of ART diversion in other high-burden settings and identify how these practices are correlated with key health outcomes like virologic failure and drug resistance.

Original languageEnglish (US)
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
DOIs
StateAccepted/In press - Jan 1 2019

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selling
HIV
Uganda
driver
community
health
medication
Therapeutics
anxiety
drug
worker
Victoria
Lakes
interaction
interview
experience
Sex Workers
Health
Drug Resistance
Fear

Keywords

  • adherence
  • ARV misuse
  • female sex workers
  • fisherfolk
  • HIV treatment
  • mobile populations
  • Uganda

ASJC Scopus subject areas

  • Social Psychology
  • Health(social science)
  • Public Health, Environmental and Occupational Health

Cite this

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title = "Antiretroviral treatment sharing among highly mobile Ugandan fisherfolk living with HIV: a qualitative study",
abstract = "Antiretroviral treatment (ART) diversion from prescribed to non-prescribed users (i.e., sharing or selling) is an understudied dimension of HIV treatment adherence. We sought to explore ART diversion patterns in high-prevalence fishing communities on Lake Victoria, Uganda. We implemented a qualitative study in two fishing communities on Lake Victoria in south-central Uganda to identify facilitators of and pathways to ART diversion. We conducted 25 semi-structured interviews with HIV-positive fishermen (n = 25) and female sex workers (n = 10) covering personal and community experiences with ART selling/sharing, reasons for medication diversion, and potential solutions to reduce diversion. Data were analyzed using an adapted framework analysis approach. Participants reported frequent ART sharing within occupational networks, but no selling. Mobility was the principal driver of ART sharing and was associated with other barriers to treatment access including stigma, fear of negative health provider interactions, and transportation. ART sharing appears to emerge in response to short-term treatment interruptions in this setting. Future studies should explore characteristics and drivers of ART diversion in other high-burden settings and identify how these practices are correlated with key health outcomes like virologic failure and drug resistance.",
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AU - Wawer, Maria J.

AU - Nalugoda, Fred

AU - Reynolds, Steven J.

AU - Nakigozi, Gertrude

AU - Grabowski, M. Kathryn

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