Imprisonment for South Ethiopian people living with HIV presents a double health burden: exploring the barriers and facilitators of optimal HIV care
Abstract Background Optimal adherence to antiretroviral therapy (ART) is crucial for ensuring treatment benefits as well as prevention of further transmission. However, whilst the prevalence of ART non-adherence in prison populations is considered to be high in many countries, little information is available about its predisposing circumstances in resource limited countries. We explored the barriers to and facilitators of ART adherence amongst inmates living with HIV (ILWHA) in South Ethiopia with the aim of contextualising this significant public health problem and to make advances towards optimal HIV care. Methods We conducted qualitative in-depth interviewing with eleven ILWHA (eight male and three female ILWHA) and eleven service providers (seven male and four female service providers). Audio recorded interview data were transcribed verbatim in Amharic language, translated into English and coded based on emerging themes. A phenomenological approach was employed to abstract meaning attributed to the prisoners’ lived experiences in relation to ART adherence and service providers’ experiential account regarding HIV care provision. Findings: Several themes emerged in relation to barriers of ART adherence amongst ILWHA in South Ethiopia: limited access to standard HIV care, insufficient health staff support, uncooperative security system, loss of patient privacy, a lack of status disclosure due to social stigma, depression related to imprisonment and food supply insufficiency appeared to negatively influence adherence. In addition to a unique opportunity offered by an imprisonment for some ILWHA to refrain from health damaging behaviours, the presence of social support in the prison system facilitated ART adherence. Conclusions This study identified important structural, social and behavioural factors that can both hinder and enhance ART adherence amongst ILWHA in South Ethiopia. Given the high prevalence of HIV infection in prisoners and the potential of transmission to others during and after incarceration, policy and practice development is required to address the barriers to ART adherence and to also strengthen the enablers with regard to an asset-based approach.