Access to HIV treatment and care for people who inject drugs in Kenya: a short report
Access to HIV treatment and care for people who inject drugs in Kenya: a short report
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DOI：
10.1080/09540121.2016.1191606
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发表时间：
2016-01-01
影响因子：
1.7
通讯作者：
Nnaji, Obiora
中科院分区：
文献类型：
--
作者：
Guise, Andy;Rhodes, Tim;Nnaji, Obiora
注射吸毒者在获得艾滋病毒治疗和护理方面遇到一系列障碍。肯尼亚政府和社区组织一直在努力为艾滋病患者提供艾滋病毒护理。在肯尼亚，提供服务的一个主要方法是由为普通民众服务的诊所提供护理，并将其与提供减少伤害外联服务的社区组织的支持联系起来。本研究探讨了在肯尼亚获得护理的PWID帐户，以确定护理的障碍和促进者。PWID账户是在一项定性纵向研究中收集的。与艾滋病毒感染者的深入访谈（n=44）与其他PWID，护理提供者和社区观察的访谈相结合。结果表明，一些PWID能够成功地获得护理，而其他PWID报告的挑战。结果集中在三个主要主题，以深入了解这些经验：成瘾的困难和护理费用，艾滋病毒在社区的沉默，然后在诊所的歧视和支持。一些艾滋病毒/艾滋病患者通常在社会和外展支持下能够克服进入诊所的障碍;对于其他人来说，成瘾、困难、耻辱和歧视的挑战过于限制。我们讨论了如何进一步调整为普通人群服务的诊所以增加就诊机会。然而，即使有社区联系，基于诊所的护理也可能对一些PWID来说是一个根本性的挑战。应考虑制定其他战略，为艾滋病毒感染者提供独立护理，并将艾滋病毒治疗和护理分散到社区环境，并让同龄人参与提供服务。
People who inject drugs (PWID) experience a range of barriers to HIV treatment and care access. The Kenyan government and community-based organisations have sought to develop HIV care for PWID. A principal approach to delivery in Kenya is to provide care from clinics serving the general population and for this to be linked to support from community-based organisations providing harm reduction outreach. This study explores accounts of PWID accessing care in Kenya to identify care barriers and facilitators. PWID accounts were collected within a qualitative longitudinal study. In-depth interviews with PWID living with HIV (n=44) are combined with interviews with other PWID, care providers and community observation. Results show that some PWID are able to access care successfully, whilst other PWID report challenges. The results focus on three principal themes to give insights into these experiences: the hardship of addiction and the costs of care, the silencing of HIV in the community and then discrimination and support in the clinic. Some PWID are able to overcome, often with social and outreach support, barriers to clinic access; for others, the challenges of addiction, hardship, stigma and discrimination are too constraining. We discuss how clinics serving the general population could be further adapted to increase access. Clinic-based care, even with community links, may, however, be fundamentally challenging for some PWID to access. Additional strategies to develop stand-alone care for PWID and also decentralise HIV treatment and care to community settings and involve peers in delivery should be considered.