Includes bibliographical references. / [Objectives] In Nigeria, free antiretroviral treatment (ART) centers are mainly located in urban and peri-urban areas despite higher HIV-prevalence in rural areas. This study investigated the socio-economic and socio-demographic characteristics together with the access barriers faced by the users of free ART in Enugu State, southeast Nigeria. [ Design ] Cross sectional study Methods The study was conducted in two purposively selected sites/facilities (one public and one private) administering free ART. In each of the two facilities, 120 patients living with HIV/AIDS (PLWHA) were interviewed. Information about socio-economic status, demographic characteristics, factors constraining access and coping mechanisms were elicited using interviewer-administered questionnaires as a patient came out of the doctor's consulting room (exit interview). Principal components analysis, frequencies and cross tabulations were used in analysis. [ Results ] Of the 240 respondents, 67.5% were female. The mean age of the respondents was 36 years and 46.7% were within the age range of 30-41 years. The main occupations of the respondents were petty trading (21.3%), artisan (20.0%) and government worker (19.2%). High cost of transport (32.5%), stigma (31.7%) and long waiting hours (23.3%) were found to be major hindrances to accessing free ART. The mean cost of transport was US$3.94 per visit although an SES analysis showed that the most poor incurred the highest cost of transport (US$5.48) per visit. Stigma is clearly more of a barrier in Enugu metropolis (49%) compared to communities outside the Enugu metropolis (18.6%) and states apart from Enugu State (22.2%). PLWHA spent an average of 3.39 hours at the clinic during their monthly appointment. Own savings and financial support from relatives were the main coping mechanism used for accessing free ART. The most poor (underprivileged) bore a higher cost of transport while the effect of stigmatization appeared to be felt by all the socioeconomic groups. [ Conclusion ] Potential findings indicate that the poor bear the highest burden of transport costs while stigmatization affects all socio-economic groups although more on non poor than the poor. Advocacy against HIV and AIDS related stigma is crucial if HIV/AIDS interventions are to achieve their desired outcomes. Concerted effort is required from government, non-governmental agencies, communities and religious groups in the campaign against HIV/AIDS related stigma. The key finding of high traveling costs, particularly for the poor, suggests the need to consider mechanisms that might enhance access for the rural poor such as mobile ART clinics. It is also imperative to employ more medical personnel so as to address the issue of long waiting hours experienced by users of free ART.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/9413 |
| Date | January 2009 |
| Creators | Okoli, Chijoke Ifeanyi |
| Contributors | Cleary, Susan |
| Publisher | University of Cape Town, Faculty of Health Sciences, Health Economics Unit |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MPH |
| Format | application/pdf |
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