Financial obligations and economic barriers to antiretroviral therapy experienced by HIV-positive women who participated in a job-creation programme in northern Uganda

Abstract

Economic costs are commonly cited as barriers to women’s use of antiretroviral therapy (ART) in sub-Saharan Africa; however, little is known about how changes in women’s income influence economic barriers to care. We analysed in-depth interviews with 17 HIV positive women who participated in a job-creation programme in northern Uganda and two key informant interviews with programme staff to examine lingering economic barriers to care experienced after programme enrolment. We found that participants continued to experience economic barriers even after receiving steady a income and improving their economic status. Two themes emerged: first, limited resources in health facilities (e.g., drug and staff shortages) led participants to view ART utilisation as a primarily economic endeavour where clients made informal payments for prompter services or sought treatment in private facilities where ART was readily available; second, increased economic status also increased expectations of economic reciprocity among participants’ social networks. Financial obligations often manifested in the form of caring for additional dependents, limiting the resources women could allocate toward their HIV treatment. When paired with limited resources in health facilities, increased financial obligations perpetuated the economic barriers to care experienced by participants. Job-creation programmes should consider how health institutions interact with participants’ financial obligations to influence women’s access to HIV services.

Informal payments for primary health services in Zambia: Evidence from a health facility patient exit survey

“…However, if more and more people encounter informal charges at facilities that are actually designated to provide free services, the poor will stay away from seeking health services due to lack of money. A number of studies have shown that when health facilities impose charges outside formal policy guidelines, important health system goals such as access, quality and financial risk protection can be undermined [9] , [39] , [42] , [43] . A two-tier health system can emerge which provides good quality care for those with money and poor quality for patients who cannot afford to pay [12] .…”