Testing experiences of HIV positive refugees in Nakivale Refugee Settlement in Uganda: informing interventions to encourage priority shifting

Abstract

BackgroundRecent initiatives by international health and humanitarian aid organizations have focused increased attention on making HIV testing services more widely available to vulnerable populations. To realize potential health benefits from new services, they must be utilized. This research addresses the question of how utilization of testing services might be encouraged and increased for refugees displaced by conflict, to make better use of existing resources.MethodsOpen-ended interviews were conducted with HIV-infected refugees (N=73) who had tested for HIV and with HIV clinic staff (N=4) in Nakivale Refugee Settlement in southwest Uganda. Interviews focused on accessibility of HIV/AIDS-related testing and care and perspectives on how to improve utilization of testing services. Data collection took place at the Nakivale HIV/AIDS Clinic from March to July of 2011. An inductive approach to data analysis was used to identify factors related to utilization.ResultsIn general, interviewees report focusing daily effort on tasks aimed at meeting survival needs. HIV testing is not prioritized over these responsibilities. Under some circumstances, however, HIV testing occurs. This happens when: (a) circumstances realign to trigger a temporary shift in priorities away from daily survival-related tasks; (b) survival needs are temporarily met; and/or (c) conditions shift to alleviate barriers to HIV testing.ConclusionHIV testing services provided for refugees must be not just available, but also utilized. Understanding what makes HIV testing possible for refugees who have tested can inform interventions to increase testing in this population. Intervening by encouraging priority shifts toward HIV testing, by helping ensure survival needs are met, and by eliminating barriers to testing, may result in refugees making better use of existing testing services.

The cascade of HIV care among refugees and nationals in Nakivale Refugee Settlement in Uganda

“…[Yes]; Can a person get HIV by sharing a meal with someone who is infected? [No]; Can a pregnant woman infected with HIV or AIDS transmit the virus to her unborn child? [Yes]; Can a woman with HIV or AIDS transmit the virus to her newborn child through breastfeeding?…”

The role of social support on HIV testing and treatment adherence: A qualitative study of HIV-infected refugees in southwestern Uganda

“…This difference may be due to the significant poverty found within the refugee settlement and should be explored in future studies. The instrumental support described in this study frequently involved assistance with tasks, which would have allowed patients to set aside the daily survival burden to proceed with testing or treatment, as has been previously described (O'Laughlin, Rouhani, Faustin, & Ware, 2013). Future work should explore how this assistance interacts with informational and emotional support, to maximize the impact of potential interventions.…”

Clinic-Based Routine Voluntary HIV Testing in a Refugee Settlement in Uganda

“…9, 13–15 Prior research suggests the hardships faced by refugees in meeting daily survival needs limit HIV testing in this population. 16 Refugees face additional burdens that hinder HIV testing including: remoteness of refugee settlements limiting access to host country health services, low resources of host countries and refugee relief organizations to dedicate to health services, and limited availability of clinic staff who understand HIV/AIDS and the languages and customs of refugees pertaining to the disease. 17 No published studies have been conducted evaluating HIV testing strategies in this challenging setting.…”