Traditional Human Immunodeficiency Virus treatment and family and social influence as barriers to accessing HIV care services in Belu, Indonesia

Abstract

Access to HIV care services, including antiretroviral therapy (ART), is essential for improving health outcomes of people living with HIV (PLHIV) and reducing HIV transmission and AIDS-related deaths. As a part of a qualitative study in Belu, this paper describes the use of traditional medicines for HIV treatment and family and social influence as barriers to access to HIV care services among PLHIV. One-on-one in-depth interviews were employed to collect data from 46 PLHIV (26 women and 20 men) and 10 healthcare professionals. They were recruited using the snowball sampling technique. The study information sheets were initially posted on information boards in healthcare facilities. Potential participants who contacted to confirm their participation were recruited for an interview and then asked for help to distribute the information sheets to their eligible colleagues who might be willing to participate. Data analysis was performed using NVivo 12 software and guided by a qualitative data analysis framework. The findings showed that the use of traditional medicines, a well-known cultural practice in Belu, was a barrier to access to HIV care services among PLHIV. The influence of family in determining the use of traditional medicines for HIV treatment, supported by the lack of knowledge of ART, effectiveness of traditional medicines in treating other health issues, and social influence of relatives, neighbours, and friends, were also significant barriers to PLHIV’s access to HIV care services. The findings indicate the need for dissemination of HIV care-related information for PLHIV, family, and community members to increase their knowledge of the service, ART and its function, and to support and improve access to HIV care services especially ART by PLHIV.

Understanding the quality of life of people living with HIV in rural and urban areas in Indonesia

“…The most significant difference is in the access to HIV care services, with most PLHIV in Yogyakarta accessing HIV care services or ART, while only about 25% in Belu accessing ART [ 40 , 41 ]. Yogyakarta and Belu were selected as the study settings because of feasibility, familiarity and the potential of undertaking the current study successfully as we have conducted several studies on HIV topics in these settings[ 17 , 42 , 43 ]. The two settings were also selected because they have different characteristics, which enabled us to make comparisons between urban and rural, good and limited HIV services, good and limited transportation systems, etc., and understand how those characteristics contribute to influencing the participants’ QoL.…”

“…Previous studies have also reported several factors associated with a lower level of QoL of PLHIV, including social factors such as stigma and discrimination [ 13 , 14 ], non-disclosure of HIV status [ 15 ] and poor access to healthcare services [ 16 , 17 ]. Rather than being discrete negative factors, social determinants may be intertwined within the lives of PLHIV, making their impact even worse in terms of QoL.…”

Barriers to Accessing HIV Care Services in Host Low and Middle Income Countries: Views and Experiences of Indonesian Male Ex-Migrant Workers Living with HIV

“…These accessibility dimensions were reflected in the fact that participants could afford to buy herbal medicines at public markets or via online sources, or were able to make traditional medicines themselves out of roots, leaves and bark of plants that they could easily find, or via care sought from local traditional healers. Although there have never been studies exploring the influence of packaged herbal medicines and traditional medicines on the access of MLHIV to HIV care services or treatment, some previous studies involving people living with HIV (PLHIV) in general have suggested that the use of traditional medicines has influenced adherence to ART [ 51 , 52 , 53 , 54 , 55 ]. Our findings also suggest that peer influence played an important role in the use of these packaged herbal and traditional medicines by the participants.…”

Understanding the quality of life of people living with HIV in rural and urban areas in Indonesia

“…Such poor environmental conditions were seen by participants as causing difficulties in their access to HIV care services and dissatisfaction towards the management of their HIV-related health conditions [10,48]. It is plausible to suggest that such conditions or limitations could have also been the barriers that impede access to ART by the majority of PLHIV in the district [17,22]. These poor environmental conditions or limitations can be categorised as system-level barriers to access to HIV care services, as highlighted in previous findings in other settings [48,49].…”

“…Previous studies have also reported several factors associated with a lower level of QoL of PLHIV, including social factors such as stigma and discrimination [13,14], nondisclosure of HIV status [15] and poor access to healthcare services [16,17]. Rather than being discrete negative factors, social determinants may be intertwined within the lives of PLHIV, making their impact even worse in terms of QoL.…”