Barriers and facilitators of optimal HIV care among prisoners in South Ethiopia: an exploratory study

Abstract

Abstract Background Optimal care is crucial for ensuring both therapeutic and preventative benefits of antiretroviral therapy (ART). Sub-optimal care use is common in prisoners and little information is available about its predisposing circumstances in resource-limited settings. We explored barriers to and facilitators of HIV care use amongst inmates living with HIV (ILWH) in South Ethiopia with the aim of suggesting contextually tailored solutions that help ensure universal access to care. Methods We conducted qualitative in-depth interviewing with eleven ILWH and eleven service providers. Audio recorded interview data were transcribed verbatim in Amharic language, translated into English and coded based on emerging themes. A phenomenological approach was employed to abstract meaning attributed to the prisoners’ lived experiences in relation to HIV care use and service providers’ experiential account regarding care provision. Findings Several themes emerged as barriers to HIV care use amongst ILWH in South Ethiopia including: limited access to standard care, insufficient health staff support, uncooperative security system, loss of patient privacy, a lack of status disclosure due to social stigma, and food supply insufficiency. In addition to a unique opportunity offered by an imprisonment for some ILWH to refrain from health damaging behaviours, the presence of social support in the prison system facilitated care use. Conclusions This study identified important structural, social and personal contexts that can both hinder and enhance HIV care use amongst ILWH in South Ethiopia. Given the disproportionate burden of HIV in prisoners and the potential of transmission to others during and after incarceration, development of contextually responsive strategies is required to address the barriers and to also strengthen the enablers.