HIV This Week

Unge C, Johansson A, Zachariah R, Some D, Van Engelgem I, Ekstrom AM. Reasons for unsatisfactory acceptance of antiretroviral treatment in the urban Kibera slum, Kenya. AIDS Care. 2008;20(2):146-9.

The aim of this study was to explore why patients in the urban Kibera slum, Nairobi, Kenya, offered free antiretroviral treatment at the Médecins Sans  Frontièrs (MSF) clinic, choose not to be treated despite signs of AIDS. Qualitative semi-structured interviews were conducted with 26 patients, 9 men and 17 women. Six main reasons emerged for not accepting antiretroviral treatment: a) fear of taking medication on an empty stomach due to lack of food; b) fear that side-effects associated with antiretroviral treatment would make one more ill; c) fear of disclosure and its possible negative repercussions; d) concern for continuity of treatment and care; e) conflicting information from religious leaders and community, and seeking alternative care (e.g. traditional medicine); f) illiteracy making patients unable to understand the information given by health workers.

Editors´note: The findings of this study guided the following urgent policy changes in the treatment programme: nutritional supplementation with ready-to-use food, adaptation of information pamphlets to local realities, alternative communication methods (peer groups, church, and traditional leaders), voluntary as opposed to mandatory disclosure to a `treatment buddy´, and enhanced links to other community partners in Kibera. Action-oriented research such as this explores problems and their underpinnings to create a platform for reality-based solutions.