Barriers to Acceptance and Adherence for ARVs in Urban Zambian Women: A Qualitative Study

Project Description

Antiretroviral therapy (ART) is known to extend the lives of persons living with HIV/AIDS. However, ART must be adhered to at the highest levels to ensure viral suppression and maintain low viral load. ART has been available in Zambia since 2004 and has rapidly expanded over time. The program starts with identification of HIV-infected persons and women are offered enrollment in HIV Care programs. Women are assessed for ART eligibility, according to the Zambian national guidelines. Women who are eligible are offered ART and monitored for adherence. If not yet eligible, women are followed to monitor their health until they are eligible for ART. Few studies have identified and described barriers to ART initiation and adherence.

In 2006, the Center for Global Health & Development conducted a qualitative study to interview women who had been identified as HIV-positive, were offered ART, and had one of the following four outcomes: 1) eligible but refused ART, (2) refused to join the CARE program, (3) initiated ART but then stopped taking the medication, and (4) initiated and were currently on ART.

Women identified seven main reasons for not starting ART, namely: “ART is bad,” “stigma,” “lack of information,” “fear that marriage will end,” “their choice not to take,” “failure to accept HIV status,” or “need help finding food.” Women identified nine main reasons for stopping ART: “side effects,” “when they get better they stop the medicine,” “fear of divorce,” “just not wanting to take it,” “rumors from others saying the drugs are bad,” “lack of food,” “fear of taking drugs for life,” “fear of being laughed at,” and “fear of death.”

The four (4) major themes from the free listing and the key informant interviews identified were:

  • Fear of divorce/husbands
  • Stopping the medication because they got better
  • Choosing not to drink/take the medicine
  • Fear of taking medicine for life

Findings from the study recommend that more information about nutritional requirements with ART and side effects is needed. Also, the importance of familial relationships and marriage in light of ART needs to be better addressed in programs.

Project Details

Principal Investigator Laura Murray
Boston University Co-Investigators Katherine Semrau, Nancy Scott, Donald Thea
Collaborators
  • Ellen McCurley
  • Mwiya Mwiya
  • Chipepo Kankasa
  • Judith Bass
  • Paul Bolton
Country(ies) Zambia
Dates of Research 2006
Donor/Funder
  • CDC_logo_150 copyCenters for Disease Control and Prevention