“It is all about the fear of being discriminated [against]…the person suffering from HIV will not be accepted”: a qualitative study exploring the reasons for loss to follow-up among HIV-positive youth in Kisumu, Kenya

BMC Public Health

Colette L Auerswald¹  Craig R Cohen⁵  Kawango E Agot⁶  Elizabeth A Bukusi²  Bonnie L Halpern-Felsher⁴  Hilary T Wolf³ 

[1] UC Berkeley-UCSF Joint Medical Program, UC Berkeley School of Public Health, Berkeley, Berkeley, CA, USA;Family AIDS Care and Education Services-Kenya Medical Research Institute, Nairobi, Kenya;Department of Pediatrics, Georgetown University Medical Center, 4200 Wisconsin Ave. NW, Washington, DC 20026, USA;Department of Pediatrics, Stanford University Palo Alto, Stanford, CA, USA;Department of OB/GYN, University of California at San Francisco, San Francisco, CA, USA;Impact Research and Development Organization, Kisumu, Kenya

关键词: Stigma;    Lost to follow-up;    Kenya;    HIV/AIDS;    Adolescent;   

Others  :  1123014
DOI  :  10.1186/1471-2458-14-1154

 received in 2014-04-23, accepted in 2014-10-15,  发布年份 2014

【 摘 要 】

Background

Youth represent 40% of all new HIV infections in the world, 80% of which live in sub-Saharan Africa. Youth living with HIV (YLWH) are more likely to become lost to follow-up (LTFU) from care compared to all other age groups. This study explored the reasons for LTFU among YLWH in Kenya.

Methods

Data was collected from: (1) Focus group Discussions (n = 18) with community health workers who work with LTFU youth. (2) Semi-structured interviews (n = 27) with HIV + youth (15–21 years old) that had not received HIV care for at least four months. (3) Semi-structured interviews (n = 10) with educators selected from schools attended by LTFU interview participants. Transcripts were coded and analyzed employing grounded theory.

Results

HIV-related stigma was the overarching factor that led to LTFU among HIV + youth. Stigma operated on multiple levels to influence LTFU, including in the home/family, at school, and at the clinic. In all three settings, participants’ fear of stigma due to disclosure of their HIV status contributed to LTFU. Likewise, in the three settings, the dependent relationships between youth and the key adult figures in their lives were also adversely impacted by stigma and resultant lack of disclosure. Thus, at all three settings stigma influenced fear of disclosure, which in turn impacted negatively on dependent relationships with adults on whom they rely (i.e. parents, teachers and clinicians) leading to LTFU.

Conclusions

Interventions focusing on reduction of stigma, increasing safe disclosure of HIV status, and improved dependent relationships may improve retention in care of YLWH.

【 授权许可】

   
2014 Wolf et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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