Adherence to antiretroviral treatment in Zambia: : a qualitative study of patients and health professionals’ views

Abstract Background: Adherence to antiretroviral therapy (ART) is important for effective treatment. Little is known about barriers and facilitators to ART in Zambia. The aim of the study was to gain knowledge about adherence to antiretroviral treatment among patients and health care professionals in Zambia, in order to identify interventions that may be efficient in increasing patients’ adherence to antiretroviral treatment. Methods: I conducted a qualitative study in Kitwe and Masaiti districts on the Copperbelt Province of Zambia in 2006. I used a combination of in-depth individual interviews and focus groups with patients on ART, health care professionals working in ART clinics and other informants. The material was analysed using qualitative methods. Results: My study identified barriers and facilitators which were diverse in nature and belonged to a wide spectrum of factors which include patient related, health service related, socio-economic and cultural factors. These include lack of communication and information about ART, inadequate time during consultations, follow up and counselling, forgetfulness, stigma, discrimination and disclosure of HIV status, lack of confidentiality in the treatment centres, lack of nutritional support, feeling better, prospects of living longer, family support, information about ART, support for income generating activities and transport.. Conclusion: This study suggests a multiplicity of factors and issues which need to be taken into consideration when providing ART. Further research is needed including participant observations to capture the actual interactions between patients and their health care providers. Also, future studies should assess the magnitude of non adherence to ART in Zambia using quantitative measures. My findings can inform the design of interventions to promote adherence to ART

Sexual behaviour and issues of HIV/AIDS prevention in an African prison

Four hundred and fifty-two (452) inmates at Kamfinsa State Prison in Zambia were interviewed about their sexual practices and knowledge and attitudes 01 HIV/AIDS. Thirty-eight (8.4%) reported homosexual intercourse though 5.ndirect questioning suggested a much higher figure. No condoms were available at the prison and homosexuality was linked to age, marital status, use of illicit liquor, cannabis and tobacco. Inmates associated homosexual relationships with long stay in prison, sexual desires, poor diet and bullying. Another risk factor identified was the sharing of shaving appliances. Although over 90% of inmates knew about HIV and its transmission and more than 75% were willing to live and share facilities with HIV positive colleagues, only 64(14%) had attended an HIV/AIDS meeting at the prison. Our findings suggest that the risk of HIV transmission at the prison is high and an intervention based on health education and distribution of condoms and shaving equipment is urgently needed. Inmates should be the key players in the intervention while socio economic issues facilitating homosexual practices and the law prohibiting homosexuality in Zambia must be reviewed in order to enhance HIV/AIDS prevention in prison