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Abstract
The aim of this study was to explore why patients in the urban Kibera slum, Nairobi, Kenya, offered free antiretroviral treatment (ART) 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 ART: a) fear of taking medication on an empty stomach due to lack of food; b) fear that side-effects associated with ART 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.
Acknowledgements
The study was financially supported by The Swedish Medical Research Council and MSF Belgium. Many thanks to Kristina Bolme, MSF Sweden, giving us background information about the Kibera context when designing the study. We are also grateful for the valuable advice and comments provided by and Helga Ritter at MSF and to Sara Norlén, Olivier Bluteau and the rest of the MSF staff in Nairobi. Special thanks to Alice Belita and Douglas for data collection, and to Professor Hans Rosling at IHCAR for always providing an extra dimension to our perception about reality.