Barriers along the care cascade of HIV-infected men in a large urban center of Brazil

Abstract

Global and national HIV/AIDS policies utilize the care cascade to emphasize the importance of continued engagement in HIV services from diagnosis to viral suppression. Several studies have documented barriers that men experience in accessing services at specific stages of care, but few have analyzed how these barriers operate along the care cascade. Brazil offers a unique setting for analyzing barriers to HIV care because it is a middle-income country with a large HIV epidemic and free, universal access to HIV/AIDS services. Semi-structured interviews were conducted in 2011 with HIV-infected men (n = 25) receiving care at the only HIV/AIDS state reference center in Salvador, Brazil, the third largest city in the country. Interviews were transcribed and coded for analysis. Researchers identified barriers to services along the care cascade: health service-related obstacles (poor-quality care, lengthy wait times, and drug supply problems); psychosocial and emotional challenges (fear of disclosure and difficulty accepting HIV diagnosis); indirect costs (transportation and absenteeism at work or school); low perceived risk of HIV; and toxicity and complexity of antiretroviral drug (ARV) regimens. The stages of the care cascade interrupted by each barrier were also identified. Most barriers affected multiple, and often all, stages of care, while toxicity and complexity of ARV regimens was only present at a single care stage. Efforts to eliminate more prevalent barriers have the potential to improve care continuity at multiple stages. Going forward, assessing the relative impact of barriers along one's entire care trajectory can help tailor improvements in service provision, facilitate achievement of viral suppression, and improve access to life-saving testing, treatment, and care.

Keywords:

• HIV/AIDS
• care cascade
• barriers
• men
• delay
• Brazil

Acknowledgements

There are no acknowledgements to report.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Brazilian National Department of STD/AIDS and Viral Hepatitis in the Ministry of Health; the Foundation for Research Support in the State of Bahia; the HIV/AIDS Reference Center of the Bahia Department of Health (CEDAP); the Pathfinder Foundation; the National Institutes of Health under [grants T32 DA12911-12; 1T37MD008655]; the Lifespan/Tufts/Brown Center for AIDS Research [grant P30 AI042853]; the National Institute of Allergy and Infectious Diseases; and the Brazil Community Health Fellows Program of Brown University.