Stigma in access to antiretroviral treatment in Abuja, Nigeria: the importance of social connections

Abstract

Access to anti-retroviral drug (ARV) therapy in Nigeria has been a big challenge. Despite the fact that ARVs have been demonstrated to improve quality of life, reduce AIDS prevalence and AIDS deaths, many people in Nigeria still do not have access to ARV therapy. At the time this study was started, the ARV access rate was 16.6%. This Grounded Theory study examines the experiences of HIV positive people accessing ARVs in Abuja, Nigeria. 30 Patients living with HIV/AIDS were interviewed in an iterative manner. The results of the Grounded Theory analysis were triangulated with the documentary analysis of preliminary and secondary literature. As reported by the participants of the study, patients initially found it very difficult to access treatment. Stigma emerged as the main concern of the research participants. Although access to anti retroviral treatment has improved over the years, different forms of stigma still pose important barriers to access in this group of participants. The results of this research suggest that stigma occurs at individual, familial, community, organisational and national levels. The main concern of research participants was resolved mainly through the use of social connections. The contribution to knowledge is the development of the Social Connection Theory. 5 main stages that patients pass through when they attempt to access ARVs were identified in this study. During each of these stages, the patient may experience barriers through stigma or other forms of structural issues such as poverty. They may also move from one stage to another through social connectors who assist them to access ARVs. In the Social Connection Theory, it is argued that in African settings, social connectors play a vital role in influencing the way that patients access antiretroviral treatment. Social connectors are social acquaintances of the patient who help shape their health care seeking decisions. They play a vital role in supporting and linking HIV positive persons to where they can access ARVS. Social connection serves as a useful tool for empowering HIV patients to overcome different obstacles and access treatment. However, these processes do not occur in a structural vacuum. Structural factors such as religion, gender, politics and the economy were also found to shape the way stigma is experienced in Nigeria and how people access HIV treatment. To improve access to ARVs, it is suggested that while taking cognisance of structural forces, multidisciplinary strategies should be developed that integrate social connectors at different critical points in the access continuum.