Gender roles and adherence to ART Miodrag Kajgana1, Branko Kostić1, Nikola Avramović1, Maja Terzić2 1 Tim Tri, Belgrade 2 Aid+, Belgrade
GoalThe goal of this research is to establish Gender roles andadherence to ART PLHIV from Belgrade.
Positive prevention includes:1. Protecting sexual and reproductive health – and avoidingother sexually transmitted infections (STIs);2. Delaying HIV disease progression;3. Promoting shared responsibility to protect sexual healthand reduce the risk of HIV transmission. Source: Positive Prevention – Prevention Strategies for People Living with HIV http://www.ippf.org/NR/rdonlyres/F8F93696-FD27-4CEF-BBA9- ACB9B97354AF/0/PositivePrevention.pdf
The main principles of positive prevention: Promotion of human rights Involvement of people living with HIV Shared ownership and responsibility Recognition of diversity
The benefits of responding to the prevention needs of peopleliving with HIV are well known:It can contribute to the full enjoyment of sexual and reproductivehealth and rights;It can promote new ways to live in sero-discordant or concordantrelationships;It can avert unnecessary illnesses and ensure timely access totreatment, care and support;
It can promote adherence to ART;It can contribute to opening up a frank dialogue among healthproviders, people living with HIV, community members,parliamentarians and other stakeholders about the need topromote an environment free from stigma and discrimination;It can help HIV-positive people to be empowered to makedecisions about their lives without the burden of feeling guilt orshame as a result of their HIV status.
The Swiss GuidelinesIn February 2008 the Swiss Federal Commission on HIV/AIDSissued guidelines based on two studies and extensive research ofavailable literature. The Guidelines stated that:An HIV-infected person on antiretroviral therapy withcompletely suppressed viraemia (“effective ART”) is notsexually infectious, i.e. cannot transmit HIV through sexualcontact. This statement is valid as long as:1 the person adheres to antiretroviral therapy, the effects ofwhich must be evaluated regularly by the treating physician, and2 the viral load has been suppressed (< 40 copies/ml) for at leastsix months, and3 there are no other sexually transmitted infections.
Key interventions for adult and adolescents living with HIVWHO has published a set of guidelines including thirteeneffective, evidence-based interventions for people living withHIV in resource limited settings that are “simple, relativelyinexpensive, can improve the quality of life, prevent furthertransmission of HIV, and for some interventions, delayprogression of HIV disease and prevent mortality.”1 Psychosocial counselling and support;2 Disclosure, partner notifi cation and testing and counselling;3 Co-trimoxazole prophylaxis;4 Tuberculosis counselling, screening and prevention;5 Preventing fungal infections;
6 Sexually transmitted and other reproductive tract infections;7 Preventing malaria;8 Selected vaccine preventable diseases (hepatitis B, es ???pneumococcal, influenza and yellow fever); rI ssu nde9 Nutrition;10 Family planning; Ge11 Preventing mother-to-child transmission of HIV;12 Needle-syringe programmes and opioid substitution therapy;and13 Water, sanitation and hygiene.Source: Essential Prevention and Care Interventions for Adults and Adolescents Living with HIVin Resource-Limited Settings. World Health Organization, Geneva, 2008.
Serbian facts and figures * 68,1% of respondants have no negative influence fromtaking their regular medication in everyday life1* 78,1% has never, or almost never forgoten to take theirmedication1* 63,3% had not missed a single dosage of medication inthe past 1* 67,5% never forgets to take their daily dosage ofmedication2* 31,4% occassionally forgets to take their daily dosage ofmedication 2* 1,1% frequently forgets to take their daily dosage ofmedication 2* 60,9% has not missed a single dosage of ARV during thepast week2 1 Bio-BSS, Srbija, 2008 2 Bio-BSS, Srbija, 2010
MethodologyA sample of 68 men and 23 women has been tested through fieldwork at the HIV/AIDS Department of the Disease Clinic inBelgrade, through personal contact and through social networks(Facebook i Gаyromeo).Criteria for stratum formation: (1) that the person is agedbetween 18-50, (2) that is a resident of Belgrade (3) that has beenon the ART therapy at least one year.
For the research a specific questionnaire has been used. It asked 3key questions: (1) how many dosages of your regular therapy do you“skip” weekly/monthly, (2) why do you “skip” and (3) what can be themain reason for skipping therapy. An interview was taken, (noquestionnaire has been filled out).All interviews have been done in a friendly and informalatmosphere.
ResultsTab. 1. Main reasons for skipping a dosage of ARV therapyreasons for skipping therapy men women TotalTotal number of respondents 68 23 91Without any reason 56 19 75Fear that their HIV status will be uncovered 62 17 79Fear of stigmatization linked to practicing risky 58 15 73sexFear of stigmatization linked to the recognition 19 12 31of other risks (most frequent:addiction)
The most frequent answer (56 men and 19 women)responded thatthey had forgotten to take their therapy without any concretereason. Fear that their HIV status will be uncovered and reasonfor “skipping” regular therapy has been stated by 62 men and 17women.Fear of stigmatization linked to the recognition of other risks(most frequent:addiction) has been stated by 19 men and 12women. One respondent stated that alcohol consumption was areason skipping therapy.
DISCUSSIONThe main reasons for skipping ARV therapy except the mostfrequent reply(“no reason”) show direct or indirect influence ofadherent influence of gender roles.The effects of gender roles, and as we can only suspect, genderinfluenced assault, can best be understood in the constatation: “Ishall skip my regular therapy in order not to be linked withcertain sexual practices”.
Also, the statement “I shall skip my therapy in order not to belinked with the HIV/AIDS-a diagnosis” has also, aside from theobvious non-gender ones which includes fear from the unknown,and elements that are linked to stigmatization (as well asdiscrimination) of people that are infected with a sexuallytransmitted disease which in return has indicators of potentiallygender based violence.Other practices for example drug injecting is a important elementin the formation of gender based stigmatization, so the statement“I fear that I shall be linked with other (IDU/methadon users)”should be understood in that context.
ConclusionThe results indicate that the makings of gender roles, and thus thefear of gender-based violence affects the adherence of PLHIVfrom Belgrade.From the aspect of concept of positive prevention, which amongothers includes the postponement of the disease, which is directlyassociated with good adherence, the research indicates, that themulti-sectoral approach is required in overcoming the negativeconsequences related to the perception of the environment andself-perception of PLHIV through gender roles and HIVinfection.
Recommendations* Training health care workers in primary health care throughContinuous Medical Education (KME) on the impact of genderroles on health;* Education Providers in VCCT centers on the most basicelements of the gender role of vulnerable populations andPLHIV;* The possibility of formal or informal education for studentsmedical schools and medical students of the elements of therecognition of the impact of gender roles on health;* Training for all providers of services for PLHIV (especiallyNGO activists who provide services to PLHIV) on elements ofgender roles;* Creating special programs for the empowerment of PLHIV whoare primarily concerned to overcome fear / stress from gender-based violence.