6th Regional Conference in Sarajevo, May 17-18 2012.

1. Gender roles and adherence to ART
Miodrag Kajgana1, Branko Kostić1,
Nikola Avramović1, Maja Terzić2
1
Tim Tri, Belgrade
2
Aid+, Belgrade

2. Goal
The goal of this research is to establish Gender roles and
adherence to ART PLHIV from Belgrade.

3. Positive prevention includes:
1. Protecting sexual and reproductive health – and avoiding
other sexually transmitted infections (STIs);
2. Delaying HIV disease progression;
3. Promoting shared responsibility to protect sexual health
and 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

4. The main principles of positive prevention:
Promotion of human rights
Involvement of people living with HIV
Shared ownership and responsibility
Recognition of diversity

5. The benefits of responding to the prevention needs of people
living with HIV are well known:
It can contribute to the full enjoyment of sexual and reproductive
health and rights;
It can promote new ways to live in sero-discordant or concordant
relationships;
It can avert unnecessary illnesses and ensure timely access to
treatment, care and support;

6. It can promote adherence to ART;
It can contribute to opening up a frank dialogue among health
providers, people living with HIV, community members,
parliamentarians and other stakeholders about the need to
promote an environment free from stigma and discrimination;
It can help HIV-positive people to be empowered to make
decisions about their lives without the burden of feeling guilt or
shame as a result of their HIV status.

7. The Swiss Guidelines
In February 2008 the Swiss Federal Commission on HIV/AIDS
issued guidelines based on two studies and extensive research of
available literature. The Guidelines stated that:
An HIV-infected person on antiretroviral therapy with
completely suppressed viraemia (“effective ART”) is not
sexually infectious, i.e. cannot transmit HIV through sexual
contact. This statement is valid as long as:
1 the person adheres to antiretroviral therapy, the effects of
which must be evaluated regularly by the treating physician, and
2 the viral load has been suppressed (< 40 copies/ml) for at least
six months, and
3 there are no other sexually transmitted infections.

8. Key interventions for adult and adolescents living with HIV
WHO has published a set of guidelines including thirteen
effective, evidence-based interventions for people living with
HIV in resource limited settings that are “simple, relatively
inexpensive, can improve the quality of life, prevent further
transmission of HIV, and for some interventions, delay
progression 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;

9. 6 Sexually transmitted and other reproductive tract infections;
7 Preventing malaria;
8 Selected vaccine preventable diseases (hepatitis B,
es ???
pneumococcal, influenza and yellow fever);
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9 Nutrition;
10 Family planning; Ge
11 Preventing mother-to-child transmission of HIV;
12 Needle-syringe programmes and opioid substitution therapy;
and
13 Water, sanitation and hygiene.
Source: Essential Prevention and Care Interventions for Adults and Adolescents Living with HIV
in Resource-Limited Settings. World Health Organization, Geneva, 2008.

10. Serbian facts and figures
* 68,1% of respondants have no negative influence from
taking their regular medication in everyday life1
* 78,1% has never, or almost never forgoten to take their
medication1
* 63,3% had not missed a single dosage of medication in
the past 1
* 67,5% never forgets to take their daily dosage of
medication2
* 31,4% occassionally forgets to take their daily dosage of
medication 2
* 1,1% frequently forgets to take their daily dosage of
medication 2
* 60,9% has not missed a single dosage of ARV during the
past week2
1
Bio-BSS, Srbija, 2008
2
Bio-BSS, Srbija, 2010

11. Methodology
A sample of 68 men and 23 women has been tested through field
work at the HIV/AIDS Department of the Disease Clinic in
Belgrade, through personal contact and through social networks
(Facebook i Gаyromeo).
Criteria for stratum formation: (1) that the person is aged
between 18-50, (2) that is a resident of Belgrade (3) that has been
on the ART therapy at least one year.

12. For the research a specific questionnaire has been used. It asked 3
key questions: (1) how many dosages of your regular therapy do you
“skip” weekly/monthly, (2) why do you “skip” and (3) what can be the
main reason for skipping therapy. An interview was taken, (no
questionnaire has been filled out).
All interviews have been done in a friendly and informal
atmosphere.

13. Results
Tab. 1. Main reasons for skipping a dosage of ARV therapy
reasons for skipping therapy men women Total
Total number of respondents 68 23 91
Without any reason 56 19 75
Fear that their HIV status will be uncovered 62 17 79
Fear of stigmatization linked to practicing risky 58 15 73
sex
Fear of stigmatization linked to the recognition 19 12 31
of other risks (most frequent:addiction)

14. The most frequent answer (56 men and 19 women)responded that
they had forgotten to take their therapy without any concrete
reason. Fear that their HIV status will be uncovered and reason
for “skipping” regular therapy has been stated by 62 men and 17
women.
Fear of stigmatization linked to the recognition of other risks
(most frequent:addiction) has been stated by 19 men and 12
women. One respondent stated that alcohol consumption was a
reason skipping therapy.

15. DISCUSSION
The main reasons for skipping ARV therapy except the most
frequent reply(“no reason”) show direct or indirect influence of
adherent influence of gender roles.
The effects of gender roles, and as we can only suspect, gender
influenced assault, can best be understood in the constatation: “I
shall skip my regular therapy in order not to be linked with
certain sexual practices”.

16. Also, the statement “I shall skip my therapy in order not to be
linked with the HIV/AIDS-a diagnosis” has also, aside from the
obvious non-gender ones which includes fear from the unknown,
and elements that are linked to stigmatization (as well as
discrimination) of people that are infected with a sexually
transmitted disease which in return has indicators of potentially
gender based violence.
Other practices for example drug injecting is a important element
in 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.

17. Conclusion
The results indicate that the makings of gender roles, and thus the
fear of gender-based violence affects the adherence of PLHIV
from Belgrade.
From the aspect of concept of positive prevention, which among
others includes the postponement of the disease, which is directly
associated with good adherence, the research indicates, that the
multi-sectoral approach is required in overcoming the negative
consequences related to the perception of the environment and
self-perception of PLHIV through gender roles and HIV
infection.

18. Recommendations
* Training health care workers in primary health care through
'Continuous Medical Education' (KME) on the impact of gender
roles on health;
* Education Providers in VCCT centers on the most basic
elements of the gender role of vulnerable populations and
PLHIV;
* The possibility of formal or informal education for students
medical schools and medical students of the elements of the
recognition of the impact of gender roles on health;
* Training for all providers of services for PLHIV (especially
NGO activists who provide services to PLHIV) on elements of
gender roles;
* Creating special programs for the empowerment of PLHIV who
are primarily concerned to overcome fear / stress from gender-
based violence.