Barriers to Utilization of HIV Care Services Among Adolescents and Young Adults in Rakai, Uganda: the Role of Economic Strengthening

Background: Early entry into HIV care is low in Sub-Saharan Africa. In Rakai, adolescents and young adults 15–24 years were at increased risk of not entering care after knowledge of their positive HIV status. This qualitative study explored barriers to entry into care from HIV-positive clients aged 15–24 years and explored the role of economic strengthening in promoting care utilization. Methods: We conducted 18 in-depth interviews among HIV-infected individuals aged 15–24 years, who had not entered care within 6 months of result receipt and referral for free care. Also, key informant interviews were conducted with 12 providers. Interviews were audio-recorded and transcripts subjected to thematic content analysis based on the health belief model. Results: Barriers to using HIV care included fear of stigma (7/18−39 %) and HIV disclosure and high transport costs. Programmatic barriers included fear of antiretroviral drug side effects, long waiting, and travel times. Denial of HIV status and absence of AIDS symptoms were also barriers. Eight (44 %) of the participants reported economic barriers to care utilization, and these included lack of money for transport to clinic and anticipated lost work time and money resulting from long waiting clinic hours. Conclusion: Economic barriers are highly prevalent as obstacles to utilization of care by young people, suggesting the role of economic strengthening for young persons living with HIV, so as to promote utilization of HIV care services.