Barriers to Linkage to HIV Care in Ugandan Fisherfolk Communities

A Qualitative Analysis

Published in: AIDS and Behavior, 2016

Posted on RAND.org on March 18, 2016

by Laura M. Bogart, Rose Naigino, Emily Maistrellis, Glenn Wagner, William Musoke, Barbara Mukasa, Riana Jumamil, Rhoda K. Wanyenze

Read More

Access further information on this document at AIDS and Behavior

This article was published outside of RAND. The full text of the article can be found at the link above.

Research Questions

  1. What are the barriers to and facilitators of linkage to HIV care among fisherfolk in Ugandan fishing communities in and around Lake Victoria?
  2. What new models of care might help to address barriers?

Among Ugandan fisherfolk, HIV prevalence (with estimates ranging from 15 to 40 %) is higher than in the general population (about 7 %), potentially due to high-risk behaviors and low access to HIV testing and healthcare. We conducted semi-structured interviews on barriers to linkage to care with 10 key stakeholders and 25 fisherfolk within 1-2 months of their testing HIV-positive at clinic outreach events in Ugandan Lake Victoria communities. Interviews were recorded, transcribed, translated, and coded using grounded theory methods. Participants cited low healthcare access and quality of care, mobility, competing needs for work during clinic hours, stigma, and low social support as barriers. Over 10 % of clients screened positive for HIV at outreach events, and only half accessed care. Linkage to care issues may begin with the failure to attract high-risk fisherfolk to testing. New models of HIV testing and treatment delivery are needed to reach fisherfolk.

Key Findings

  • High population mobility, competing needs, low or inconvenient access to healthcare, and HIV stigma all play a role in impeding linkage to HIV care among fisherfolk.
  • New, flexible models of outreach for HIV testing and treatment delivery are needed to reach fisherfolk at highest risk, to accommodate their mobile lifestyles and competing needs for work.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.