Q And A Forum: For Key Populations in Uganda Taking ARVs As Prescribed Is Easier Said Than Done

MARPS in Uganda, has helped KP-led Organizations in Uganda access Health information in a readily digestible and usable way.

One of the most frequent questions fielded is how to maintain ARVs medication at individual levels. ARV service paths can be divided into the proximate and distal parts. 

At the proximate are the immediate causes and processes (factors) such as time for taking prescription, actual taking of a prescription, availability of food or water and no barriers to one’s taking medication.

At the distal part are those structural and environmental factors such as price, political conditions, status, stigma, discrimination, harassment, availability of health facilities to ensure refills and regular supply of medicines before stocks run out.

But for KPs in Uganda, the case may be different. Some cannot afford housing, cannot afford transport to go to clinics for regular check-ups or refills. The likelihood of facing stigma and discrimination in their domicile communities and at other points of call is so high. These conditions combine into what are known as a Vulnerability and Susceptibility Chain (VASC). VASC opens ways for HIV transmission, poor or no possibility to negotiate for safer sex, a possibility for abused partners in a relationship to remain silent, poor ARV-adherence and subsequent lack of viral suppression.

But, what can be done to address VASC?

This is a question our editor explored and found three compelling answers.

The first was to establish HIV Prevention Programmes using viable groups to create a durable prevention culture enabling access to HIV Testing, put those with positive diagnosis on ARVs and ensure those on ARVs adhere so that they experience viral suppression over time. This means that people who choose to form, join and maintain viable groups, enjoy many advantages. The advantages range from building self esteem, assurance of stable housing, affinity to caring for others, motivation to commit to ARV adherence for those with positive diagnosis and an enduring companionship. This in turn addresses what is known as Generalized Anxiety Disorder (GAD) known to be faced by PLHIV who are not cared for or who fail to seek care services. 

According to Benjamin Ryan (2019) in an article titled “A High Proportion of People With HIV Suffer From Anxiety,” generalized anxiety disorder is associated with lower rates of HIV treatment, adherence to treatment and very poor or no viral suppression. 

Ryan continues to argue that “Linda Beer, PhD, and colleagues from the Centers for Disease Control and Prevention (CDC) showed that , people had higher rates of anxiety symptoms if they were men, lacked a college education, were living in poverty and had recently experienced homelessness.”

The second was to enroll in Clinical Trial Programmes that are available, so that it increases opportunities for regular monitoring and evaluation by well trained and qualified health workers.

The third was to embrace new health technologies that increase opportunities for avoiding breaks in taking ARVs e.g.,for vulnerable women and girls. One such example is the vaginal ring.

In an article by Roxy de Villiers (2019) titled “The quest for the (vaginal) ring,” it is argued that “a vaginal ring inserted monthly could reduce women’s risk of contracting HIV by 63%, according to a recent study. It is a long-acting form of treatment that HIV-negative women can take before being exposed to HIV to reduce their chances of contracting the virus. The treatment, which is also known as pre-exposure prophylaxis (PrEP), can be easily replaced at home each month. The women the study used the ring made of silicon band and showed it was  effective at protecting them from HIV ”

If the above three suggestions are combined, Key Populations in Uganda taking ARVs as prescribed will find it both easier said and done.