Background
Despite evidence
supporting the preventative potential of HIV Treatment as Prevention (TasP),
scientific experts and community stakeholders have suggested that the success
of TasP at the population level will require overcoming a set of complex and
population-specific implementation challenges. For example, the factors that
might influence decisions to initiate ‘early’ treatment have yet to be
thoroughly understood; neither have questions about the factors that enhance or
impede their ability to achieve long-term adherence to ARVs or the social norms
regarding various treatment regimens been examined in detail. This knowledge
gap may hamper opportunities to effectively develop public health practices
that are informed by the various challenges and opportunities related to TasP
implementation and scale up.
Methods
Drawing on 50 in-depth,
individual interviews with young men ages 18–24 in Vancouver, Canada, this
study examines young men’s perspectives regarding factors that might affect
their engagement with TasP.
Results
While findings from the
current study indicate young men generally have a high receptiveness to TasP,
our findings also identify key social and structural forces that will warrant
ongoing consideration for TasP implementation. For example, participants described
how an enhanced awareness regarding treatment (including awareness of the
universal availability of treatment in Vancouver) would be a necessary, but not
sufficient, condition to decide to endorse TasP. Their decisions about engaging
in HIV care in the context of TasP (e.g., HIV testing, treatment initiation,
long-term adherence) also appear to be contingent on their ability to negotiate
or ‘balance’ the risks and benefits to themselves and others. The findings also
offer insight into the complex and sometimes controversial narratives that
continue to emerge regarding risk compensation practices in the context of
TasP.
Conclusion
Based on the results of
this study, we identify several areas that hold promise for informing the
effective scale up of TasP, including new information regarding implementation
adaptation strategies.
[sample of interview responses]
But I don’t know if that [information
about HIV treatment and prognoses] makes
me any less concerned about certain aspects of the disease just because I also
know that it’s [treatment] expensive, and that definitely plays into me, ‘cause I know
that if I needed to afford expensive medication, I just couldn’t right now. (#018)
You’re still fucked [in
the event of an HIV diagnosis]. I don’t even know
if it’s covered by MSP [Medical Services Plan, the
provincial health care plan in the province of British Columbia]. I highly doubt it. So if you’re on welfare and you have
HIV, I think you’re pretty fucking screwed. And I would not want to have to
figure it out, either. (#041)
The person
may feel like, ‘Well, you’re only making me undergo treatment because you just
wanna protect those around me and decrease their chance of contracting the
infection, as opposed to treating me and being concerned about me.’ So I can
see the person viewing the measure as ‘all but me.’ (#001)
Full article at: http://goo.gl/xmw22R
By:
Faculty of Health
Sciences, Simon Fraser University, Burnaby, Canada
British Columbia
Centre for Excellence in HIV/AIDS, Vancouver, Canada
School of
Population and Public Health, University of British Columbia, 2206 East Mall,
Vancouver, British Columbia V6T 1Z3 Canada
Ontario HIV
Treatment Network, Toronto, Canada
More at: https://twitter.com/hiv insight
No comments:
Post a Comment