AIDS doesn't kill its customer : understanding barriers to access and adherence to HIV treatment among young people living in peri-Urban Uganda

Introduction: Uganda’s current success story in its battle against the HIV/AIDS epidemic is being questioned as recent research has estimated a possible increase in both prevalence and incidence across the country, specifically within the rural southwest. Rakai district has long been recognized as the Ugandan epicentre of HIV/AIDS and appears to again be in a vulnerable positive. As universal care to free HIV treatment has only been available in Uganda in 2004, there remains a paucity of literature understanding the current barriers to access and adherence to HIV treatment programs, especially among young people living in the heavily affected southwestern community of Lyantonde. Therefore, objectives of this thesis were to: 1. Investigate the current barriers young men and women experience when attempting to access HIV treatment and care in town;(2) Document the barriers young women and men living in this peri-urban setting experience when attempting to adhere to HIV treatment while living in town; (3) Develop community appropriate recommendations to address the results found within this study. Results: Participants not accessing treatment identified three barriers to treatment access: relationship-based fears, workplace-based fears and food insecurity leading to treatment attrition. None of the participants who were accessing treatment at the time of the study were able to remain adherent to their treatment, all of which reported that food insecurity was their only barrier to adherence. Discussion: these data indicate that the conditions for young people living with HIV/AIDS in Lyantonde remain incredibly difficult and, despite free treatment availability, many are not able to access care and those who are, face such food security-related barriers that they are unable to adhere to their treatment. Recommended actions include community based farming programs for young people living with HIV/AIDS, small household farming workshops, micro-credit groups for young people and finally the training of couples to offer dual counselling for both concordant and discordant couples during HIV/AIDS educational workshops and testing times.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat