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. 2018 Sep 18;17(1):147.
doi: 10.1186/s12939-018-0863-4.

"I attend at Vanguard and I attend here as well": barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases

Lucia Knight  1 , Enid Schatz  2 , Ferdinand C Mukumbang  3
Affiliations

"I attend at Vanguard and I attend here as well": barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases

Lucia Knight et al. Int J Equity Health. .

Abstract

Background: HIV and non-communicable disease (NCD) are syndemic within sub-Saharan Africa especially among older persons. The two epidemics interact with one another within a context of poverty, inequality and inequitable access to healthcare resulting in an increase in those aged 50 and older living with HIV and experiencing an NCD co-morbidity. We explore the challenges of navigating healthcare for older persons living with HIV and NCD co-morbidity.

Methods: In-depth semi-structured interviews were conducted with a small sample of older persons living with HIV (OPLWH). The perspectives of key informants were also sought to triangulate the evidence of OPLWH. The research took place in two communities on the outskirts of Cape Town, South Africa. All interviews were conducted by a trained interviewer and transcribed and translated for analysis. Thematic content analysis guided data analysis.

Results: OPLWH experienced an HIV-NCD syndemic. Our respondents sought care and accessed treatment for both HIV and other chronic (and acute) conditions, though these services were provided at different health facilities or by different health providers. Through the syndemic theory, it is possible to observe that OPLWH and NCDs face a number of physical and structural barriers to accessing the healthcare system. These barriers are compounded by separate appointments and spaces for each condition. These difficulties can exacerbate the impact of their ill-health and perpetuate structural vulnerabilities. Despite policy changes towards integrated care, this is not the experience of OPLWH in these communities.

Conclusions: The population living with HIV is aging increasing the likelihood that those living with HIV will also be living with other chronic conditions including NCDs. Thus, it is essential that health policy address this basic need to integrate HIV and NCD care.

Keywords: Chronic disease care; HIV; Health policy; Health services; Older persons; South Africa; Syndemic.

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Conflict of interest statement

Ethics approval and consent to participate

This study is part of a larger project “Addressing the social and health needs of older South Africans living with HIV”, which has received ethics clearance from the University of the Western Cape Research Ethics Committee (UWC REC) (Registration No: 15/7/103). In addition, we obtained ethical clearance from the Provincial Department of Health of the Western Cape Province and the permission of facility management prior to data collection. All study participants received information about the study and provided informed consent for their participation.

The respondents were approached to talk about their health as older people regarding access to health care and support from the community no explicit reference to HIV in general nor their own HIV status was included in the information sheet as agreed with the ethics committee to prevent possible inadvertent disclosure and to allow respondents to be given the opportunity to self-disclose during the interviews (and all but one respondent disclosed their HIV status). This means that we respondents did not know they had been selected because of their HIV status and ensured they did not feel victimized by their inclusion in the study. Confidentiality of all information shared and the anonymity of the respondents were a precondition of the informed consent and have been ensured at all stages of the research.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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