(see Poster Gallery) Social Influences on HIV Services Engagement Among Adolescents Experiencing HIV Stigma and Discrimination in Uganda

Background: HIV/AIDS-related stigma, catalyzed by restrictive laws, policies and attitudes are invoked as a persistent and pernicious problem resulting in limited access to HIV testing services, condom use, PrEP, and low adherence to treatment, stand in the way of health service utilization among Adolescents and young people living with HIV. Critically affected are sexual minorities, sex workers and injecting drug users. In 2019, more than 33% of key populations living with HIV in Uganda did not have adequate access to care. Using Andersen's model of health utilization, the study aimed to identify HIV utilization structural barriers, focusing on specific role of social influences and disengagement due to restrictive and less inclusive laws in Uganda.

Methods: The study was conducted using grounded theory involving in-depth semi-structured interviews with 31 focus group YPLHIV participants ages 18 and 25, recruited through urban HIV clinics and counseling facilities in Kampala between December 2020 and May 2021. The interviews were recorded in English, transcribed verbatim, and analyzed using Dedoose, a cross-platform App for analyzing qualitative and mixed methods research data.

Results: Consistent with the Andersen model of service utilization, five barriers to HIV services utilization were mapped: Theme 1: Governmental restrictive HIV laws and policies, Theme 2: Stigma practices that include discrimination and prejudice, intersectional stigma, including internalized, perceived, and interpersonal. Theme 3: Inadequate healthcare providers trained to address the needs of adolescents living with HIV, Theme 4: Influence of informal social networks (i.e., sexual partners, peers, families); interactions with healthcare workers; and 5: Health service delivery mechanisms.

Conclusions: Future interventions should advocate for less discriminatory policies that marginalize vulnerable populations. Strengthening social support improving care-seeking, behaviors and increasing privacy assurances while engaging in HIV care will break down the barriers in Uganda. Building solutions to future HIV prevention, testing, treatment, and care responses could address inequities by drawing on peer support network to partner with already understaffed health workforce and help fellows navigate the heavily criminalized and stigmatized settings to utilize healthcare services.