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.