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The Role of Gender in Patient–Provider Relationships: A Qualitative Analysis of HIV Care Providers in Western Kenya with Implications for Retention in Care

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Abstract

The disproportionate burden of HIV among women in sub-Saharan Africa reflects underlying gender inequities, which also impact patient–provider relationships, a key component to retention in HIV care. This study explored how gender shaped the patient–provider relationship and consequently, retention in HIV care in western Kenya. We recruited and consented 60 HIV care providers from three facilities in western Kenya affiliated with the Academic Model Providing Access to Healthcare (AMPATH). Trained research assistants conducted and audio recorded 1-h interviews in English or Swahili. Data were transcribed and analyzed in NVivo using inductive thematic analysis. Gender constructs, as culturally defined, emerged as an important barrier negatively impacting the patient–provider relationship through three main domains: (1) challenges establishing clear roles and sharing power due to conflicting gender versus patient/provider identities, (2) provider frustration over suboptimal patient adherence resulting from gender-influenced contextual barriers, and (3) negative provider perceptions shaped by differing male and female approaches to communication. Programmatic components addressing gender inequities in the health care setting are urgently needed to effectively leverage the patient–provider relationship and fully promote long-term adherence and retention in HIV care.

Resumen

La prevalencia desproporcionada del VIH entre las mujeres en África subsahariana refleja las desigualdades subyacentes del género que también impactan la relación entre pacientes y proveedores, un componente clave para la retención en la atención del VIH. Este estudio exploró cómo el género influye la relación paciente-proveedor y, en consecuencia, la retención en la atención del VIH en el oeste de Kenia. Se reclutaron y otorgaron el consentimiento a proveedores de atención del VIH (N = 60) de tres centros afiliados con el Modelo Académico Promocionando Acceso a la Salud (AMPATH) en el oeste de Kenia. Personal capacitado llevó a cabo entrevistas a profundidad en inglés o suajili. Las mismas fueron grabadas, transcriptas y codificadas en NVivo, y se realizó un análisis inductivo temático. Los constructos de género, definidos culturalmente, surgieron como una barrera importante que impacta negativamente la relación paciente-proveedor a través de tres temas principales: 1) desafíos debido a conflictos de identidad entre el género y el rol de paciente/proveedor, 2) frustración del proveedor con pacientes con dificultades de adherencia debido a barreras contextuales influenciadas por el género, y 3) las percepciones negativas del proveedor formadas de pacientes masculinos y femeninos por las diferentes formas de comunicación debido al constructo de género. Se necesitan con urgencia el desarrollo de programas que aborden las desigualdades de género en la atención del VIH para optimizar la relación paciente-proveedor y al hacer eso, fortalecer la adherencia y la retención a largo plazo en la atención del VIH.

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Acknowledgements

We would like to acknowledge the health care providers who participated in this study whose time and insights made this work possible. We would also like to thank the AMPATH clinical and administrative team, and the research assistants involved in data management for their dedication, commitment and skill.

Funding

This research was supported by a Career Development Award (K01MH099966) from the National Institute of Mental Health (NIMH), and in part by a grant to the USAID-AMPATH Partnership from the United States Agency for International Development (USAID) as part of the President’s Emergency Plan for AIDS Relief (PEPFAR).

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Authors and Affiliations

  1. Brown University School of Public Health, Providence, RI, USA

    Jennifer Knight, Ira B. Wilson, Abigail Harrison & Becky Genberg

  2. School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya

    Juddy Wachira & Paula Braitstein

  3. Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

    Juddy Wachira, Catherine Kafu, Paula Braitstein, Regina Owino, Jacqueline Akinyi & Beatrice Koech

  4. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Paula Braitstein

  5. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Jennifer Knight & Becky Genberg

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  1. Jennifer Knight
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Correspondence to Jennifer Knight.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Knight, J., Wachira, J., Kafu, C. et al. The Role of Gender in Patient–Provider Relationships: A Qualitative Analysis of HIV Care Providers in Western Kenya with Implications for Retention in Care. AIDS Behav 23, 395–405 (2019). https://doi.org/10.1007/s10461-018-2265-4

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  • DOI: https://doi.org/10.1007/s10461-018-2265-4

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