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Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia

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Abstract

Russia has a large HIV epidemic, but medical care engagement is low. Eighty HIV-positive persons in St. Petersburg completed in-depth interviews to identify barriers and facilitators of medical HIV care engagement. The most commonly-reported barriers involved difficulties accessing care providers, dissatisfaction with the quality of services, and negative attitudes of provider staff. Other barriers included not having illness symptoms, life stresses, low value placed on health, internalized stigma and wanting to hide one’s HIV status, fears of learning about one’s true health status, and substance abuse. Care facilitators were feeling responsible for one’s health and one’s family, care-related support from other HIV-positive persons, and the onset of health decline and fear of death. Substance use remission facilitated care engagement, as did good communication from providers and trust in one’s doctor. Interventions are needed in Russia to address HIV care infrastructural barriers and integrate HIV, substance abuse, care, and psychosocial services.

Resumen

Rusia experimenta una importante epidemia de VIH, pero tiene baja retención de las personas VIH positivas en la atención médica. Ochenta personas viviendo con VIH en San Petersburgo completaron entrevistas en profundidad con el fin de identificar barreras y facilitadores en cuanto a estar bajo atención médica del VIH. Las barreras más comúnmente reportadas fueron dificultades en el acceso a proveedores de salud, insatisfacción con la calidad de los servicios de salud, y actitudes negativas de los proveedores de salud. Otras barreras fueron no tener síntomas de enfermedad, experimentar otros estresores vitales, tener una baja valoración de la propia salud, experimentar estigma internalizado y necesitad de esconder el estatus VIH positivo, tener miedo a conocer el propio estado de salud, y usar sustancias. Los facilitadores de mantenerse bajo cuidado médico fueron sentirse responsable por la propia salud y la de la familia, recibir el apoyo de otras personas VIH positivas, y sentir el comienzo de la declinación de la salud y el miedo a la muerte. Además de la buena comunicación con los proveedores de salud y de tener un médico de confianza, la reducción del uso de sustancias facilitó la retención en el cuidado médico. En Rusia, se necesitan intervenciones que tengan en cuenta las barreras de infraestructura en la atención del VIH e integren los servicios de VIH con los psicosociales y de abuso de sustancias.

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Acknowledgments

This research was supported by grants R01-MH098729, R21-MH102193, P30-MH52776 from the US National Institute of Mental Health and by Grant 13-06-91440 from the Russian Foundation for Basic Research. The authors extend their appreciation to Laura Glasman, Maria Donskaya, Dmitry Mescheryakov, Dmitry Pirogov, Rudolph Amirkhanian, and Nikolay Chaika.

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Authors and Affiliations

  1. Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS Research and Training (ICART), St. Petersburg, Russia

    Anna V. Kuznetsova, Anastasia Y. Meylakhs, Yuri A. Amirkhanian, Alexey A. Yakovlev, Vladimir B. Musatov & Anastasia G. Amirkhanian

  2. Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit Avenue, Milwaukee, WI, 53202, USA

    Yuri A. Amirkhanian & Jeffrey A. Kelly

  3. Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia

    Alexey A. Yakovlev & Vladimir B. Musatov

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  1. Anna V. Kuznetsova
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  2. Anastasia Y. Meylakhs
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Correspondence to Yuri A. Amirkhanian.

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Kuznetsova, A.V., Meylakhs, A.Y., Amirkhanian, Y.A. et al. Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia. AIDS Behav 20, 2433–2443 (2016). https://doi.org/10.1007/s10461-015-1282-9

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