Factors Influencing Access and Use of Care and Treatment Services among Iranian People Living with HIV and AIDS: A Qualitative Study.

The number of people living with HIV is increasing in the eastern Mediterranean region and the world (1) but still the coverage of anti-retroviral therapy in the region is very low (1). In Iran, there are many observed gaps in the process of HIV testing, treating and retaining cascade (2). Iran has a long way to achieve the goals published by the UNAIDS fast-track, accordingly, by the year 2020, 90% of people living with HIV and AIDS have to know their HIV status; 90% of people who know their status be on treatment; and 90% of people on treatment have suppressed viral loads (3). From about 95000 people living with HIV and AIDS in Iran, only 28.5% knew their status, 16.5% of them are on ART with an estimated adherent rate of 67.8% (2). Anti-retroviral therapy in Iran is free of charge for all of the patients in the governmental settings known as Behavioral Disease Counseling Centers that provides related services in the field of diagnosis , prevention, care and treatment (4). HIV/AIDS epidemic in Iran is in concentrated phase among people who inject drugs with the average rate of 15.2% (5). Prevention strategies alone are not enough to stop or reverse HIV epidemic (6), on the other hand, treatment as prevention is a successful strategy in countries with adequate resources that are in concentrated epidemic stage (7). Despite enormous efforts and interventions, many of people living with HIV and AIDS do not yet have access to health services in the world (1). This research is one of the very few studies conducted in Iran to find what barriers influencing access and use of health services among Iranian people living with HIV and AIDS. This study was conducted using focus group discussion (FGD). The participants were recruited from the patients attending behavioral disease counseling center of six largest cities in Iran (Isfa-han, Mashhad, Bandar Abbas, Kermanshah, Rasht and Urmia) in 2010. Sixty-eight (50 males, 18 females) HIV positive patient, participated in the study. Level of education among male participants were higher than female participants were (average years of education: Male 6.9, female 4.3) but the average of the age was lower among male participants (35 for male vs. 41.8 for female participants). Eight domains can influence access and use of care and treatment services among Iranian people living with HIV and AIDS. These domains each one take effects from many …