Barriers towards utilization of HIV-related services among injecting drug users in Urban-West region, Zanzibar.

Abstract

Background: Injection drug use is a growing social and public health concern in Tanzania and Zanzibar in particular due to its implications in HIV/AIDS transmission. Studies conducted in Tanzania Mainland and Zanzibar estimated a high prevalence of HIV among injecting drug users (IDUs) than that of the general population. Despite this, utilization of HIV-related services by IDUs is low and constrained by some challenges in the form of individual, social and structural barriers. Objective: To describe the barriers in utilization of HIV-related services among injecting drug users in Zanzibar Urban-West region. Methodology: A descriptive cross-sectional study was conducted in June 2014 among IDUs residing in urban-west region, Zanzibar through time-location sampling. A study sample of 100 IDUs was obtained using a time-location sampling method. Data were collected on socio-demographic characteristics, awareness and utilization of services in place and barriers in relation to utilization of HIV-related services. The analysis of data was mostly of descriptive type, and SPSS software version 16 was used for data management. Results: A total of 100 IDUs (93 men; 7 women) participated in the study. Age ranged from 20 to 56 years with a mean of 34.5±7.9 years. Three quarters of participants were from urban district, 48% divorced and majority attained primary or secondary education. Three mostly mentioned barriers for utilization of HIV test were fear of being found HIV positive (52.7%), fear of being stigmatized (34.5%) and lack of time (12.7%). Misconception that screening was done for someone who is sick was the most cited barrier on utilizing TB and hepatitis services (55.7% vs. 28.0%, respectively). Lack of laboratory test for TB and hepatitis at VCT and unavailability of drugs for opportunistic infections were some of the structural barriers for utilizing the services. More than two-fifth (43% of the participants were apparently able to mention three services available and 25% could not mention a single service. Services mostly known to the study participants and which can be utilized were HIV testing and supply of condoms and ARVs. Diagnosis and treatment of conditions like TB and hepatitis are least known. Meanwhile, 93.5% of the respondents reported having experienced stigma and discrimination from the community at some stage, with 73.9% of them mentioning family members and 13% mentioning health care providers as for the behavior. Conclusions: The findings suggest that awareness and utilization of HIV-related services among IDUs in Zanzibar are low. IDUs are challenged more with personal barriers than structural barriers in relation to utilization of HIV-related services. Recommendations: Ministry of Health Zanzibar and its collaborating partners shall increase the awareness on the health services available to IDUs. Community needs to be educated about the relationship between HIV and injection of drugs so as to end the existing stigma and discrimination.