For people to use treatment, it must not only be available but also accessible. This means that the treatment should be found in the appropriate place and that it should be easy for people to obtain and use properly.
Sometimes, drugs for a treatment can be available locally but are not accessible. This might occur because:
• people cannot afford the right drug;
• the treatment provider discriminates against people living with HIV/AIDS and refuses to give them the drug;
• the treatment provider does not have the right skills to give the drug; and
• it is too difficult for people living with HIV/AIDS to get to where the drug is available.
A barrier to access to treatment is anything that prevents a person from getting the treatment they need. There can be many barriers for people living with HIV/AIDS. These barriers may be related to:
• a service - such as its location, cost, staff attitudes, skills or facilities offered. For example, a clinic might only be open during the day when many people living with HIV/AIDS are working.
• the context - such as the political, economic and cultural situation in which treatment is provided. For example, women might not be able to access treatment for STIs because sex is a taboo subject or because of the stigma of being seen at an STI clinic.
• attitudes to treatment - such as the knowledge and beliefs of community members. For example, local people might believe that HIV counselling and testing are only for members of 'high-risk' groups such as sex workers.
There are many different types of barriers to access to HIV/AIDS-related treatment. These include:
• financial barriers - such as the cost of drugs and the need to prioritize other general supplies, such as food;
• organizational barriers - such as poor administration of treatment services and lack of skilled staff;
• physical barriers - such as treatment facilities being distant and transport not being available; and
• social barriers - such as stigma being associated with a treatment and people being concerned about confidentiality.
Further information on this subject can be found in two information sheets: 'Barriers to access to treatment' and 'Factors affecting access to HIV/AIDS-related treatment'; at the end of this chapter (see pages 30-34).
Participatory group activity
To identify barriers and opportunities for access to HIV/AIDS-related treatment.
Part 1: Identifying barriers
1. Explain the aim of the activity.
2. Present participants with a definition of access to HIV/AIDS-related treatment based on the description on the previous page.
3. Lead a group in brainstorming about what access to HIV/AIDS-related treatment means.
4. Divide the participants into small groups of four to six people.
5. Ask each group to brainstorm about the barriers to access to treatment for people living with HIV/AIDS. Ask them to write each barrier on a separate piece of folded card.
6. Bring everybody back together and ask each group to share their results by explaining their cards and placing them in a row along the floor (to represent road-blocks on the path to access to treatment). Encourage the participants to ask each other questions and to make comments.
7. Facilitate a brief group discussion about what has been learned from the activity, based upon questions such as:
• How many major barriers are there to access to HIV/AIDS-related treatment?
• How might barriers vary for people living with HIV/AIDS?
Part 2: Classifying barriers
8. Write the following headings at the top of separate pieces of flipchart paper:
Present to participants what each heading means, in terms of the types of barriers to access to HIV/AIDS-related treatment (see previous page).
9. Working as a large group, classify the barriers that were presented by the small groups (see Part 1 above), by writing each one down under the heading on the flipchart that best describes it. 10. Facilitate a brief group discussion about what has been learned from the activity, based upon questions such as:
• Is there more of one type of barrier than another? Why?
• Which types of barriers might be easier to overcome?
Part 3: Identifying opportunities
11. Divide the participants into four groups.
12. Give one of the lists of physical, organizational, financial and social barriers (see Part 2 above) to each group. 13. Ask each group to identify which barrier on their list is the most important.
14. Ask each group to write the most important barrier at the centre of a piece of flipchart paper. Then ask them to add opportunities to overcome the barrier, by putting them in circles around it. If the opportunity can be addressed easily, it should be placed near to the barrier. If it is difficult, it should be placed further away.
15. Bring everybody back together and ask the groups to share their results. Encourage participants to ask each other questions and to make comments.
16. Facilitate a brief group discussion about what has been learned from the activity, based upon questions such as:
• To what extent can something be done about all of the barriers?
• Which opportunities would it be suitable for NGOs/CBOs to tackle?
• It may be useful to allow participants time to read Information Sheet 1: 'Barriers to access to treatment' before they classify the types of barriers.
• Encourage participants to be as concrete as possible when identifying barriers; that will make it easier to find solutions.
• Encourage participants to focus on simple, practical steps to overcome barriers, rather than on complex strategies that would be difficult to achieve.
At a skills-building workshop, NGO/CBO participants brainstormed about barriers to access to treatment for people living with HIV/AIDS. They wrote the barriers on folded cards and then presented them on the floor to represent road-blocks to access to treatment.
Then, the participants classified the barriers to treatment under four headings.
• Negative attitudes of health-care workers
• Lack of materials needed for treatment
• Delays in treatment/health-care workers not available
• Corruption in health-care facilities
• Distance to health facilities
• Lack of transport
• Traditional beliefs
• Myths and misinformation about HIV/AIDS
• Cost of drugs
• Expense of user fees in hospitals
• Cost of transport to health-care facilities
• Lack of medical insurance schemes
Finally, small groups selected the most important barrier from one of the lists of financial, organizational, physical and social barriers. They then identified opportunities to overcome that barrier. For example, the group focusing on financial barriers identified the cost of transport as the barrier that causes the most difficulty for people living with HIV/AIDS. The same group identified the following opportunities to overcome the cost of transportation to health-care facilities:
Afterwards, the facilitator led a group discussion about what had been learned from the activity. For example, participants agreed that a variety of people and organizations needs to be involved in overcoming barriers to treatment access.
Reference: Adapted from a workshop on access to HIV-related treatment, Catholic Diocese of Ndola and the International HIV/AIDS Alliance, Zambia, April 2001.