The one who doesn’t take ART medication has no wealth at all and no purpose on Earth

Saya et al. BMC Public Health (2022) 22:1056

https://doi.org/10.1186/s12889-022-13461-w

RESEARCH

“The one who doesn’t take ART medication

has no wealth at all and no purpose on Earth” –

a qualitative assessment of how HIV-positive

adults in Uganda understand the health

and wealth-related benefts of ART

Uzaib Saya1,2*, Sarah MacCarthy3

, Barbara Mukasa4

, Peter Wabukala4

, Lillian Lunkuse4

, Zachary Wagner1,2 and

Sebastian Linnemayr1,2

Abstract

Background: Increases in life expectancy from antiretroviral therapy (ART) may infuence future health and wealth

among people living with HIV (PLWH). What remains unknown is how PLWH in care perceive the benefts of ART

adherence, particularly in terms of improving health and wealth in the short and long-term at the individual, house￾hold, and structural levels. Understanding future-oriented attitudes towards ART may help policymakers tailor care

and treatment programs with both short and long-term-term health benefts in mind, to improve HIV-related out￾comes for PLWH.

Methods: In this qualitative study, we conducted semi-structured interviews among a subsample of 40 PLWH in

care at a clinic in Uganda participating in a randomized clinical trial for treatment adherence in Uganda (clinicaltrials.

gov: NCT03494777). Interviews were transcribed verbatim and translated from Luganda into English. Two co-authors

independently reviewed transcripts, developed a detailed codebook, achieved 93% agreement on double-coded

interviews, and analyzed data using inductive and deductive content analysis. Applying the social-ecological frame￾work at the individual, household, and structural levels, we examined how PLWH perceived health and wealth-related

benefts to ART.

Results: Our fndings revealed several benefts of ART expressed by PLWH, going beyond the short-term health ben￾efts to also include long-term economic benefts. Such benefts largely focused on the ability of PLWH to live longer

and be physically and mentally healthy, while also fulflling responsibilities at the individual level pertaining to them￾selves (especially in terms of positive long-term habits and motivation to work harder), at the household level pertain￾ing to others (such as improved relations with family and friends), and at the structural level pertaining to society (in

terms of reduced stigma, increased comfort in disclosure, and higher levels of civic responsibility).

Conclusions: PLWH consider short and long-term health benefts of ART. Programming designed to shape ART

uptake and increase adherence should emphasize the broader benefts of ART at various levels. Having such benefts

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Open Access

*Correspondence: [email protected]

1

Pardee RAND Graduate School, Santa Monica, CA 90401, USA

Full list of author information is available at the end of the article