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Interviews from 28 HIV positive participants are used in this analysis of the influences that enabled or inhibited HIV treatment initiation and treatment adherence. Enablers included awareness of the biomedical benefits of treatment; experiences of the social, familial and health benefits of early treatment initiation and adherence; support provided by family and friends; and non-judgmental and supportive HIV service provision.
Factors that inhibited treatment initiation and adherence included perception of good health and denial of HIV diagnosis; poor family support following positive diagnosis; and anonymity and stigma concerns in HIV care services. Exploring health promotion messages that highlight the positive health impacts of early treatment initiation and adherence; providing client-friendly services and community-based treatment initiation and supply; and rolling out HIV viral load testing across the country could improve health outcomes for these key populations.
Globally, key populations, including female sex workers FSW , men who have sex with men MSM and transgender women TGW , have increased risk of acquiring HIV and experience a greater burden of disease compared to the general adult population [ 1 β 3 ]. Early linkage and retention in the HIV care cascade, from testing to antiretroviral therapy ART initiation and adherence and HIV viral suppression, is essential to slowing disease progression in individuals and HIV transmission within the population more broadly [ 4 , 5 ].
In this setting key populations including FSW, MSM and TGW are particularly vulnerable to HIV due to high prevalence of HIV-related risk behaviours, including concurrent sexual partnerships, low condom use and high prevalence of sexually transmissible infections [ 17 , 18 ].
