Enablers and Barriers to ART adherence among Female Sex Workers in Midwestern Uganda: A qualitative study

Abstract Introduction: Female sex workers (FSWs) in Uganda experience challenges in adhering to antiretroviral therapy (ART). We used the theory of planned behavior to explore the enablers and barriers to ART adherence among FSWs. Materials and methods We conducted six key informant interviews with healthcare workers and leaders of the FSWs association. Furthermore, 30 in-depth interviews were conducted among FSWs. Thematic deductive analysis was applied to analyze the data through the lens of the theory of planned behavior. Findings The attitudes, subjective norms, and perceived behavioral control influenced adherence to ART. Positive attitudes including positive appraisal of and evaluation outcomes with ART use enabled adherence to ART. Subjective norms such as social support, disclosure of HIV status, seeing others take ART and aspirations for longer life enabled ART adherence. The perceived ability to comply with ART adherence was facilitated by appropriate scheduling or timing on when to take ART, responsive and respectful healthcare workers, and availability of food/basic needs. Negative attitudes such as misconceptions and fear of side effects hindered ART adherence. Social disapproval of sex work and or HIV hindered ART adherence among FSWs. Social disapproval including lack of social support, gender-based violence, non-disclosure, stigma and abandonment hindered use of ART among FSW. The ability to adhere to ART has affected by the socio-economic constraints (e.g., food scarcity), and occupation related factors (substance use, incarceration, busy and predictable schedules, and abrupt migrations). Conclusion ART adherence among FSW was influenced by attitudes, subjective norms, and perceived behavioral control. Addressing these challenges in ART adherence through targeted interventions could facilitate ART adherence and improve health outcomes among FSW.