Social Landscape of the Magnitude of Health Care Needs&Barriers in Accessing Health Care among the PLHIV Attended in NGO Clinics of Dhaka City

Introduction: HIV/AIDS is an worldwide public health concern, over the past years data reflects the variance in epidemic concentration from high, medium to low across countries, however, the social dynamics and adversity around the PLHIV still remain an agenda to explore. In Bangladesh since, the first HIV positive case in 1989 till date, the HIV prevalence remains low ( 0.1 %) in the general population. While current global trends show stabilizing or decreasing epidemics in many high-prevalence countries, Bangladesh has had a greater than25 % increase over the past decade and 1.5 % new cases over past year among high risk groups ( IDU). The prevailing stigma and discrimination are strong barrier for accessing health services and information�s and the community support for PLHIV needs. Methods: This is a descriptive cross sectional study, the focus was on both quantitative ( n=100 PLHIV) and with high emphasis on qualitative to capture in-depth insights of health care needs and barriers, the data recorded, and interpreted through matrices, graphs, charts and story base. For surfacing the PLHIV stigma, UNAIDS Stigma checklist on the essential stigma indicators were applied. The qualitative method also includes Focus Group Discussion ( 3, FGD audio taped and transcribed), 2 case stories, 1 expert group consultation, 7 in-depth interview done with the clinics manager, providers and program people engaged in HIV interventions. Results: Of the 100 PLHIV clients interviewed the male 63.64 % and female 36.44 % and of them 70 % married and rest 30 % percent either single, widow or divorced. The education status is around 18.2 % received no formal education, Primary 23.4 %, secondary 35.5 % and higher secondary 20.9 % and only 1.8 % with bachelor level or even higher degree. The occupation predominates traditional work, house wife, regular job and business 34.5 %, 21.8 %, 27.11 % respectively. Around 96.4 % repeated service seeker whom 7.6 % came more than once and around 92.5 % came to clinic several times and only 2.7 % is first time service seeker. The diagnosis made within two years of whom the male 24.3 % and female 25 % respectively where as 25.7 % male and 13 % female diagnosed within six to ten years period and a very few 2.9 % even later ( ten years and above). The type of service received mostly Opportunistic Infection (35.5 %) and ARV (83.6 %), STI (17.3 %), pain relief (30 %), Gastric (32.7 %), and a significant percentage (80.7 %) received counseling services. Further service needs includes high response 70 % on social care support like emotional, legal& spiritual, Financial support 30.9 %, other essential Reproductive Health (RH) care (22.7 %) and even their capacity building (40 %). Regarding barriers the fear of disclosure both at home (67.3 %), and at community (51.8 %), , 21.8 % stated about side effects and 12.7 % shared refusal from health clinic a significant percentage 42.7 % also reasoned stigma& denial as barriers to access clinics. Conclusion: Most common view points around the barriers to health care access are like service denial, provider�s attitude factor, distance, service hour, long waiting, and imposed service fees. Comprehensive service needs are often denied such as dental care, eye care, other RH service needs, including common medicines like vitamins, eye drops, mental health care, children support health care and education support, transportations, food and nutrition supports. To overcome the clinical level barriers, most importantly the health care providers need proper training/orientation and there should be provision of comprehensive and quality service package for PLHIV linking with other care and support services through Government and NGO clinics in an accessible and affordable manner which can be a true evidence of Public Private Partnership (PPP