"Double Wahala for dead body …" - perspectives of service providers about adherence to antiretroviral therapy among persons with disabilities living with HIV in Nigeria.

Abstract

This study explores service providers' perspectives on factors limiting ART adherence among persons with disabilities living with HIV in Nigeria (PWDLWHIV). It argues that adherence is hindered by stigma, prejudiced views from service providers, and insufficient tailored programming for PWDLWHIV in the HIV response. Thirteen service providers from six Nigerian states participated in in-depth interviews. Participants included medical doctors, nurses, clinical pharmacists, community development workers, and adherence counsellors. Interviews were analysed using Reflexive Thematic Analysis. Findings revealed unhelpful sociocultural beliefs about PWDLWHIV persist and are drivers of stigma that negatively impacts ART adherence. The lack of disability-disaggregated data has contributed to the non-recognition of PWDs as a key population. Consequently, there is limited attention to targeted programming and HIV funding for PWDs. Further, service providers held stigmatising attitudes towards PWDs, underpinned by the medical model of disability. These discriminatory views can affect the quality of ART services PWDLWHIV receive. Achieving Nigeria's UN HIV targets of 95-95-95 necessitates a stronger emphasis on supporting PWDLWHIV, who are currently not recognised as a key population in the HIV response. By addressing this gap, Nigeria can position itself as a global leader in accelerating progress in its HIV response.