The effect of gender on accessing antiretroviral therapy and its link to neurocognitive functioning

Abstract

Objective: To determine the effect of gender on accessing antiretroviral therapy and its link to neurocognitive impairment. Methods: The study was in two parts. Part 1 used the qualitative approach and 38 participants comprising 34 HIV infected adults, equal numbers of men and women and 4 health providers were recruited. The 34 HIV infected adults were a subset of the full sample tested in part 2. Part 2 used the quantitative approach and 263 participants from the bigger study were recruited. All participants were recruited from 6 clinics run by the Lusaka Urban District Health Management Team (LUDHMT).These were Chilenje, Chipata, Matero main,Matero referral, Kabwata and Kalingalinga. For the qualitative approach all the participants (N= 38) went through interviews using semi structured interview guides-one for the HIV infected adults and the other for the health providers. The interviews were audio-recorded and transcribed, and the scripts were analysed qualitatively. In the quantitative approach the participants(N =263) were evaluated with the neuropsychological test battery to assess executive function, verbal fluency, working memory, learning memory, recall, motor skills and speed of information processing. The test scores were subjected to analysis of variance as a function of gender, age and level of education. Results: In the first part of the study, the qualitative part two sets of themes emerged from the interviews. The first set was that of barriers to ART access that affected both males and females. In this set of themes 7 barriers were identified and these were: i) beliefs and misconceptions; ii) stigma; iii) medical environment; iv) side effects; v) disclosure; vi) feeling better; and vii) socio-economic status. In the second set of themes the following 3 gender barriers were identified: a) Male dominance; b) men less proactive in health matters; and c) unequal distribution of HIV and AIDS programmes across gender groups. Based on the significant barriers faced by women it was hypothesised that the performance of the female participants on the neuropsychological test would be lower than that of the male participants of the same age and educational level. However, the results revealed that there were no significant differences except in one test the stroop word where the performance of the female participants was higher than that of the male participants. Conclusions: The results from this study revealed that despite the gender barriers that exist in the access to ART there were no gender differences in performance in the neuropsychological testing. Failure to find any significant differences in the test scores was due to biased sampling of women who were accessing and adhering to ART.