Socioeconomic status and barriers to the use of free antiretroviral treatment for HIV/AIDS in Enugu State, south-eastern Nigeria

  • Chijioke I Okoli
  • Susan M Cleary


With about 3 million people living with HIV, Nigeria has approximately 8% of the global burden of HIV cases. In 2009, only about 34% of those in need of antiretroviral treatment (ART) were able to access care, which means that Nigeria was far from achieving the United Nations target of ‘universal access’ by 2010. This study aimed to describe the barriers to accessibility and the coping strategies employed to overcome these barriers among users of free ART services overall and by socioeconomic status (SES). Data were collected from 240 people receiving ART at one urban and one peri-urban health facility in Enugu State, south-eastern Nigeria. Information on SES, demographic characteristics, and barriers and coping mechanisms for accessing ART were elicited from the respondents. The high cost of transportation, HIV stigma, and long waiting hours were found to be key barriers to the use of ART services. On average, ART clients spent just under four hours at the clinic during their monthly appointments. The use of personal savings and financial support from relatives were the main means to access treatment. When the data were analysed according to clients’ SES, transportation costs were a chief concern among the poorest while those who were better off were more likely to be concerned about  stigma and discrimination. These findings should be borne in mind when  designing and locating services to maximise ongoing accessibility to ART.

Keywords: accessibility; equity; sub-Saharan Africa; utilisation patterns

African Journal of AIDS Research 2011, 10(2): 149–155

Author Biographies

Chijioke I Okoli
Health Policy Research Group, University of Nigeria, College of Medicine, Enugu Campus, PMB 01129, Enugu, Nigeria
Susan M Cleary
University of Cape Town, Health Economics Unit, Observatory 7925, Cape Town, South Africa

Journal Identifiers

eISSN: 1608-5906
print ISSN: 1727-9445