Understanding HIV service preferences of South African women 30-49 years old missing from or linked to care: An exploratory study of Gauteng and Limpopo provinces.

Background: The HIV epidemic in sub-Saharan Africa has a disproportionate gender impact, with women bearing the brunt of the epidemic. South Africa carries the largest share of the global HIV burden, with similar trends seen for women due to unequal socio-cultural and economic status.
Objectives: This study aims to understand 30-49 year-old women's barriers and facilitators to accessing HIV services in order to maximize health in resource limited settings and reach women missing from HIV care.
Design: Employing a convenience sampling strategy, we recruited, informed, and consented participants at clinics and public areas. Interviews were conducted in respondent's preferred languages, transcribed verbatim, translated into English if needed, and thematically analyzed using grounded theory.
Methods: We conducted 81 interviews with women aged 30-49 either missing from care ( n  = 21), having unknown HIV status ( n  = 30) or linked to care ( n  = 30) within two sites: City of Johannesburg district, Gauteng Province and Mopani district, Limpopo Province.
Results: Participants missing from care reported negative staff attitudes, queues, family rejection, medication side effects, and painful blood tests as key deterrents. Participants with an unknown status were deterred by fear of being diagnosed as HIV positive and family rejection, which was similar to women missing from care who often dropped out from care due to actual family rejection. Participants linked to care reported that long queues and staff shortages were challenges but stayed in care due to a will to live for themselves and their children, in addition to counselling and feeling emotionally supported. Interestingly, participants missing from care often accessed medication from friends but, similarly to those with unknown status, noted that they would access care if attended to by supportive nurses and by having non-clinical HIV services.
Conclusions: The accounts of women in this research highlight significant improvements needed to address inequities in the fight against HIV in South Africa. Additionally, the healthcare service access preferences of women aged 30-49 need to be further explored quantitatively in order to design policy relevant interventions.