Gender Barriers to Access to Antiretroviral Therapy and its Link to Neurocognitive Functioning

Abstract

Objective: To determine the effect of gender on access to antiretroviral therapy and its link to neurocognitive impairment.
Methods: The study used a mixed methodology. Part 1 used aqualitative approach and 34 participants who were HIV infected adults, equal numbers of men and women were recruited. These were a subset of the full sample tested in part 2. Part 2 used a quantitative approach with 263 participants from the bigger study, whose aim was to study the impact of HIV on neurobehavioral functioning in adults. All participants were recruited from 6 clinics run by the Lusaka Urban District Health Management Team. For the qualitative approach all the participants were interviewed with a semi structured interview guide. The interviews were audio-recorded, transcribed, and analysed qualitatively.In the quantitative approach the participantswere 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 qualitative part, three gender specific barriers were identified: I)Men's power dominance; ii) Stigma making men to be less proactive in health matters; and iii) 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 battery 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 specific 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 attributed to biased sampling of women who were accessing and adhering to ART.