Perceptions of the benefits and affordability of antiretrovirals among HIV-positive persons in a rural area of South-West Nigeria
To assess the affordability of antiretroviral drugs (ARVs) and accessibility to treatment for opportunistic infections (OIs) among HIV-1 seropositive persons, we used semi-structured interviewer-administered questionnaires to interview 154 individuals seeking ARV treatment at the Daughter of Charity German Leprosy and Tuberculosis Centre in South-West Nigeria. The respondents' mean age was 37 years (range 13–65 years) and their average monthly income was NGN9 603 (approx. US$73). One hundred and eleven respondents (72.1%) had sought care elsewhere before seeking ARV therapy: 67 (60.4%) from private hospitals, 26 (23.4%) from public hospitals, 17 (15.3%) from traditional healing homes, and one from an NGO; the remaining 43 (27.9%) had not sought medical care before ARV therapy. Thirty-nine respondents (25.3%) had symptomatic AIDS with evidence of opportunistic infections (OIs), and 115 (74.7%) were HIV-1 seropositive only. One hundred and twenty-six (81.8%) believed that ARV treatment would prolong their lives, of which 27 anticipated a cure for AIDS; eight (11.7%) had no knowledge of the benefits of ARV therapy, six (3.9%) had strong fears of stigmatisation and discrimination as a consequence of ARV therapy, and four (2.6%) did not express any opinion. Sixty-three respondents (40.9%) perceived the cost of ARVs as expensive and unaffordable, 58 (37.7%) wanted free drugs, 20 (12.9%) wanted to pay a maximum of NGN2 000 (US$15) for monthly supplies (while the actual cost was NGN13 000 or US$98), and 13 (8.5%) did not comment. There was a strong association between literacy level and knowledge of ARV therapy. The more educated tended to have higher incomes and their perception of ARV therapy was laudable despite having sought other treatment elsewhere, while the less educated tended to earn less and perceived ARV therapy as unaffordable, and therefore had not bothered to seek previous treatment. We urge that ARVs be made more affordable to enhance their accessibility and treatment compliance, especially among lower-income patients.