Barriers and enablers to accessing HIV services at South Sudan military facilities: Using qualitative data for program improvement

Abstract

ABSTRACTIntroductionSouth Sudan established an HIV program for the South Sudan People’s Defense Force (SSPDF) in 2006, recognizing the potential national security threat posed by HIV’s impact in post-conflict settings. By 2018, the SSPDF program’s scope had expanded to include three VMMC clinics and four ART service delivery facilities. This qualitative study examined participant feedback on two existing HIV services, ART and VMMC, with the goal of identifying and prioritizing barriers and improving program performance. We used focus group discussions to gather information from male and female participants chosen at random across the four main project sites.MethodsWe conducted a cross-sectional qualitative study from March to April 2022 involving 177 people (108 men and 69 women) within fifteen focus group discussions. We collected data on enablers and barriers to HIV service uptake and utilization using a thematic framework approach.ResultsPerceived high-quality HIV services in a secure environment, organizational support systems, peer-led mobilization, and transportation facilitation were all identified as HIV service delivery enablers. HIV service delivery was hampered by knowledge gaps, poverty and food insecurity, access issues, a lack of treatment support groups, transportation challenges, social cultural barriers (stigma and discrimination), and the need for permission from commanders.ConclusionsThe findings show some overlap in client needs for VMMC and ART services. To increase ART retention and overall HIV service demand, the program will focus on improving the quality of HIV services and tailored client support, as well as addressing barriers resulting from structural and social cultural challenges to increase ART retention and overall HIV service demand.