Speaker

Ms Stefani Baca-Atlas
Doctoral Student
University Of North Carolina – Chapel Hill

Correlates of Perceived Lack of Safety and Its Association with Treatment and Psychosocial Health Outcomes in People Living with HIV in Rural Zambia

Abstract Narrative

Background: Distance and travel time to health clinics are strong predictors of access and usage of health services, including HIV treatment. Geographic inaccessibility disproportionately affects health outcomes of rural populations due to lack of suitable transport, prolonged travel time and income poverty. Rural patients are left with few options, including walking to health clinics. Walking may present additional challenges such as safety. However, little is known about factors predicting perceived safety (or lack of), and its effect on health outcomes in people living with HIV. We addressed gaps by examining the correlates of perceived safety when walking to and from a clinic and its association with HIV treatment and psychosocial outcomes among adults living with HIV in Eastern Province, Zambia.

Methods: We used a cross-sectional design and analyzed baseline data collected from a sample of adults living with HIV (N = 101) in Lundazi District. Average distance and travel time to Lundazi District Hospital (8 km, 77min) differed from Lumezi Mission (15km, 123 min) Hospital. Perceived lack of safety was measured by asking respondents whether they felt unsafe traveling to and from the clinic, and an indicator variable was created based on the distribution: 0 (never felt unsafe) or 1 (felt unsafe). HIV treatment and mental health outcomes included medication adherence, perceived stress, hope for the future, and barriers to pill taking. Linear and logistic regression methods were used to examine the correlates of perceived safety and its association with HIV treatment and health outcomes. Significance level was set at p ≤ .05, two-tailed test. Missing data was addressed using multiple imputation by chained equations (MICE).

Results: Nineteen percent of respondents reported feeling unsafe when going to and from the clinic. Being older, a woman, having a primary education, living farther from the clinic, traveling longer to reach the clinic, and owing money were associated with higher likelihood of feeling unsafe when going to and from the clinic. Further, feeling unsafe when going to and from the clinic was associated with adverse outcomes, including medication nonadherence (p = .083), higher level of stress (p = .000), lower level of agency(p = .062), and more barriers to pill taking (p = .001).

Implications: In many rural and low-resource communities, walking or bicycling to and from health clinics remains an important and popular transport mode. Though popular, these methods may be viewed as unsafe as they may increase risk of gender-based violence, especially when women travel alone, or unintentional injury as a result of underdeveloped roads and other safety hazards. Feeling unsafe when traveling to and from a clinic is associated with adverse outcomes. Study results demonstrate that perceived lack of safety appears to deter people living with HIV to visit clinics, which in turn, may be associated with poor treatment and mental health outcomes. These relationships call for efforts to address safety concerns and to expand outreach to rural communities where rates of violence and injuries associated with traveling to and from clinics are increasing.

Poster Presentation

Biography

Stefani Baca-Atlas is a doctoral student at the University of North Carolina at Chapel Hill School of Social Work. She uses a transdisciplinary lens to study structural violence, trauma, and health inequities among marginalized, migrant, and displaced people domestically and abroad. She has worked on research projects based in the U.S., Gambia and Zambia. Her research is informed by her social work practice experience in international child welfare, sex and labor trafficking, and work with minoritized youth, immigrants, refugees, and asylum seekers in Arizona, Maryland, and North Carolina.