Barriers to Accessing HIV Care Services in Host Low and Middle Income Countries: Views and Experiences of Indonesian Male Ex-Migrant Workers Living with HIV
Abstract
:1. Introduction
2. Methods
2.1. Study Setting
2.2. Participant Recruitment and Data Collection
2.3. Data Analysis
3. Results
3.1. Sociodemographic Characteristics of the Participant
3.2. Language Barriers and Lack of Knowledge of Healthcare Systems in Host Countries
“The biggest challenge to me is the language. When planning to meet a nurse or doctor I started to feel nervous and unconfident because I just didn’t know what to say. That was also the reason I came back here to do the treatment (ART) properly”.(Participant 9, 36 years old)
“I had made up my mind before I left Indonesia and intended to access the [ARV] medicines, but when I was there [in Thailand] I was not brave enough to look for and meet doctors because I didn’t know their language. I didn’t know how to explain what I was going through. Another concern was that I didn’t even know where to start. For example, here [in Indonesia] the procedure is that you just need to go to a public health centre and the nurse will examine your condition and refer you to the HIV clinic. But I didn’t know the procedure over there, so I didn’t make any efforts to access the [ARV] medicines while I was there”(Ali, aged 48)
3.3. Being Undocumented Migrant Workers
“At that time, I brought some medicines [ARV] from here [Indonesia], and after taking them all I didn’t try to access the medicines over there because I was afraid of getting caught by the authorities. I didn’t have documents; I was an illegal migrant worker. I was afraid that if I looked for the medicines, then doctors or nurses might ask for some documents and that would be a problem for me. I could get caught and jailed or deported. Sometimes, authorities such as the police went to check for illegal people [migrant workers] in the plantation areas. I remember some friends of mine and I had to run and hide in the forest a few times because of that”.(Isto)
3.4. Unavailability of HIV Care Services Close to Working Sites
“In the plantation area where I worked, HIV care services or treatment were not available. After two months I arrived there [the place where he worked in Malaysia] I tried to find information about antiretroviral therapy. I was told that it was not available in the district. So, after I finished the [ARV] medicines I brought from here [Indonesia] I didn’t access the medicines because they were not available in the place where I worked. The nurse here gave me the medicines for two months and I planned to access the medicines when I arrived in Malaysia, but I didn’t access them because the medicines were not available. So, after two years working there, I started to feel that my physical condition was getting weaker”.(Anton)
“When I first arrived in Malaysia, I checked on the internet about HIV clinics so I knew. However, I worked in an oil palm plantation which was far from the city. The distance from the plantation to the city where there was an HIV clinic was very far. The problem was that there was no public transportation in the plantation area, so it was very difficult to get to the city. Besides, I didn’t know anyone or friends or relatives in the city, so at that time I thought if I went to the city then who would help me to get the access to HIV clinic and the [ARV] medicines, and where I should sleep because I believed I couldn’t go back to the plantation area on the same day, there was no transportation. Therefore, for almost three years I worked there I didn’t access the medicines”.(Kobus, 40 years old)
3.5. Mobile, Transient Nature of the Work
“I worked in Thailand for two years as a construction worker. I found out that I had HIV in the second year. Initially, I had a problem with my throat; it was painful, and I couldn’t swallow food so I went to get a check-up with the doctor. After he checked my mouth, he asked me whether I would agree for him to also test for a virus called HIV and I said ‘yes’. After the test he told me that I have the virus in my blood. Then he gave me medicines for one month and asked me to go back to meet him afterwards but I didn’t go back because I had already moved to another place for construction work which was far away from the doctor’s office. We [construction workers] regularly moved from one place to another every two to three months. So, at that time I didn’t really think about accessing the services”.(Nelis, 35 years old)
“I worked on an oil palm plantation for three years in Malaysia. We regularly moved from one plantation area to another, which was often across multiple districts. It depended on the work and on our boss. If the boss said we had to move to another plantation area for a few months, then we would go. I knew about my HIV status before I went there, and I was on antiretroviral therapy medication before I arrived. I was thinking of continuing the treatment over there but it seemed impossible because my working situation was not supportive for me to access the medication as I regularly moved from one place to another. So, I didn’t even try to look for information about the services. I felt sick during the third year and that is why I decided to come back here [Indonesia] and restarted the treatment”.(Sius, aged 45)
3.6. Self-Treatment and the Use of Herbal and Traditional Medicines
“I consumed packaged herbal medicines which I bought from supermarkets. Sometimes I ordered them online, but those are a little bit expensive. They were easier to access and I didn’t need any prescription from a medical doctor to get them. It is not like ARV medicines where everybody has to go through a lot of procedures and tests to be able to access them. So, I didn’t think of accessing ARV medicines. I worked nearby a hospital for more than one year and I knew about HIV care services there, but I didn’t access them. I took herbal medicines for nearly two years and then switched to [ARV] medicines once I came back here [to Indonesia]. I continued the treatment using herbal medicines for six months here [in Indonesia] because I bought a few bottles [while abroad] and brought them with me [to Indonesia]. Once I finished them all, I restarted the ARV medicines”.(Primus, aged 28)
“I brought a plastic bag of traditional medicines from here [Indonesia] given to me by a traditional healer in my village. But when I had finished taking them, I then made the medicines myself. I used roots, leaves and the bark of plants to make them. I found those herbal ingredients around the plantation area where I worked [abroad]. I harvested them, cleaned them up and boiled them, and then drank the infusion and also bathed myself with the infused water. A traditional healer here told me the names of the plants I should use, and how to mix them up so I knew”.(Nestor, aged 41)
“One day health workers came to the plantation area and sampled our blood to check for malaria. After a week I was told that I didn’t have malaria, but that I had HIV. I knew some local people, so I asked them about traditional healers and they told me about a traditional healer nearby; he was the one who gave me the traditional medicines. I felt fine, so I didn’t think of taking ARV medicines. I was told by the health workers about [ARV] medicines from doctors but I didn’t access them. I continued taking the traditional medicines until I came back here [to Indonesia]”.(Marsel, aged 37)
“Before I went to work overseas, I used traditional medicines here in combination with the medicines (ARV) from the clinic. So, I was on the medical therapy but sometimes I took traditional medicines. I brought them (traditional medicines) with me when I went to work in Malaysia so I kept on taking the medicines for nearly two years ….”(Iku, 26 years old)
“Actually, I took traditional medicines when I was working overseas because they were easy to get or I could make them by myself. It was not because I thought they were more effective than medical treatment (ARVs). Besides, the medicines from doctors (ARVs) were difficult to find in the place where I worked, I didn’t even know where to access them”.(Metak, 45 years old)
3.7. Social Influences
“After I was diagnosed with HIV over there [in Malaysia], I asked a friend of mine to help me access HIV treatment, and he told me that he knew a traditional healer who could give [traditional] medicines. So, we both went to that traditional healer, and I got the medicines from him. I took the medicines from that traditional healer for about a year and didn’t access the medicines [ART] from doctors”.(Sebas, aged 39)
“I worked in Taiwan for a few years. I knew my HIV status before I went there [to Taiwan], and I was already on medication [ART] here [in Indonesia]. I stopped the medication once I left for Taiwan. After two and a half years working there, I felt that my physical strength had reduced, and I was easily getting sick. So, I talked to a [Indonesian] friend of mine about my intention to access [ARV] medicines but he said that if the doctors were to know about my HIV status, they would report it to the police and I could be detained in prison. So, the solution was to purchase herbal medicines from supermarkets. A friend of mine bought those medicines for me at the beginning …”.(Agus)
4. Discussion
Study Limitations and Strengths
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | No = 22 |
---|---|
Age | |
25–30 | 6 |
31–40 | 9 |
41–50 | 7 |
Education | |
Senior high school graduates | 5 |
Junior high school graduates | 12 |
Elementary school graduates | 3 |
Elementary school dropouts | 2 |
Occupation | |
Motorbike taxi drives | 12 |
Fishermen | 3 |
Farmers | 5 |
Construction workers | 2 |
Host countries where they worked | |
Malaysia | 15 |
Thailand | 3 |
Taiwan | 3 |
Hong Kong, China | 1 |
Duration of HIV diagnosis | |
1–5 years | 7 |
6–10 years | 9 |
Location of HIV diagnosis | |
Indonesia | 17 |
Malaysia | 3 |
Thailand | 1 |
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Fauk, N.K.; Gesesew, H.A.; Seran, A.L.; Raymond, C.; Tahir, R.; Ward, P.R. Barriers to Accessing HIV Care Services in Host Low and Middle Income Countries: Views and Experiences of Indonesian Male Ex-Migrant Workers Living with HIV. Int. J. Environ. Res. Public Health 2022, 19, 14377. https://doi.org/10.3390/ijerph192114377
Fauk NK, Gesesew HA, Seran AL, Raymond C, Tahir R, Ward PR. Barriers to Accessing HIV Care Services in Host Low and Middle Income Countries: Views and Experiences of Indonesian Male Ex-Migrant Workers Living with HIV. International Journal of Environmental Research and Public Health. 2022; 19(21):14377. https://doi.org/10.3390/ijerph192114377
Chicago/Turabian StyleFauk, Nelsensius Klau, Hailay Abrha Gesesew, Alfonsa Liquory Seran, Christopher Raymond, Roheena Tahir, and Paul Russell Ward. 2022. "Barriers to Accessing HIV Care Services in Host Low and Middle Income Countries: Views and Experiences of Indonesian Male Ex-Migrant Workers Living with HIV" International Journal of Environmental Research and Public Health 19, no. 21: 14377. https://doi.org/10.3390/ijerph192114377