ArticleBMJ global health2021
'You just prefer to die early!': how socioecological context impedes treatment for people living with HIV in Iran.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- What leads to treatment failure among people living with HIV: first systematic review from the middle east and North Africa.Virology journal · 2025Pooled it
- How Social-Relational Context Impacts the Mental Health of Adolescent and Young Adults Living with and Without HIV in Mozambique: A Social Network Analysis Study.Journal of epidemiology and global health · 2025Article
- How Mobile Health Can Change the Contexts of Living With HIV and Engaging With Treatment and Care in Iran: A Realist-Informed Qualitative Study.Qualitative health research · 2025Article
- Barriers and Facilitators to HIV Treatment Adherence in Indonesia: Perspectives of People Living with HIV and HIV Service Providers.Tropical medicine and infectious disease · 2023Article
- Complementary and alternative medicine use among people living with HIV in Shiraz, Southern Iran.Frontiers in public health · 2023Article
- Factors Associated With Late Antiretroviral Therapy Initiation Among People Living With HIV in Southern Iran: A Historical Cohort Study.Frontiers in public health · 2022Article
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Authors and funding
7 authors.
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Abstract
introductionDespite the low prevalence of HIV and broad provision of antiretroviral therapy, the Middle East and North Africa (MENA) remains the only region where new HIV infections and AIDS-related deaths are not declining. There is a dearth of evidence from MENA on antiretroviral therapy engagement. In this qualitative study, we sought to identify the ways in which successful treatment is hindered in Iran, which is home to 24% of HIV infections in MENA.
methodsFrom August 2018 to January 2019, we used purposive sampling and conducted 12 individual interviews and 8 focus group discussions with 27 female and 31 male patients, in addition to 5 individual interviews with HIV care providers and 1 focus group discussion with 8 care providers. Social constructivism augmented with realist-informed thematic analysis was used to understand how the socioecological context triggers cognitive and affective mechanisms that disrupt antiretroviral therapy.
resultsThe use of Thematic Network Analysis resulted in the identification of three key cognitive and affective mechanisms that appear to shape treatment experience and are triggered via HIV's socioecological context and changing economic conditions in Iran: denial in response to societal negative perceptions of HIV; fear in response to societal lack of awareness regarding HIV and misinformation; and despair in response to HIV-related stigma and enacted discrimination, economic insecurity and social support.
conclusionsTo our knowledge, this is the first study within MENA to identify pathways through which successful treatment is hindered. It appears that lack of societal awareness regarding HIV is specific to low prevalence settings, such as MENA countries, where negative perceptions, stigma, discrimination and misinformation regarding HIV and its treatment produce denial, fear and despair, acting as mechanisms that disrupt antiretroviral therapy. The experience of despair, in response to changing economic conditions and social support, further impacts treatment experience.
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