The impact of stigma and socioeconomic barriers on HIV treatment adherence in Conakry, Republic of Guinea: a gender perspective

Introduction: HIV infection remains a major global health challenge, with sub-Saharan Africa being the region most heavily affected by the pandemic. Despite increased access to antiretroviral therapy (ART), adherence and retention in care remain problematic in many parts of West Africa, including the Republic of Guinea. Stigma, socioeconomic challenges, and healthcare access are key factors influencing treatment outcomes. This study aims to explore the determinants of ART adherence and the impact of stigma among people living with HIV (PLHIV) in Conakry, with a specific focus on gender differences. Methods: a cross-sectional study was conducted in four Dream Centers in Conakry, Coyah, and Dubreka, Guinea. Data were collected using a structured questionnaire covering participants' relationship with healthcare services, adherence to treatment, experiences of stigma, and sociodemographic characteristics. Adherence was measured using the Morisky Medication Adherence Scale (MMAS-8), and stigma was assessed using a modified HIV Stigma Scale. Descriptive and multivariate analyses were performed to identify factors associated with treatment adherence and discontinuation. Results: during the study period, 472 patients met the inclusion criteria, of whom 70 refused to participate; a total of 402 participants were included, with 330 (82%) actively engaged in care and 72 (18%) re-engaging after treatment interruption. The median age was 32 years (IQR: 27-40), with 82% female and 18% male participants. Education levels were 37% illiterate and 63% educated, with 91% employed and 9.5% unemployed. Among participants, 52% had children, and the median travel time to the Dream center was 1 hour (IQR: 0.75-2). High stigma levels were reported by 42%. Patients who were lost to follow-up and later re-engaged lived farther from the clinical center (median: 2 vs. 1 hour, OR 1.18 [1.00-1.39], p= 0.038) and had lower adherence rates (78% vs. 32%, OR 0.14 [0.07-0.24], p < 0.001). Patients with lower adherence rates were more often in therapy for over one year (82% vs. 96%, COR 0.19 [0.07-0.43], p < 0.001). Conversely, those with higher adherence rates reported greater trust in treatment (99.6% vs. 77%, COR 42 [8.65-757], p < 0.001), were more likely to live with children (59% vs. 41%, COR 1.93 [1.23-3.04], p = 0.004), and were less likely to report high stigma scores (34% vs. 55%, OR 0.55 [0.34-0.87], p = 0.011). Among men, stigma was the only significant factor for low adherence (OR: 0.32, 95% CI: 0.10-1.00, p= 0.05), while for women, higher adherence was associated with shorter time in care, higher trust in treatment, and having children (AOR 0.22 [0.08-0.52], p = 0.001; AOR 38.5 [7.80-698], p < 0.001; AOR 2.09 [1.28-3.46], p = 0.004). Conclusion: stigma and healthcare access are critical barriers to ART adherence among PLHIV in Conakry, Guinea. Gender-specific differences suggest that tailored interventions are needed to address these unique challenges. Reducing stigma, ensuring consistent follow-up, and fostering trust in healthcare providers are essential strategies to improve adherence and treatment outcomes. Addressing these barriers can enhance the quality of care and support viral suppression among PLHIV in Guinea.