Socio-Cultural Influences on ART Adherence among People Living with HIV/AIDS in Rural Ghana
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Abstract
Background: Achieving optimal adherence to antiretroviral therapy (ART) remains a critical challenge in sub-Saharan Africa, where socio-cultural factors continue to influence treatment behaviours. Understanding these influences is essential for designing effective, context-specific interventions.
Objective: This study examined the socio-cultural determinants of ART adherence among people living with HIV (PLHIV) in Wassa Amenfi West Municipality, Ghana.
Methods: A cross-sectional survey was conducted among 602 PLHIV receiving ART at designated health facilities. Data on socio-demographic characteristics, perceived stigma, HIV status disclosure, family and community support, and cultural beliefs were collected using a structured questionnaire. Adherence was assessed through self-report and verified against clinic refill records. Chi-square tests were used to examine associations between socio-cultural variables and adherence.
Results: The majority of respondents were female (62.1%), aged 40–49 years (34.9%), and had low educational attainment (34.2% with no formal education). High perceived stigma was associated with significantly lower adherence (61.7%) compared to low stigma (86.9%, p < 0.001). Disclosure of HIV status to both family and friends yielded the highest adherence (90.7%), while non-disclosure was linked to the lowest adherence (50.0%, p < 0.001). Participants with family or community support demonstrated higher adherence (87.2%) than those without support (51.5%, p < 0.001). Belief in spiritual causation of HIV was associated with lower adherence (54.5%) compared to those rejecting such beliefs (85.6%, p < 0.001).
Conclusion: Socio-cultural factors exert a substantial influence on ART adherence in rural Ghana. Stigma reduction, safe disclosure facilitation, mobilisation of family and community support, and culturally sensitive engagement with traditional belief systems should be prioritised in HIV programs. These strategies are essential to improving adherence outcomes and achieving national HIV treatment targets.
Keywords: ART adherence, socio-cultural factors, HIV/AIDS, stigma, disclosure, Ghana, rural health
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