Inequalities in access to healthcare services among people living with HIV/AIDS in Nigeria.

The study investigated the magnitude of social inequities in access to subsidised healthcare services among people living with HIV and AIDS (PLWHA) in Nigeria. Structured interviews were conducted with 1 056 PLWHA selected from 60 community based support groups in 12 local government areas across 3 Nigerian states and the federal capital territory, using a multi-stage cluster sampling method. Data were collected on socio-economic characteristics of the respondents; awareness about location of health facilities; current health status; distance to facilities; and utilisation and expenditure on healthcare. The socio-economic characteristics of the respondents were used to compare their level of access to healthcare services from antiretroviral therapy (ART) sites and government hospitals. Awareness about location of health facilities was generally high (≥79%) among the respondents but higher among males, urban dwellers and those in highest wealth class (p < 0.05). About 60% of rural PLWHA and 55.2% of those in the lowest wealth class reported illness compared with 49.4% of urban residents and 47.4% of those in the highest wealth class. However, PLWHA in urban areas utilised government hospitals more than those in rural areas while rural PLWHA and those in the lowest wealth class travelled longer distances to ART sites (p < 0.05). PLWHA in lowest wealth class and females faced catastrophic health expenditure of 67.6% and 55.5% of their monthly income respectively. Social inequities were observed in the subsidised HIV-treatment programme in Nigeria. Expansion of ART sites in rural areas and decentralisation of HIV care at government hospitals will reduce travel distance and transport costs and ensure universal access to healthcare services among PLWHA.