A Qualitative Inquiry of Adherence to Antiretroviral Therapy and Its Associated Factors: A Study with Transgender Women Living with HIV in Indonesia

Background: Successful antiretroviral therapy (ART) mainly depends on sustaining high rates of adherence. In the context of Indonesia, none of the previous studies have looked at determinants of HIV adherence among transgender populations. Objectives: This study aimed to explore factors associated with the adherence to ART among HIV-positive transgender women in Yogyakarta, Indonesia. Methods: Face-to-face in-depth interviews with 29 transgender women, also known as Waria, living with HIV were conducted from December 2017 to February 2018. Participants were recruited using purposive and snowball sampling techniques. Data were analyzed thematically using a qualitative data analysis framework. Results: Factors associated with ART adherence among transgender participants were divided into three major levels as follows: (i) individual factors, (ii) social factors, and (iii) structural factors. Feeling tired and lazy due to work, falling asleep before taking medicine, schedule to take the medicine, healthy physical condition of other HIV-positive friends who did not take antiretrovirals, and the lack of finances to travel to health facilities were the influencers of the participants' ART adherence. Conclusion: These findings indicate the need for the development of HIV/AIDS-related health service supporting system in health-care facilities and the dissemination of knowledge and information of HIV/AIDS and its related service for HIV-positive transgender women and other people living with HIV and general populations in other parts of the country and other similar settings globally.