649 AIDS PATIENT CARE and STDs Volume 20, Number 9, 2006 © Mary Ann Liebert, Inc. Barriers to Accessing Antiretroviral Therapy in Kisesa, Tanzania: A Qualitative Study of Early Rural Referrals to the National Program GERRY HILLARY MSHANA, B.A., 1,2 JOYCE WAMOYI, M.Sc., 1 JOANNA BUSZA, M.Sc., 2 BASIA ZABA, M.Sc., 1,2 JOHN CHANGALUCHA, M.Phil., 1 SAMUEL KALUVYA, M.D., 3 and MARK URASSA, M.Sc. 1 ABSTRACT This community-based, qualitative study conducted in rural Kisesa District, Tanzania, ex- plores perceptions and experiences of barriers to accessing the national antiretroviral pro- gramme among self-identified HIV-positive persons. Part of wider operations research around local introduction of HIV therapy, the study involved consultation with villagers and docu- mented early referrals’ progress through clinical evaluation and, if eligible, further training and drug procurement. Data collection consisted of 16 participatory group discussions with community members and 18 in-depth interviews with treatment-seekers. Although partici- pants welcomed antiretroviral therapy, they feared that transportation and supplementary food costs, the referral hospital’s reputation for being unfriendly and confusing, and diffi- culties in sustaining long-term treatment would limit accessibility. Fear of stigma framed all concerns, posing challenges for contacting referrals who did not want their status disclosed or expressed reluctance to identify a “treatment buddy” as required by the programme. To mitigate logistical barriers, transportation costs were paid and hospital visits facilitated. Par- ticipants reported satisfaction with eligibility testing, finding the process easier than antici- pated. Most were willing to join a support group and some changed attitudes toward dis- closure. However, both experienced and anticipated discrimination continue to hinder widespread antiretroviral therapy (ART) uptake. While simple measures to reduce perceived barriers improved initial access to treatment and helped overcome anxiety among early re- ferrals, pervasive stigma remains the most formidable barrier. Encouraging successful refer- rals to share their positive experiences and contribute to nascent community mobililzation could start to address this seemingly intractable problem. INTRODUCTION T HE WORLD HEALTH ORGANIZATION’S “3 by 5” initiative and establishment of the Global Fund to fight AIDS, TB, and Malaria have placed scale-up of antiretroviral therapy (ART) at the forefront of national AIDS programs. 1,2 With growing evidence that treatment pro- grams in resource-poor settings can achieve ad- herence levels comparable to those of devel- oped countries, 3–5 most sub-Saharan African countries have policies to increase access to 1 National Institute for Medical Research, Mwanza, United Republic of Tanzania. 2 Centre for Population Studies, London School Hygiene and Tropical Medicine, London, United Kingdom. 3 Bugando Medical Centre, Mwanza, United Republic of Tanzania.