Barriers to healthcare access and utilization among people living with HIV in Iran: a scoping review with recommendations

A successful national response to the HIV epidemic requires improved access to comprehensive HIV services. However, the majority of people living with HIV (PLHIV) in Iran face significant barriers to accessing HIV health care. This study aimed to identify, classify, and synthesize the barriers to accessing and utilizing HIV healthcare among PLHIV in Iran and to provide recommendations for improving access to care. This scoping review was conducted in accordance with the methodological framework proposed by Arksey and O’Malley. A comprehensive search of English-language databases, including PubMed, Scopus, Web of Science, and Google Scholar, was conducted without time restrictions using relevant English keywords. In addition, the Scientific Information Database, IranMedex and Magiran databases were searched to identify Persian-language studies. The framework analysis method was used to synthesize the data. Of the 6242 studies identified in databases and other sources, 18 studies met the inclusion criteria and were included in the final analysis. Barriers and recommendations were categorized as financial, structural, and cognitive. Financial barriers included unfavorable economic conditions and concerns about healthcare costs. Structural barrier themes were categorized as healthcare provider behaviors, issues of healthcare centers, difficulties of the care process, and issues in the health system. Cognitive barrier themes included patients’ personal circumstances, inadequate awareness, stigma and discrimination, fear and concern of patients, reaction of relatives, and privacy of patients’ information. The findings suggest that efforts to improve access to and utilization of HIV health care for PLHIV in Iran need to address financial, cognitive, and structural barriers. Addressing these barriers and implementing the identified recommendations could increase the willingness of those in need of comprehensive services to access and utilize HIV health care.