Exploring musculoskeletal health among individuals living with HIV/AIDS in rural Nepal: prevalence, barriers to care, and community perspectives

Abstract

Abstract: Background: People living with HIV/AIDS (PLHIV) are at increased risk of musculoskeletal (MSK) disorders, yet the burden and barriers to care in rural Nepal remain underexplored. This study assessed the prevalence, determinants, healthcare access challenges, and community perceptions related to HIV-associated orthopedic health in Gorkha District. Methods: A descriptive cross-sectional study was conducted at Gorkha Hospital among 158 PLHIV aged ≥18 years, recruited via purposive sampling. Data were collected using a pre-tested structured questionnaire and analyzed with descriptive statistics, Chi-square tests, and Cochran-Armitage tests for trend.

Results: Overall, 55.7% of participants reported at least one MSK condition, most commonly joint pain/arthritis (47.5%). Only 52.3% sought orthopedic care, mainly at the district hospital. Barriers included lack of specialized services (86.1%), transportation challenges (62.7%), and financial constraints (57.6%). Stigma persisted, with 70.9% perceiving the community as unwelcoming for open HIV-related discussions. MSK prevalence increased significantly with advancing age (p=0.026) and duration of HIV infection (p=0.046), peaking at 63.6% among those with 3–7 years since diagnosis. Participants prioritized public health education campaigns (94.3%), improved access to specialized rural orthopedic care (86.1%), financial assistance (52.5%), and community support groups (94.3%).

Conclusions There is a high burden of MSK disorders among PLHIV in rural Nepal, compounded by healthcare access barriers and persistent stigma. Integrated HIV–orthopedic care models, age-targeted screening, stigma reduction strategies, and community-based education are urgently needed to improve outcomes.

Keywords: HIV/AIDS, musculoskeletal, orthopedics