Negotiating access to comprehensive HIV healthcare: Fear, stigma, and health system constraints in Tamale Metropolis, Ghana.

Access to comprehensive HIV healthcare services remains uneven in many low-resource settings, despite the availability of antiretroviral therapy. In northern Ghana, limited qualitative evidence exists on how people living with HIV/AIDS experience, interpret, and navigate access to care within public health facilities. This qualitative study explored factors influencing access to comprehensive healthcare services among people living with HIV/AIDS in public hospitals in the Tamale Metropolis, Ghana. In-depth interviews guided by a semi-structured interview guide were conducted with 30 participants receiving HIV care at three public hospitals. Data were analyzed thematically using NVivo software. Access to comprehensive HIV care was shaped by intersecting psychological, social, and health system factors. Fear of confronting one's HIV status influenced the depth of engagement with services, often limiting care to medication collection. Anticipated stigma and community reactions, including religious moral framing of HIV, discouraged disclosure and delayed or selective care-seeking. Participants also described health worker attitudes and service environments that undermined trust and constrained fuller engagement with care. While geographical distance was not perceived as a barrier, many participants deliberately sought care outside their communities to protect confidentiality. Inconsistent clinical assessment and non-functional diagnostic equipment further limited access to comprehensive care. For people living with HIV/AIDS in the Tamale Metropolis, access to comprehensive healthcare extends beyond physical availability of services or clinic attendance. Fear, stigma, and health system constraints shape how individuals engage selectively with care over time. Interventions aimed at improving HIV service delivery must address confidentiality, provider-patient interactions, and system reliability, alongside efforts to reduce stigma within communities.