Exploring antiretroviral treatment adherence in an urban setting in South Africa
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Antiretroviral treatment requires high levels of adherence to be effective. This qualitative study explores the reasons for poor adherence among 22 purposively selected poor urban participants in South Africa. Over a 4-month period in 2009, we prospectively investigated experiences of HIV diagnosis and treatment, adherence, and withdrawal from treatment. Patients with no stable food sources faced significant barriers in adhering to treatment regimens and staying sufficiently healthy to search for, obtain or retain a job. The narratives also identify the influence on adherence of self-esteem and social support, vulnerability generated by ill health, gendered conflict, social inequities amplified by HIV, and exhaustion due to the social burden of the epidemic. Multi-dimensional, inter-sectoral programs that tackle the social determinants of health, such as food insecurity, poverty, gendered inequities, and treatment adherence are more likely to be successful, than single interventions to support adherence.
Keywordsadherence HIV patient retention food insecurity South Africa
We wish to thank the Australian government's overseas aid program, AusAID, for funding this project through the Joint Economic, AIDS and Poverty Programme, who also provided technical assistance during the study, as well as Professor Udjo for his comments on the tools and the final report. We are indebted to the research participants who were willing to describe their experiences to us and to Hloni Senoko for her skilled interviewing.
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