“Even if you’re HIV-positive there’s life after if you take your medication”: experiences of people on long-term ART in South Africa: a short report

ABSTRACT

South Africa’s national antiretroviral treatment (ART) programme, initiated in 2004, is the largest HIV treatment programme in the world with an estimated 4.2 million people on ART. Today, an HIV diagnosis is no longer associated with certain death, but is rather a manageable chronic disease, with all HIV-positive patients now eligible to receive treatment. In this study, we explore patient experiences at the onset of the ART programme, including facilitators and barriers around decision-making along the HIV care cascade (HIV testing, ART initiation, retention, and adherence). We conducted twenty-four in-depth interviews among adults (≥18 years old) who initiated ART between April 2004 and March 2005 and were alive, on treatment at enrolment (October 2015–March 2016) at a large public-sector clinic in Johannesburg, South Africa. Data were analysed using a thematic analysis approach. Patients cited physical wellbeing, responsibility for raising children, supportive clinic staff and noticeable improvements in health on ART as key facilitators to continued care. In contrast, changing clinic conditions, fear of side-effects and stigma were mentioned as barriers. This study provides a unique lens through which to evaluate factors associated with long-term retention and adherence to ART at a crucial time in ART programming when more people will be initiating life-long treatment. We must continue to focus on supportive and empathetic clinic environments, more convenient ways to access medication for patients, and developing tools or interventions that continue to address the issues of stigma and discrimination and build the support networks for all those on treatment.

KEYWORDS:

• Antiretroviral therapy
• testing
• adherence
• initiation
• quality of care
• stigma
• disclosure

Acknowledgements

The authors wish to thank the staff at the clinic and the patients who were interviewed as part of this study. A special thank you to Barbara Xhosa for her help in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclosure

CH and MPF conceptualised the study. CH, MM and SP designed the study. CH, AM and SP conducted the analysis. CH, AM, and SP prepared the original draft. CH, AM, SP, MM, LL, IS, PM and MPF reviewed and edited draft.

Source of support

This study has been made possible by the generous support of the American People and the President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID under the terms of Cooperative Agreements AID-674-A-12-00029 and 72067419CA00004 to HE2RO. The contents are the responsibility of the authors and do not necessarily reflect the views of PEPFAR, USAID or the United States Government.

ORCID

C. Hendrickson http://orcid.org/0000-0002-2744-5208

Additional information

Funding

This work was supported by United States Agency for International Development: [grant number 674-A-12-00029]; United States Agency for International Development: [grant number 72067419CA00004].