Non-adherence to antiretroviral treatment in Maquassi Hills, North West Province: a Social Work perspective

Abstract

HIV and AIDS continue to be a major public health issue worldwide. The HIV and AIDS epidemic is equally a major threat to social and economic development globally and in South Africa. Although antiretroviral (ARV) medication has brought hope, high adherence levels are required to ensure treatment success. While there is no cure for the disease, people are living longer with all the accompanying support they receive from health care, which include adhering maximally to antiretroviral treatment (ART). This study examined non-adherence to antiretroviral treatment in MaquassiHills, North-West Province, and looked at it from a social work perspective. The main problem in this study is that access to ART does not necessarily mean adherence to the ARV regimen, with the main question being : “of those people initiating ART in the North West Province – Maquassi Hills district in particular, how many adhere maximally (about 95%) to the regimen. The research problem pointed towards relevant literature in order to review aspects such as: the phenomena of adherence and non-adherence to ART, the rate of ART globally and in South Africa, the goals of ART medication, ART monitoring tools, barriers and facilitators of adherence to ART, and strategies that could enhance adherence to ART. The study was undertaken from a social work perspective due to its relevance in the health care. Two theoretical perspectives, the Health Belief Model (HBM) and the Strength-based perspective, provided frameworks for the research. Qualitative research was used, specifically eliciting data through in-depth interviews, focus group discussions and key-informant interviews, where a total of 28 participants were purposefully selected. Descriptive stories and content analysis were used to analyse the data. It emerged that barriers encountered by sampled patients on ART were related to patient, stigma, and health-care including systems factors. Food insecurity, pill-burden, lack of income due to unemployment, discrimination from employers, side effects, stigma from former intimate partners, having to walk long distances when collecting ARV medication, long waiting times at the clinics, few counseling rooms impeding privacy and shortages of staff (hindering on the quality of counseling received) pose as barriers to ART adherence in the demarcated area of study. Patient-centred policies and practices are recommended as a way of addressing the identified barriers to ART.