Assessing Social Preparedness for Antiretroviral Therapy in a Generalized AIDS Epidemic: A Diffusion of Innovations Approach

Abstract

Researchers conducted focus groups in the Eastern Cape Province of South Africa concerning AIDS and treatment options. Constituent groups included adults aged 25-45, HIV/AIDS caregivers, HIV-positive adults, nurses, rural elders, teenagers, and traditional healers. This pilot work aimed to gather early evidence on perceptions about the government's rollout of antiretroviral treatment (ART), identify potential barriers to success, and inform a subsequent pilot survey. Diffusion of innovations theory was used to interpret the data and helped identify potential obstacles to the ART rollout. AIDS stigma and a weakened healthcare system were negatively impacting the program. There was a lack of accurate knowledge about HIV/AIDS and antiretroviral treatment, with wide disparities among groups. Many people were not convinced that antiretroviral treatment is superior to other treatments, and a few people were afraid it was poisonous. There was no evidence that people were aware of the long-term difficulties of adherence to the regimen.

Obstacles and Proposed Solutions to Effective Antiretroviral Therapy in Resource-Limited Settings

“…Thirty relevant studies were identified, of which 11 were in peerreviewed journals [15][16][17][18][19][20][21][22][23][24][25] and 19 were in conference abstracts. [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] The earliest studies included in this review were from 2004, reflecting a greater emphasis on research in this field after major initiatives were undertaken (such as ''3 by 5'' by the WHO and the President's Emergency Plan for AIDS Relief [PEPFAR]) to increase ART access in resource-limited countries.…”

“…Among the 30 studies, 21 were from Africa,* 6 from east/southeast Asia,The data collection methods described in the papers comprised mostly of interviews (22 studies), y surveys (7 studies), 16,27,29,34,39,40,42 review of clinical data (7 studies), 18,20,22,27,31,36,38 and focus-group discussions (6 studies). 21,23,28,32,42,43 Respondents included PLWHA with/without ART (22 studies), z noninfected people including elders, teenagers, and university students (11 studies), § health care workers including nurses, doctors, social workers, laboratory technologists (7 studies), 15,21,25,28,30,42,43 family members and/or friends of PLWHA (5 studies), 17,19,21,25,43 traditional healers (1 study), 21 and representatives of nongovernmental and community-based organizations (NGOs and CBOs; 1 study).…”

“…In some instances, PLWHA have received negative reactions from FBOs. 21 For example, people in the community have been unwilling to sit next to PLWHA during services or refused to discuss the cause of death at funerals if AIDS was the cause of death. The legacy of apartheid in Africa made many people and government leaders suspicious about any knowledge or treatment regarding HIV that was derived and communicated from Western sources.…”

“…The legacy of apartheid in Africa made many people and government leaders suspicious about any knowledge or treatment regarding HIV that was derived and communicated from Western sources. 21 In addition, lack of willingness to break social traditions led many people to trust approaches advocated by their traditional healers more than the approaches endorsed by Western medicine. 24 19 (even though ART is available for free, patients cannot afford the cost of laboratory testing which might be prerequisite for free ART).…”

“…23 ART is being offered only at certain clinics which might be inaccessible to a large number of people needing care. 21 6. Lack of advertisement for HIV/ART clinics offering free treatment.…”