HIV disclosure and other factors that impact on adherence to antiretroviral therapy: the case of Soweto, South Africa

Abstract

Some authors argue that there are no predictors of adherence to medication, while others proffer indicators of likely adherence. These contextual factors are wide-ranging and may be interdependent. There are few studies of adherence in resource-poor settings. Of these, many were linked to particular trials whose conditions were highly controlled. For instance, the number of participants in the trial was small, the participants were strictly selected and they were offered much adherence support. These conditions will largely fall away with wider access to antiretroviral drugs (ARVs) such as South Africa is undertaking. Poor adherence remains one of the challenges to scaling-up access to ARVs, and, as such, the likely barriers to adherence need to be understood and countered. This study explores contextual factors - such as disclosure, preparation for treatment, treatment meaning and treatment acceptance - as aspects of lifestyle that can bear on adherence. Those who had disclosed were largely supported at household level, and after initial problems with adherence, participants adjusted and were able to include ARV treatment in their daily repertoire. Although the anticipation of stigma remains an obstacle to wide disclosure, antiretroviral therapy offers new hope and has the potential to impact on stigma.

To tell or not to tell: Negotiating disclosure for people living with HIV on antiretroviral treatment in a South African setting

“…This included avoiding or planning visits to family or going out around their medication to avoid disclosure (Skogmar et al 2006). This is similar to the results by Skhosana, Struthers, Gray and McIntyre (2006) and Klitzman, Kirshenbaum, Dodge, Remien, Ehrhardt, Johnson, et al (2004) who described how their respondents adjusted their lifestyles (such as avoid going out), lied about their treatment (such as treatment was for TB) or their status (such as claiming to have a different illness) to avoid being disclosed. The current study demonstrates how these tactics were employed to enable participants to remain adherent to their treatment when household or other circumstances were not conducive to disclosure of status or use of medication.…”

“…The current study demonstrates how these tactics were employed to enable participants to remain adherent to their treatment when household or other circumstances were not conducive to disclosure of status or use of medication. This was unlike the study by Skhosana et al (2006) wherein respondents skipped there treatment to avoid disclosure in order to maintain certain family and social ties.…”

Differences Between Patients Who Do and Do Not Adhere to Antiretroviral Therapy

“…Patients in the maintenance group were generally also better educated about ARVs and adherence than patients in the relapse group. This confirmed findings by various other researchers that patients with good knowledge about their treatment, the importance of adherence, and their bodies' reactions to ARVs (or side effects) generally showed significantly higher levels of adherence (Aspeling & Van Wyk, 2008;Kip et al, 2009;Skhosana et al, 2006;Van Dyk, 2010). Finally, patients in the maintenance group received proper counseling and follow-up support, and they mentioned that having a treatment supporter was one of the reasons that they found it not so hard to be on ARVs.…”

“…The lack of selfefficacy is a major problem in disempowered communities where behavior is often not under the control of the individual but in the hands of powerful others such as sex partners (Skhosana, Struthers, Gray, & McIntyre, 2006). The best intentions will also not translate into behavior if the person does not have the skills (e.g., communication, negotiation, and problem-solving skills) to perform the desired behavior.…”

Developing visual images for communicating information aboutantiretroviral side effects to a low-literate population

“…Low health literacy has been identified as a factor influencing adherence to ARV medication (Kalichman, Ramachandran & Catz, 1999;Hardy, 2005;Skhosana, Struthers, Gray & McIntyre, 2006;Wolf, Davis, Osborn, Skripkauskas, Bennett & Makoul, 2007). Treatment literacy or medication literacy implies that the patient has a good understanding of how to take prescribed medicines and it should enable the patient to make informed decisions about medicine-taking to ensure that it is used safely and effectively (Raynor, 2009).…”