The perspectives of users of antiretroviral therapy on structural barriers to adherence in South Africa

Background: The effectiveness of antiretroviral therapy (ART) and the importance of adherence to treatment regimens are widely known. Yet, suboptimal adherence to ART and retention in care of patients still persists and, by many accounts, is fairly widespread. The aim of this study was to identify the structural barriers that influenced adherence among patients who were enrolled in the national ART programme in South Africa.Method: In this qualitative study, semi-structured interviews were conducted with a sample of 10 patients receiving ART at a public hospital in South Africa.Results: The results of the interviews were categorised according to poverty-related, institution-related and social barriers to clinic attendance and pill-taking, which collectively formed the structural barriers to adherence. The chief structural barriers to clinic attendance were time away from work, transport expenses, long waiting times and negative experiences with clinic staff. The chief barriers to pill-taking were food insecurity, stigma and discrimination.Conclusion: The barriers to adherence are discussed. Attention is called to the extraindividual factors that influenced ART adherence. We conclude that contextual factors, such as a healthcare-enabling environment, might play an important role in influencing healthcare-promoting behaviour among patients

Development Studies Working Paper, no. 1

State control over the labour market usually results in the creation of different categories of labour, each having partial and unequal access to that market. In the Third World, typically, justification for control arises from an over-supply of unskilled rural labour and a small demand for such labour in the wage economy. To reduce massive urban unemployment, the state attempts to control the process of rural-urban migration by, inter alia, manipulating the labour market. ^ In South Africa, the civilised labour policy of the Pact government and the highly sophisticated system of black influx control introduced after the Second World War are two examples of such state control. In these cases, racial categories of labour, having differential access to the labour market, were created. The policy of Coloured Labour Preference is another South African example which is of particular interest since it is applied solely to one region of the Republic. Since 1962, when it was administratively coordinated for the first time, this policy has been applied in the Western Cape, a region comprising the 68 magisterial districts situated south-west of Port Elizabeth, Kimberley and the Orange River. In this region, black work-seekers' access to the labour market is severely curtailed. A series of regulations, particular to the Western Cape, are applied with the object of restricting the number of blacks resident in the region; denying blacks permanent rights of sojourn in the region; restricting the scope of employment for blacks in the region; and favouring coloured above black work-seekers throughout the region. In short, the policy aims to replace black by coloured labour and thereby aims to reduce to a minimum the number of blacks in the region.Digitised by Rhodes University Library on behalf of the Institute of Social and Economic Research (ISER