Structural barriers to ART adherence in Southern Africa: Challenges and potential ways forward

Structural barriers to antiretroviral therapy (ART) adherence are economic, institutional, political and cultural factors, that collectively influence the extent to which persons living with HIV follow their medication regimens. We identify three sets of structural barriers to ART adherence that are...

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Bibliographic Details
Published in:Global public health 2011-01, Vol.6 (1), p.83-97
Main Authors: Kagee, A., Remien, R.H., Berkman, A., Hoffman, S., Campos, L., Swartz, L.
Format: Article
Language:English
Subjects:
Access to health care
Adherence
AIDS
Anti-Retroviral Agents - therapeutic use
Antiretroviral drugs
Antiretroviral therapy
Community health services
Counselling
Culture
Drug therapy
Health care
Health Promotion
Health Services Accessibility
HIV
HIV Infections - drug therapy
Human immunodeficiency virus
Humans
Literacy
Medical care
Medical service
Medical sociology
Medical treatment
Mental health services
Patient Compliance
Politics
Poverty
Prejudice
Public health
Social services
South Africa
Southern Africa
structural barriers
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Summary:Structural barriers to antiretroviral therapy (ART) adherence are economic, institutional, political and cultural factors, that collectively influence the extent to which persons living with HIV follow their medication regimens. We identify three sets of structural barriers to ART adherence that are salient in Southern Africa: poverty-related, institutional, and political and cultural. Examples of poverty-related barriers are competing demands in the context of resource-constrained settings, the lack of transport infrastructure, food insecurity, the role of disability grants and poor social support. Examples of institutional factors are logistical barriers, overburdened health care facilities, limited access to mental health services and difficulties in ensuring adequate counselling. Examples of political and cultural barriers are controversies in the provision of treatment for AIDS, migration, traditional beliefs about HIV and AIDS, poor health literacy and gender inequalities. In forging a way forward, we identify ways in which individuals, communities and health care systems may overcome some of these structural barriers. Finally, we make recommendations for further research on structural barriers to ART adherence. In all likelihood, enhancing adherence to ART requires the efforts of a variety of disciplines, including public health, psychology, anthropology, sociology and medicine.
ISSN:1744-1692
1744-1706
DOI:10.1080/17441691003796387