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

• 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
• ISSN: 1744-1692; 1744-1706
• DOI: 10.1080/17441691003796387

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.