In 2007, less than one-third of all HIV-positive South Africans in need of life extending highly-active antiretroviral treatment (HAART) are accessing it through the public health system. This ‘treatment gap’ poses a significant challenge to health practitioners and researchers given the complex factors that influence the provision (supply) and uptake (demand) of this public health intervention.
This qualitative study, conducted in 2006, set out to explore some of the demand-side factors affecting uptake and adherence to HAART among a cohort of HIV-positive people living in the Western Cape. Two significant and interrelated findings emerged from the research: one, political equivocation influenced the use of lay and untested HIV remedies among the cohort, with lay remedies represented as ‘benign’ compared to the ‘risks’ of using biomedicine like HAART; second, psycho-social and physical factors, like hope, stigma and fear or experience of HAART’s side-effects, affected the respondents’ health seeking behaviour.
This preliminary qualitative study suggests that political equivocation and national activism compound, and also obscure, nuanced personal responses to managing illness and securing health. In order for the hard-won HAART roll-out to succeed in reaching 80% of all those in need by 2011, as per the 2007 – 2011 HIV/AIDS and STI National Strategic Plan, researchers and practitioners need to consider and address both supply and demand-side factors inhibiting access and adherence to HAART in South Africa.