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Hopes interrupted: accessing and experiences of antiretroviral therapy in South Africa
  1. Jana Fried1,
  2. Bronwyn Harris2,
  3. John Eyles1,2
  1. 1School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
  2. 2Centre for Health Policy (CHP), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Jana Fried, School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; friedja{at}


Objectives Using the example of South Africa, this study aimed to examine and obtain a better understanding of the experiences and challenges of urban and rural patients on antiretroviral therapy (ART) in accessing this complex treatment in a resource-limited setting.

Methods Following a narrative approach, in-depth interviews were conducted with 20 patients successfully and unsuccessfully (ie, with interruptions) receiving ART in urban Johannesburg and rural Bushbuckridge, using a detailed interview guide structured to illuminate interviewees' life circumstances and contextualise illness and treatment trajectories. Participants were interviewed by trained fieldworkers in their local languages. The translated and transcribed interviews were coded by several team members. Codes were cross-examined and showed good congruence.

Results All interviewees emphasised the positive aspects of receiving ART, the lifeline and hope it provided by improving health, increasing their ability to live actively and reducing visible signs of (stigmatised) illness. Important factors supporting continuing adherence included social and economic support by individuals, role models and networks as well as positive experiences within the healthcare system and of the treatment itself. The main challenges were linked to patients' difficult life circumstances, especially those related to poverty (eg, transport and food costs) and health system constraints, including perceived lack of compassion and flexibility by healthcare workers.

Conclusions While there are many challenges for the sustainability of ART on an individual and health system level, this study emphasised the need for a patient-centric focus to continue to provide and increase the number of HIV-positive people receiving this lifeline, receiving hope.

  • Access to healthcare
  • Africa
  • AIDS
  • antiretroviral therapy
  • health service research
  • health promotion
  • HIV
  • migration
  • patient narratives
  • service delivery
  • South Africa

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  • Funding This work was carried out with support from the Global Health Research Initiative (GHRI), a collaborative research funding partnership of the Canadian Institutes of Health Research, the Canadian International Development Agency, Health Canada, the International Development Research Centre and the Public Health Agency of Canada.

  • Competing interests None.

  • Patient consent This article does not contain personal medical information about an identifiable living individual. All research participants' names have been changed to protect privacy. Presented patient narratives are ensured to be generic enough not to allow tracing of any individual interview partners.

  • Ethics approval The study was approved by the research ethics boards of Witwatersrand University and the University of Cape Town. The study was also approved by the relevant provincial and local Department of Health bodies in each province in South Africa.

  • Provenance and peer review Commissioned; externally peer reviewed.