Department of Sociology and Social Anthropology

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Browsing Department of Sociology and Social Anthropology by browse.metadata.advisor "Bock, Peter"

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    Exploring how the management of household incomes impact on antiretroviral therapy adherence behaviour of people living with HIV in the Western Cape, South Africa
    (Stellenbosch : Stellenbosch University, 2021-12) Mcinziba, Abenathi; Viljoen, Lario; Bock, Peter; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Sociology and Social Anthropology.
    ENGLISH ABSTRACT: The Human Immunodeficiency Virus (HIV) epidemic presents a global health crisis, with approximately 38 million people worldwide living with HIV (PLHIV) in 2019. Amongst them, an estimated 7.8 million PLHIV live in South Africa. In 2016, the South African government increased access to HIV testing and treatment following the proposed ‘universal test and treat’ strategy advocated by the World Health Organisation (WHO). However, there remains a significant treatment gap as only 4.8 million PLHIV are estimated to be receiving antiretroviral therapy (ART) in the country, and many of those on ART are experiencing challenges in adhering to treatment. Several studies have found that factors surrounding household income are contributing to these challenges. In this study, I explored how the management of household incomes impact the ART adherence behaviour of PLHIV from 13 families affected by HIV in the Western Cape of South Africa. I have drawn findings from the data collected as part of the HPTN 071 (PopART) trial, where in intervention communities, HIV care was delivered at a household level and HIV treatment was made available to all PLHIV prior to changes in the national HIV guidelines. I used Bronfenbrenner’s ecological framework, which entails characterising social life in five levels including the microsystem, mesosystem, exosystem, macrosystem, and chronosystem to interpret the results. Using a thematic approach to organise and analyse data, I first described how families ‘got by’ including social grants and social support; informal borrowing and loans; employment; and independent survival strategies. I found that families managed their procured incomes differently depending on varying household priorities. I found that there is fluidity on the ART adherence behaviours of PLHIV. People could iteratively move from being reluctant, to being adherent and interrupt treatment due to life changes. In the study, I found that factors in the immediate environment (micro-level), including competing household priorities, lack of resources, and recreational activities, have the strongest influence on ART adherence behaviours of PLHIV. I found that households have the potential to create a positive health-enabling environment for PLHIV through adjusting their expenditure patterns in a manner that facilitates optimal adherence to care. However, there were various determinants surrounding ART adherence that operated beyond the influences located at the household level. I propose that future health interventions should be increasingly tailored for household-specific needs, but should also be wary of neglecting factors associated with ART adherence existing beyond the household level.