Abstract #189  -  Factors influencing HIV treatment adherence among HIV positive employees in a multinational mining company in South Africa
Authors:   Presenting Author:   Prof Inge Petersen - University of KwaZulu-Natal
Additional Authors:  Mr  Anil Bhagwanjee, Dr  Olagoke  Akintola, Mr  Gavin George, Dr  Kaymarlin Govender,
Aim: Against the backdrop of considerable investments by the South African corporate sector in rolling out treatment services for their HIV-positive employees, and limited evidence on the efficacy of these services, this paper explores factors influencing adherence to HIV treatment services in a single site of a multinational mining company in South Africa.
Method / Issue: Using a rapid focused ethnographic approach, in depth individual interviews were conducted with 33 male and 2 female HIV-positive employees attending the on-site mine clinic. Thematic analysis of this qualitative data set was complimented by the results of a quantitative survey conducted with the employee population, including HIV positive and HIV negative cohorts.
Results / Comments: Treatment adherence emerged as a complex problem, with both pre-HAART and HAART patients demonstrating varying degrees of default. Organisational factors undermining treatment adherence included difficulty in follow-up of patients’ post-VCT and difficulty in follow-up of patients who might be on private treatment. From the perspective of service users, factors impeding treatment adherence included: perceived lack of confidentiality from clinical staff and the organisation of clinical services; shortcomings in patient-practitioner communication; reticence to commit to life-long treatment, especially for symptoms that are not visible; difficulty with taking medication during work shifts for fear of stigma & drowsiness at work; negative side effects of chemotherapy; fear of drug interactions with traditional medicine and alcohol; a failure to disclose HIV status to partners; failure to disclose alternative traditional treatment seeking behaviours to health professionals; and significant stress and depression arising from the medical, psychological and social fallout arising from being on chronic treatment. Participants cited support from spouses/ sexual partners and other family members as a factor facilitating adherence. The availability of free medication and positive attitudes of health personnel were also positive influences on adherence.
Discussion: These findings highlight the need for: improvements in the quality of pre and post test counselling; creating opportunities for a continuity of clinical care and de-stigmatisation and normalisation of the disease process and its treatment; tailored interventions to enable greater spousal involvement and opportunities for disclosure; organisational restructuring to address concerns with regard to confidentiality violations; and concerted campaigns to de-stigmatize HIVAIDS at the target site as well as the surrounding communities. Workplace treatment programmes should include a focus on promoting family support to assist patients to accept their condition and associated treatment, deal with the incumbent stressors of being HIV positive as well as develop an agreed upon treatment regimen through a process of illness negotiation which takes traditional explanatory models of illness into consideration.
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