HIV/AIDS Competent Households: Interaction between a Health-Enabling Environment and Community-Based Treatment Adherence Support for People Living with HIV/AIDS in South Africa

In the context of severe human resource shortages in HIV care, task-shifting and especially community-based support are increasingly being cited as potential means of providing durable care to chronic HIV patients. Socio-ecological theory clearly stipulates that-in all social interventions-the inter...

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Published in:	PloS one 2016-03, Vol.11 (3), p.e0151379
Main Authors:	Masquillier, Caroline, Wouters, Edwin, Mortelmans, Dimitri, van Wyk, Brian, Hausler, Harry, Van Damme, Wim
Format:	Article
Language:	eng
Subjects:	Acquired immune deficiency syndrome Acquired Immunodeficiency Syndrome - epidemiology Acquired Immunodeficiency Syndrome - therapy Adhesion AIDS AIDS treatment Antiretroviral drugs Biology and Life Sciences Chronic illnesses Community Networks Community participation Community support Data processing Disease control Disease management Drug therapy Evaluation Family Characteristics Female HIV Households Human immunodeficiency virus Humans Influence Intervention Male Medical personnel Medication Adherence Medicine Medicine and Health Sciences Occupational health Patient compliance Patients Public health R&D Research & development Research and Analysis Methods Shortages Social aspects Social environment Social networks Social Sciences Social support South Africa - epidemiology Stigma Studies Tuberculosis Womens health Workers
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Summary:	In the context of severe human resource shortages in HIV care, task-shifting and especially community-based support are increasingly being cited as potential means of providing durable care to chronic HIV patients. Socio-ecological theory clearly stipulates that-in all social interventions-the interrelatedness and interdependency between individuals and their immediate social contexts should be taken into account. People living with HIV/AIDS (PLWHA) seldom live in isolation, yet community-based interventions for supporting chronic HIV patients have largely ignored the social contexts in which they are implemented. Research is thus required to investigate such community-based support within its context. The aim of this study is to address this research gap by examining the way in which HIV/AIDS competence in the household hampers or facilitates community-based treatment adherence support. The data was analyzed carefully in accordance with the Grounded Theory procedures, using Nvivo 10. More specifically, we analyzed field notes from participatory observations conducted during 48 community-based treatment adherence support sessions in townships on the outskirts of Cape Town, transcripts of 32 audio-recorded in-depth interviews with PLWHA and transcripts of 4 focus group discussions with 36 community health workers (CHWs). Despite the fact that the CHWs try to present themselves as not being openly associated with HIV/AIDS services, results show that the presence of a CHW is often seen as a marker of the disease. Depending on the HIV/AIDS competence in the household, this association can challenge the patient's hybrid identity management and his/her attempt to regulate the interference of the household in the disease management. The results deepen our understanding of how the degree of HIV/AIDS competence present in a PLWHA's household affects the manner in which the CHW can perform his or her job and the associated benefits for the patient and his/her household members. In this respect, a household with a high level of HIV/AIDS competence will be more receptive to treatment adherence support, as the patient is more likely to allow interaction between the CHW and the household. In contrast, in a household which exhibits limited characteristics of HIV/AIDS competence, interaction with the treatment adherence supporter may be difficult in the beginning. In such a situation, visits from the CHW threaten the hybrid identity management. If the CHW handles this sit
ISSN:	1932-6203 1932-6203