Page 187 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 7 Original Research

Social factors Differential treatment and verbal abuse by health care
A lack of financial support was reported to have a negative workers towards patients who had defaulted or missed
impact on ART adherence, as participants often did not have appointments deterred adolescents from returning to the
money to pay for public transport to the clinic: clinic to re-start treatment:
‘Oh … maybe I can use it [financial support] for a taxi fare to Participant: Is that I am scared because it’s been a while
collect my medication.’ (Group 4, male, 18) since I came to the clinic.
Facilitator: And what are you scared of?
Participants cited negative relationships with non-biological Participant: Like the doctor is going to shout at me
caregivers as a barrier to adhering to ART with some orphans
even saying they defaulted ART in an attempt to end their Facilitator: Anything else?
lives and be with their deceased biological parents: Participant: The doctor will shout at me, and I will have to
wait at the clinic since they will start with the
‘Yoh, when I am feeling bad, I stop taking my pills. For
example, when I have quarrelled with my mother, sometimes non-defaulters. That makes me angry. (Group 4,
she says things that are not so nice. Like saying she never male, 18)
infected me. My mother is not my biological mother mos. My
biological parents are dead. So when she talks like that I feel A key informant admitted that often the unique attributes of
lonely and I feel bad, I stop taking the pills because I also want adolescents were not completely understood by health care
to die.’ (Group 4, male, 18) workers and that this impacted on service delivery to this
group and resultant adherence. They were of the opinion that
Furthermore, adolescence is characterised by a desire to fit in. the health care system should be set up in such a way so as to
Some respondents reported feeling like outcasts amongst focus on the unique needs of adolescents:
their immediate family because they were the only ones who ‘I don’t think we have systems in place yet because there is
were HIV positive: nothing that focuses on them (adolescents). They are just in
‘I would not feel different from them [if I was HIV negative]; now another group of adults taking ARVs so there is nothing focusing
I feel like an outcast. I am the only person with this thing [HIV] specifically on assisting them so I would say we do not have a
and I do not belong here. I feel like staying away from them … system that really supports them maybe if we could establish
I wish I could stop taking medication [ART] and be like them.’ something that really focus on them because [they] are just
(Group 4, male, 18) dumped among the adults because they are just part of the whole
group who is taking the ARVs.’ (Nurse)
Health services factors
Long waiting times at the health facility were mentioned Treatment-related factors
by all participants as a deterrent to adhering to clinic Treatment fatigue was mentioned as a profoundly significant
appointments (picking up medications), as these interfered barrier to adherence by all participants:
with attending school that day: ‘I sometimes feel that this thing that I have to take the pills every
‘… Sometimes if you come here at half past 8 and the doctor day does not sit well with me, I just get bored and feel like I could
doesn’t attend you. … Doctors can make you wait for a very long just throw them in the bin.’ (Group 1, female, 13)
time before they can attend you. You can come here at 8am and ‘Because it has been a while since I started taking the pills,
they only start to attend to you at 9. Mind you, you will go home I started when I was staying in Mandela at Worcester, but I was
at 4 that is why I get bored.’ (Group 1, female, 13) not used to them by then. I always ask mom and my sister,
when I will ever stop taking these pills and my sister says, you
In addition, participants feared that the flow of patients at will take them till you die. So that is why I do not like them.’
this health facility may lead to unintended disclosure of (Group 1, female, 13)
their HIV status, because the area in which you waited in
the clinic gave clear indication of the services you were Participants in this study found the treatment routine
coming for: associated with ART extremely rigid and were frustrated by
the fact that apparently no leniency was allowed:
‘One time I came to fetch my medication and I saw my
neighbour. Now she knows [I am HIV positive] because it’s ‘Yah, I also miss them sometimes. I am a playful person. So at
obvious that people who wait this side are HIV positive.’ times I miss my time and I do not want to take them after that
(Group 4, male, 16) time because I do not know if they will have negative effects
after.’ (Group 4, male, 16)
Missing and misplaced files also served as a major barrier to
adhering to ART as adolescents would be told by clinic staff Patient-related factors
to return to the clinic on a different day to collect their The dynamics of disclosure played a pivotal role in
medication: ART adherence amongst these participants. The majority of
‘I do go home without help, they keep losing my folder and participants preferred selective disclosure where they chose
sending me home and ask me to come back tomorrow. When I to disclose their HIV status to some people but not to others.
come again, they will say it is you again, and they are not keen to Many participants feared rejection, stigma and discrimination
help me. Mind you I ran out of medication.’ (Group 3, female, 15) if their status is known. Therefore, participants chose not to

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