Patterns of disclosure and antiretroviral treatment adherence in a South African mining workplace programme and implications for HIV prevention

Abstract

Social and psychological barriers to the disclosure of one's seropositive HIV status to significant others and poor adherence to taking medications pose significant challenges to the scaling-up of access to antiretroviral treatment (ART) in the workplace. Such barriers are predictive of sub-optimal treatment outcomes and bedevil HIV-prevention interventions at a societal level. Against this background, this article explores the lived experiences of 19 HIV-positive male participants, between the ages of 33 and 57 years, who were enrolled in an ART programme managed at an occupational health clinic at a mining company in South Africa. The majority of these mineworkers had been aware of their HIV status for between 5 and 7 years. The study explored psychological and relational factors, as aspects of these participants lived experiences, which had a bearing on their adherence to their ART regimen and the disclosure choices that they made regarding their HIV status. In our sample, those participants who were adherent demonstrated higher levels of control and acceptance of their HIV infection and were more confident in their ability to manage their treatment, while the group who were non-adherent presented with lower levels of adherence motivation and self-efficacy, difficulties in maintaining a healthy lifestyle and significant challenges in maintaining control over their lives. While most of the men favoured disclosing their HIV status to their partners for the sake of treatment support, they were less sure about disclosing to family members and non-family members, respectively, because of their need to protect these persons and due to their fear of being stigmatised. It was evident that treatment adherence choices and behaviours were impacted by psychological and relational factors, including disclosure decisions. We conclude with a bivariate model for understanding the adherence behaviours that influenced different patterns of ART adherence among the sample, and offer recommendations for HIV-prevention and treatment interventions in a mining workplace.

Gendered constructions of the impact of HIV and AIDS in the context of the HIV‐positive seroconcordant heterosexual relationship

“…In addition, women provided support to their husbands, even at their own physical and emotional expense, thereby facilitating the maintenance of their husbands' hegemonic behaviours (and traditional masculine position), despite being subordinated by them. In fact, Bhagwanjee et al [61] reported that despite the support rendered by their female partners, most of the men in their study continued to remain unfaithful, thereby actively maintaining their hegemonic masculine position.…”

“…For instance, in a study on HIV-positive male mine-workers in South Africa, Bhagwanjee et al . [61] found that participants associated their control over their adherence behaviours with the belief that that they could live a long, healthy and normal life despite their HIV infection.…”

“…In fact, Bhagwanjee et al . [61] reported that despite the support rendered by their female partners, most of the men in their study continued to remain unfaithful, thereby actively maintaining their hegemonic masculine position.…”

“…In the face of the very real public health threat presented by HIV and AIDS, the above discourse is critical in offering containment, reduction of fear and the enablement of a range of healthy behaviours and lifestyle changes [60]. For instance, in a study on HIV-positive male mine-workers in South Africa, Bhagwanjee et al [61] found that participants associated their control over their adherence behaviours with the belief that that they could live a long, healthy and normal life despite their HIV infection.…”

Age-targeted HIV treatment and primary prevention as a ‘ring fence’ to efficiently interrupt the age patterns of transmission in generalized epidemic settings in South Africa

“…Outreach programs already have the potential to reach populations with diverse age distributions. These include school-based programs, 25 workplace wellness programs, 26 – 28 youth centers 29 and programs leveraging health care utilization such as antenatal care 30 and sexually transmitted disease treatment. 31 Age targeting considerations could potentially help to prioritize and justify the expansion of outreach methods that can reach young adults.…”