‘You Have to Withstand That Because You Have Come for What You Have Come for’: Barriers and facilitators to antiretroviral treatment access among older South Africans living with HIV

Abstract

Nationwide rollout of antiretroviral treatment (ART) is increasing the number of older persons living with HIV (OPLWH) in South Africa. Yet, little is known about how the sociological aspects of ageing – stigma, finances and family dynamics – impact access to ART. Qualitative interviews with 23 persons aged 50‐plus living near Cape Town highlight the barriers and facilitators to the acceptability, affordability and availability of ART access among OPLWH. Key age‐related barriers included perceived shame of sexuality and disclosing HIV status to others, perceived disrespect by clinical staff, affording transportation to clinics and pre‐existing co‐morbidities. Key age‐related facilitators included family moral and financial support, particularly from children and grandchildren, and access to social grants. Importantly, many barriers and facilitators had feedback loops, for example social grants reduced transportation barriers to clinics when ageing and poor health limited mobility. As the population living with HIV ages, it is critical to assess the ways ageing, as a social process, impacts ART access and to address these to improve older persons’ HIV care.

Uptake of community‐ versus clinic‐based antiretroviral therapy dispensing in the Central Chronic Medication Dispensing and Distribution program in South Africa

“…Younger age is associated with loss to follow‐up from clinic care and higher attrition from DSD programs, highlighting the need for CCMDD to ensure continued engagement [ 6 , 10 , 38 , 39 ]. For older adults, while there is limited knowledge on interventions to improve ART access, strategies must address barriers of stigma, transportation, waiting times and non‐communicable disease service integration commonly experienced by this population [ 40 , 41 ].…”

Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma

“…For some it was active and purposeful in order to secure social support, for others health care workers encouraged and supported the OPLWH to disclose to their families, for some it was unintentional. Previous analyses of these data also show the importance of social support from family as a key means of improving acceptability of ART adherence, retention in care, and reducing stigma among respondents [ 55 ].…”

Understanding advances in treatment and care of people living with and alongside HIV: Contributions from the Sociology of Health and Illness

“…‘ You have to withstand that because you have come for what you have come for’: barriers and facilitators to antiretroviral treatment access among older South Africans living with HIV by Schatz et al (2021) is our second paper, published in the March issue. The authors draw on interviews from older people in two low‐income townships outside Cape Town, originally created as part of apartheid, to understand the acceptability, affordability and availability of ART.…”