Open Access Research article

"That is why I stopped the ART": Patients' & providers' perspectives on barriers to and enablers of HIV treatment adherence in a South African workplace programme

Mison Dahab123*, Salome Charalambous2, Robin Hamilton2, Katherine Fielding4, Karina Kielmann5, Gavin J Churchyard124 and Alison D Grant1

Author Affiliations

1 Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK

2 Aurum Institute for Health Research, Johannesburg, South Africa

3 Collaborative Programme for AIDS Research in South Africa, University of Kwa-Zulu Natal, Durban, South Africa

4 Infectious Disease and Epidemiology Unit, Department of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK

5 Health Policy Unit, Department of Public Health Policy, London School of Hygiene & Tropical Medicine, London, UK

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BMC Public Health 2008, 8:63  doi:10.1186/1471-2458-8-63

Published: 18 February 2008



As ART programmes in African settings expand beyond the pilot stages, adherence to treatment may become an increasing challenge. This qualitative study examines potential barriers to, and facilitators of, adherence to ART in a workplace programme in South Africa.


We conducted key informant interviews with 12 participants: six ART patients, five health service providers (HSPs) and one human resources manager.


The main reported barriers were denial of existence of HIV or of one's own positive status, use of traditional medicines, speaking a different language from the HSP, alcohol use, being away from home, perceived severity of side-effects, feeling better on treatment and long waiting times at the clinic. The key facilitators were social support, belief in the value of treatment, belief in the importance of one's own life to the survival of one's family, and the ability to fit ART into daily life schedules.


Given the reported uncertainty about the existence of HIV disease and the use of traditional medicines while on ART, despite a programme emphasising ART counselling, there is a need to find effective ways to support adherence to ART even if the individual does not accept biomedical concepts of HIV disease or decides to use traditional medicines. Additionally, providers should identify ways to minimize barriers in communication with patients with whom they have no common language. Finally, dissatisfaction with clinical services, due to long waiting times, should be addressed.