Why HIV-positive patients in 2020 still don’t take their medicineAuthor: firstname.lastname@example.org
South Africa has the largest antiretroviral therapy (ART) programme in the world and we have seen a significant reduction in mortality and HIV transmission as a result.
Despite this progress and the success of government’s centralised chronic medicines dispensing and distribution programme in expanding access to treatment, a programme that Right ePharmacy actively supports by providing reliable alternatives to in-facility dispensing, serious challenges remain when it comes to medicine adherence.
To manage HIV and stay well, an HIV-positive person must stay on their medication. We have focused programmes to work with patients and understand their challenges while providing quick, easy and convenient ways for them to collect their medicine. In getting closer to patients, we learned that the same obstacles that people faced years ago still stand in the way of medicine adherence today.
Stigma and disclosure
Negative attitudes and beliefs about people living with HIV still exist, leaving many HIV-positive patients reticent to disclose their status. “If my medicine parcel is a certain size and it rattles in a certain way, then people will know that I am taking ART,” a patient recently told her healthcare worker. In 2020, HIV-positive people still do not disclose their status because they fear being judged or discriminated against. Even family members and intimate partners are not disclosing to one another.
Religious and traditional beliefs and customs
We all grow up with certain religious beliefs and traditional customs. While most continue to observe these and take ART, a person’s allegiance to their religion and tradition may take precedence over taking ART every day. There is also no scientific proof to substantiate the use of traditional herbs as effective and safe treatment for HIV. The traditional practice of ukugcaba sees medicine rubbed into incisions in the skin has a place, but it does not cure HIV. In some instances, it is often performed on different people with the same razor blade, increasing the risk of HIV transmission. Even those with the strongest faiths shouldn’t rely on prayer to cure HIV.
South Africans from rural areas that live in cities go home for funerals where they stay until all the ceremonial practices have been observed. While multi-month dispensing options are available to patients (medicine collection for more than one month), many patients travel home without their required medicines. This means that they may go without their ART for weeks or even months.
The healthy patient syndrome
HIV-positive patients who take ART every day can lead productive and healthy lives. Sometimes, they may feel so healthy that they don’t see the need to stay on their treatment. People who feel sick are more inclined to take medicine. We are working with patients to help them collect their medicine and remain adherent. Our aim is for every HIV-positive person to be on treatment and to remain virally suppressed.
At Right ePharmacy, we saw Covid-19 upset medicine collection patterns. Many people were fearful of police and security services during the hard lockdown and didn’t collect their ART, though this changed as restrictions lifted. At our Collect & Go smart locker sites and our ATM pharmacies, instead of a consistent flow of patients, we saw a patient surge to collect their medicine. They were combining shopping trips on payday with their medicine collection. The lockdown ensured that we fast-tracked our Collect & Go smart locker medicine collection programme in Gauteng, Mpumalanga and the Free State. Patients also benefited from an extended grace period of two weeks to collect their medication, as well as the 12-month extension (instead of 6 month) of their scripts which gave them more flexibility.
By better understanding the challenges patients face, we can work with them, as well as with the National Department of Health and our funders, to address these challenges and help HIV-positive people stay on their treatment and lead full and successful lives.
Right ePharmacy remains steadfast in its commitment to provide convenient, reliable and safe pick-up points for medicine outside of healthcare facilities.
Author of opinion piece: Belinda Strydom