Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
Glob Public Health. 2011;6(1):83-97. doi: 10.1080/17441691003796387.
Structural barriers to antiretroviral therapy (ART) adherence are economic, institutional, political and cultural factors, that collectively influence the extent to which persons living with HIV follow their medication regimens. We identify three sets of structural barriers to ART adherence that are salient in Southern Africa: poverty-related, institutional, and political and cultural. Examples of poverty-related barriers are competing demands in the context of resource-constrained settings, the lack of transport infrastructure, food insecurity, the role of disability grants and poor social support. Examples of institutional factors are logistical barriers, overburdened health care facilities, limited access to mental health services and difficulties in ensuring adequate counselling. Examples of political and cultural barriers are controversies in the provision of treatment for AIDS, migration, traditional beliefs about HIV and AIDS, poor health literacy and gender inequalities. In forging a way forward, we identify ways in which individuals, communities and health care systems may overcome some of these structural barriers. Finally, we make recommendations for further research on structural barriers to ART adherence. In all likelihood, enhancing adherence to ART requires the efforts of a variety of disciplines, including public health, psychology, anthropology, sociology and medicine.
抗逆转录病毒疗法(ART)依从性的结构性障碍包括经济、制度、政治和文化因素,这些因素共同影响艾滋病毒感染者遵循其治疗方案的程度。我们确定了在南部非洲地区存在的三组与 ART 依从性相关的结构性障碍:与贫困相关的障碍、制度障碍以及政治和文化障碍。与贫困相关的障碍的例子包括在资源有限的环境下存在竞争需求、缺乏交通基础设施、粮食不安全、残疾津贴的作用以及社会支持不足。制度因素的例子包括后勤障碍、医疗机构负担过重、获得心理健康服务的机会有限以及难以确保充分的咨询。政治和文化障碍的例子包括在提供艾滋病治疗方面存在争议、移民、关于艾滋病毒和艾滋病的传统观念、健康素养差以及性别不平等。在为前进铺平道路的过程中,我们确定了个人、社区和医疗保健系统可以克服其中一些结构性障碍的方法。最后,我们就进一步研究抗逆转录病毒疗法依从性的结构性障碍提出了建议。很可能,提高抗逆转录病毒疗法的依从性需要公共卫生、心理学、人类学、社会学和医学等多种学科的共同努力。