School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
Sex Transm Infect. 2012 Mar;88(2):147-51. doi: 10.1136/sextrans-2011-050140.
Using the example of South Africa, this study aimed to examine and obtain a better understanding of the experiences and challenges of urban and rural patients on antiretroviral therapy (ART) in accessing this complex treatment in a resource-limited setting.
Following a narrative approach, in-depth interviews were conducted with 20 patients successfully and unsuccessfully (ie, with interruptions) receiving ART in urban Johannesburg and rural Bushbuckridge, using a detailed interview guide structured to illuminate interviewees' life circumstances and contextualise illness and treatment trajectories. Participants were interviewed by trained fieldworkers in their local languages. The translated and transcribed interviews were coded by several team members. Codes were cross-examined and showed good congruence.
All interviewees emphasised the positive aspects of receiving ART, the lifeline and hope it provided by improving health, increasing their ability to live actively and reducing visible signs of (stigmatised) illness. Important factors supporting continuing adherence included social and economic support by individuals, role models and networks as well as positive experiences within the healthcare system and of the treatment itself. The main challenges were linked to patients' difficult life circumstances, especially those related to poverty (eg, transport and food costs) and health system constraints, including perceived lack of compassion and flexibility by healthcare workers.
While there are many challenges for the sustainability of ART on an individual and health system level, this study emphasised the need for a patient-centric focus to continue to provide and increase the number of HIV-positive people receiving this lifeline, receiving hope.
以南非为例，本研究旨在探讨和深入了解城市和农村接受抗逆转录病毒疗法（ART）的患者在资源有限的环境中获取这种复杂治疗的经验和挑战。
采用叙述性方法，对在约翰内斯堡市区和农村 Bushbuckridge 成功（即无中断）和不成功（即有中断）接受 ART 的 20 名患者进行深入访谈，使用详细的访谈指南来阐明受访者的生活环境，并将疾病和治疗轨迹背景化。访谈由经过培训的现场工作人员用当地语言进行。翻译和转录的访谈由几名团队成员进行编码。对代码进行交叉检查，结果显示出很好的一致性。
所有受访者都强调了接受 ART 的积极方面，它通过改善健康、提高积极生活的能力以及减少（污名化）疾病的可见症状，提供了生命线和希望。支持继续坚持治疗的重要因素包括个人、榜样和网络提供的社会和经济支持，以及医疗保健系统和治疗本身的积极体验。主要挑战与患者困难的生活环境有关，特别是与贫困相关的因素（例如交通和食品成本）以及卫生系统的限制，包括医疗工作者缺乏同情心和灵活性的看法。
尽管在个人和卫生系统层面上，ART 的可持续性存在许多挑战，但本研究强调需要以患者为中心的重点，继续提供和增加接受这种生命线、获得希望的 HIV 阳性人数。
