Treatment literacy, therapeutic efficacy, and antiretroviral drugs: notes from Bushbuckridge, South Africa.

Health activists often see the uptake of antiretroviral drugs and adherence to antiretroviral treatment as the outcome of 'treatment literacy.' Organizations have invested considerable resources into educating the public in conventional scientific understandings of HIV and AIDS. Drawing on the results of fieldwork in South Africa and the life history of a man living with AIDS, I highlight the complex and unstable relationship that exists between therapeutic literacy and treatment efficacy. Factors that have little to do with treatment literacy have impacted upon uptake and adherence. These include a lack of political support, stigma generated by labelling, access to social welfare, and gender constructs. Moreover, in situations of medical pluralism, marked by multiple, constantly shifting understandings of sickness, it is very difficult to ascertain treatment literacy, and treatment literacy neither implies therapeutic efficacy, nor vice versa.