| Laurel A. Giddy |
| Department of Family Medicine, Stellenbosch |
| December, 2009 |
Abstract |
| In South Africa, the highest HIV prevalence is amongst young people, who may have the greatest potential to contribute to the country’s economy. South Africa has one of the world’s largest antiretroviral (ARV) rollout programs. Like all medications, ARVs need to be taken as prescribed to be safe and effective. Excellent adherence is necessary to ensure that drug resistance does not develop. HIV cannot be cured, and at present ARVs must be taken for the rest of the patient’s life. In the ARV clinic in Knysna, an unanticipated category of patients has been identified: those who “bounce” in and out of long term therapy. Not only do these patients put their own health at risk, but the development and transmission of drug resistant HIV threatens the potential treatment options of the whole community. One of the problems identified in recurrently defaulting patients, is the difficulty in maintaining long term adherence to an ARV treatment program, while in full time employment. This is because as time goes on, patients need to balance the need for ARV care, which has rigorous clinic attendance parameters, with work attendance. Many employees have only twelve days of paid sick leave per annum, and patients require an average of eleven clinic visits in the first six months of treatment. This qualitative study gauges whether the services provided to HIV positive people living in Knysna meets the needs of their employers. The study interviewed both employees and employers to gauge the effects of HIV on local businesses, and explored the knowledge and attitudes of employers towards services provided by the Knysna ARV program. Employers were asked to suggest ways in which the services could be improved to better meet their needs, and ultimately, the needs of their employees. Options to improve access which emerged from the study include extending the opening hours of the ARV clinic, as many patients have working hours which directly correspond to the opening hours of the ARV clinic. Tools need to be developed to deliver information about HIV disease and treatment to employers, as in general, knowledge about these aspects of HIV care is poor. Information on legislation governing HIV in the workplace should be included for employers and employees. Opportunities to be counseled and tested for HIV, at work, should be explored. Improving communication between employers, employees and the providers of care was identified as a factor which may mitigate many of the problems associated with long term access to care. It is imperative to find ways to integrate full time employment with effective HIV care and treatment programs to ensure their long term success. |
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