Adherence to Antiretroviral Therapy in the Context of the National Roll-Out in South Africa: Defining a Research Agenda for Psychology

Abstract

Since 2004, antiretroviral therapy (ART) has been provided by the South African Department of Health to patients who need it as part of the national ART roll-out. Despite the initial success of a trial ART programme in Khayelitsha near Cape Town, it is unclear that adherence to ART is optimal among the patients receiving treatment in the context of the national roll-out. In this article I call attention to the psychosocial barriers to adherence that may potentially be faced by patients receiving ART. These barriers include poverty, health literacy, perceived social support, mental health, substance abuse, and stigma. Three social cognitive theories are briefly reviewed to conceptualise the phenomenon of ART adherence, namely, the Health Belief Model, the Theory of Planned Behaviour, and the Informational—Behavioural—Motivational Model. Constructs such as health motivation, perceived threats, perceived barriers, attitudes towards ART, perceived subjective norms, and perceived behavioural control are examined for their potential role in developing a theoretical understanding of adherence to ART. Finally, the role of culture is considered in response to concerns that social cognitive models developed in industrially developed countries are limited in their application in a developing country such as South Africa. As the question of adherence to ART in South Africa has received little attention from social science researchers, I set a tentative agenda for psychosocial research with a view to enhancing the likelihood of optimal adherence among AIDS patients.