Beyond supplying HIV and TB treatment

Improved access to acceptable care in South Africa by engaging with patients’ health contexts, experiences and illness perceptions

HIV/AIDS and TB are much more than chronic diseases requiring medical treatment. As illnesses, they entail more than physical discomforts or difficulties. Instead they are deeply affecting how patients perceive their own emotional well-being, self-worth, and bodies – and how others in society perceive and interact with patients.

Such perceptions, beliefs and experiences are central to patients’ lives because they frame the options available to them, affect relationships within families and communities, and influence their decisions and actions. Crucially, these factors fundamentally impact on the treatment pathways that patients decide on and the acceptability of the care that the health system provides.

Access to acceptable care, however, is not only about the perceptions and circumstances of each patient, but transcends the individual to encompass the broader social context or “healthworld”; the socially shared, collective ways in which societies pursue health and well-being. This brief explores how HIV and TB patients in South Africa construct their illnesses through their beliefs, experiences and perceptions and how these constructions and patients’ healthworlds influence their access to care, in particular, the acceptability of that care.

Understanding acceptability and access is crucial as South Africa, a country with a history of polarizing debates around HIV, has experienced the world’s fastest growing HIV/AIDS epidemic, is the country with the highest number of people living with HIV, has seen TB become the leading cause of death, manages what is now the world’s largest anti-retroviral (ART) programme, and is challenged to deliver uninterrupted ART and TB treatment. Click here