Harrison (2014) argues that infected individuals in most African countries delay internalising their HIV positive status or taking action to properly care for themselves,which leads to delays to employ coping strategies and learning about their disease. Instead, infected individuals spend a lot of time holding on to the perceptions that HIV and AIDS occur as the result of either sorcery or a conspiracy. These perspectives have some obvious implications for raising awareness about HIV and AIDS and its treatment. But for people who are infected these non-medical beliefs divert attention from realising how the disease is transmitted.
In many countries, developed and developing, the challenges in relation to HIV infection still persist and need closer attention to how one reacts to the virus in order to curb the spread of the disease. They include having to interpret and comprehend one’s HIV positive results, accepting living with the virus, stigma and discrimination, attempting to be productive often among young, active, child-bearing age groups who occupy industries or family businesses. The burden of coping with various emotions can start with anger and trauma and reach the stage where productive resources get diverted for access to medical needs (such as agricultural work being neglected) and with devastating effects on children (WHO, 2003). Therefore, WHO urges researchers to explore the functioning of support groups in relation to each of the challenges with a view to encouraging support groups to employ innovative solutions which can protect lives and enable strategies for treating millions of people in future.
One big challenge for individuals infected by a complicated virus such as HIV is that they have to learn to understand their illness and strive for better self-management to prolong life. The
39 challenges of being infected are very hard for African women who still observe the importance of patriarchal lineage. This issue delays acceptance and practices of prevention strategies by women because they need to seek permission from males for services they need as women.
Buckley (2013) argues that, culturally, men enjoy occupying the high-ranking position of the family which had to be occupied by their sons during temporary or permanent absence of the father. Buckley points out that the male cultural practice signifies the protection of patriarchal lineage. The Government of Lesotho (GOL) (2016) indicates that it is appropriate for a small nation like Basotho to compromise their culture to protect life such as adhering to the PMTCT programme. This programme demands several behaviour changes which at some point involves compromising culture to save life.
Hodge and Nadir (2008) postulate that most African cultures believe that women are the cause of HIV and AIDS and that men can only be infected by women. Davies and McCartney (2003) indicates that women are not free to speak of their HIV positive status to their partners for fear of violence, divorce and blame imposed by other family members who do not even know their own HIV status and therefore keep their distance from necessary information about the disease. There is a significant association between the challenges of being infected and adherence, hence this study also looks at other factors contributing to re-infection and mother to child transmission of HIV, adherence being one of them. Harrison, Colvin, Kuo, Swartz et al. (2015) elucidate that women have long been stigmatised for many reasons which are mostly beyond their control, such as staying unmarried without a choice, or being labelled barren without checking the male partner’s fertility, and a sustained high HIV incidence in young women in Southern Africa.
Daniels and Sabin (2002) see adherence as yet another challenge due to limited medical resources and requires counselling. Counselling concerns itself with helping clients accept themselves in order to focus on the positive elements of their being, in order to cope with and stick to the demands of their new lives.
The task of ensuring sustainability in taking medication is somewhat challenging. However, GOL (2008) argues that treatment success is highly dependent on the patient’s ability to adhere to their medication schedule. Adherence is viewed by GOL (2008) as a journey which starts with
40 behaviour change communication strategies and proceeds to exploring ambivalences about condom use and practicing condom negotiations. He indicates that the two practices need to be considered as core skills required for remarkable adherence progress.
It is significant that the Botha-Bothe support groups in this study decided to discuss adherence at every clinical visit. According to these support groups (personal communication with health care worker 23rd November 2013), barriers to adherence can include lack of access to refills, insufficient food and water with which to take the medications, inability to get to the clinic for scheduled appointments because of bad weather conditions (river floods and sometimes heavy snow falls), problems with transportation and lack of a personal support system.
According to Namwamba-Ntombela (2010) one way the support group can help members maintain good adherence to their medication, is by giving each other tips on how to effectively and consistently take medication. There are a number of tips given. Some of them include a) brushing one's teeth every morning and using this activity as a cue to take the morning dose of medication, b) using radios – linking a particular radio programme as a reminder to take medication, or c) developing pill count calendars for themselves which indicates when a pill is taken.
Masentlhe, Jacques and Mmatli (2013), however, argue that for some patients the task of taking medication every day for the rest of their lives without missing a dose is still daunting.
Masentlhe et al. therefore discourage patients’ adherence to self-assessment without monthly supervision because patients mask poor or non-adherence practice when they experience treatment fatigue or manifest as poor negotiators who may not have disclosed even to very close relatives. This means they usually do not get a chance to take their medications secretly and miss some doses due to fear of being seen. Maile (2011) indicates that good adherence improves health, and as a result, self-esteem increases and coping mechanisms are enhanced. This suggests there is a need for interventions geared towards members’ involvement in sharing experiences throughout the support group sessions. The Department of Health states that acceleration in adjusting to treatment also depends on confidentiality between doctor and patient and between
41 patients. However, it will be seen that in relation to HIV treatments confidentiality becomes problematic.