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Branstrom, Acree and Maskowitz, (2011). Friends’ support upon disclosure is witnessed by Lee, Harris, Harper and Ellen, (2015) in their study about HIV positive youth disclosure to their friends. The responses from the study pointed to the fact that friends and family members continue to socialise with HIV infected youth after disclosure. That level of acceptance of their status gave them a higher level of perceived social support.
The literature about disclosure to friends is relevant in this study as the women interacted with a number of people during their HIV positive journey of coping with their condition.
Having reviewed scholars’ perspectives about HIV positive status disclosure to various groups, the next section looks at what scholarship says about HIV treatment enrolment.
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There could also be the need to do some drug resistance test to determine the best medication options for each person. The result of all of these tests will provide a baseline measurement for future tests (Meintjes, Black, Conradie, Fox et al., 2014). In their guidelines for adult initiation with regard to ARV therapy, Meintjes et al., (2014) provide holistic principles on ART initiation. Key among them are: a) the standard of care which emphasises the strict adherence to medication for maximum suppression of HIV, b) the available regimen in southern Africa, c) the indication for initiation on ART including the CD4 threshold, d) all investigations prior to starting ART, e) ART failure and f) indications for changing or switching to other regimens.
While the literature does not dwell extensively on the medical aspect of HIV treatment enrolment per se, it is worth noting all the available treatment regimens for southern African countries. These are the first regimen also known as the first line; the second line regimen or second line drugs are those given to patients when failure of first line regimen is noticed and the final level or the third line, which are drugs dispensed when the two other types fail to suppress the viral load as expressed by Woldemedhin and Wabe, (2012); Van Zyl, Liu, Claassen, Engelbrecht et al., (2013); Koigi, Ngayo, Khamadi, Ngugi et al., (2014); Meintjes et al., (2014); and Mosha et al., (2014). Depending on the outcome of the tests and general clinical appearance of an individual, the health care professionals may conduct some other tests such as complete blood count; the blood chemistry which will include liver and kidney function tests; tests for sexually transmitted infections; tests for hepatitis B, tuberculosis or toxoplasmosis; urinalysis for proteinuria and serum creatinine and calculation of creatinine clearance. These tests are done in order to assess the type of treatment regime suitable for a particular person.
49 Starting on HIV treatment
Meintjes et al., (2014) put emphasis on individual readiness as key towards effective uptake of HIV treatment. In their guidelines, considerations are given to health provider-client education about the benefits of ART; the importance of good adherence to AR; lists of all the possible side effects, including what to do and who to contact, if serious side effects occur; development of a personal treatment plan; issues of disclosure to partners and/or family members; encouraging patients/clients to join support groups or identification of treatment buddy, as well as provision of on-going counselling for the patients and his/her family members, and on-going education on reproductive health.
While these drugs are available for free in most countries (including the study country), there are still some costs that are associated with getting them. These costs include transport for regular visits to the hospitals or clinics. These visits range from at least once in three months, with laboratory monitoring every six months to once a year (Rosen & Fox, 2011; and Lesotho Government Report, 2016). While initially the CD4 cell count was a threshold for initiation to ART, there are recent developments within the HIV and AIDS treatment regime, whereby all persons who are tested and found HIV positive are immediately put on treatment. This initiative or approach is termed “test and treat” and was launched in Lesotho in June 2016 (Lesotho Government Report, 2016). This approach works hand in hand with other approaches such as the KYS, and various condom promotion campaigns. The test and treat approach, however, is believed to be an accelerated approach towards stabilisation and reduction of annual HIV new infections, which has since placed Lesotho at the second highest position within global HIV and AIDS prevalence rates (as mentioned in Chapter One). This ambitious approach is expected to contribute to the global commitment of attaining an AIDS free society by 2030 (UNAIDS, 2015).
50 Factors that undermine adherence to ART
In the event of a low income status, patients who are supposed to visit the clinics may end up not being regular visitors. Given that Lesotho is a poor country, this is especially pertinent to my study. Ngarina, Popenoee, Kilewo et al., (2013) noted the following barriers: a) decreased motivation especially if a woman is diagnosed during pregnancy, b) a feeling of hopelessness, c) overwhelming demands of everyday life such as having to carry treatment around every time one has to travel, d) having to set aside other activities whenever it is time to take medication, e) poverty and f) lack of empowerment. Another area identified by De Mossa et al., (2013) that negates adherence to treatment, is the element of not fully understanding the initial ARV education session. This deficit in understanding, they note, is very crucial for patients to overcome as it may promote adherence or create non-adherence to medication. As a result emphasis is placed on the issue of disclosure to family members, in order to get treatment support, as outlined by Meintjes, (2014) above.
Having reviewed scholarly writings about treatment enrolment, the next section looks at the research focusing on adult learning, as this forms part of the knowledge acquisition when it comes to HIV and AIDS.