Structural barriers to adherence to antiretroviral therapy in a resource-constrained setting: the perspectives of health care providers

The present study examined the chief structural barriers to antiretroviral treatment (ART) adherence from the perspective of health care workers who provide treatment to patients living with HIV and AIDS in South Africa. The main barrier to adherence as identified by participants in the study was the stigma associated with living with HIV, and thus with receiving AIDS treatment. A second barrier was the fact that some patients willfully decide to forgo treatment so that they could retain state disability benefits associated with a low CD4 count. Other barriers included the lack of finances for transport to clinics and food insecurity, especially when medication needed to be taken with food. These barriers to ART adherence are conceptualized in terms of Bronfenbrenner's Ecological Systems Theory.