A study on the influence of HIV related stigma and alcohol use on adherence to antiretroviral therapy among adults on treatment at the infectious disease care clinics in Princess Marina and Nyangabgwe referral hospitals in Botswana
Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--Stellenbosch University, 2008.
HIV-related stigma and alcohol abuse have been identified as some of the barriers to optimal adherence to antiretroviral therapy (ART) in Botswana. However, not much is known about the extent to which the two factors affect adherence to ART among adults on treatment at the Infectious Disease Care Clinics (IDCC) in the country. The overall aim of this study was to investigate the extent to which HIV-related stigma and alcohol use independently affect compliance to HIV medicine among adults on treatment and also elucidate their interactive effect on adherence. Cross-sectional data was collected by administering a questionnaire and conducting interviews and focus group discussions with adults receiving antiretroviral treatment at Princess Marina and Nyangabgwe referral hospitals situated in Gaborone and Francistown, Botswana respectively. Participants were selected from a daily schedule list of all adult patients attending the IDCC at the two hospitals during the study period using a systematic sampling. Data gathered included information on socio-demographic characteristics of the sample population, HIV-related stigma, alcohol use and adherence to ART. The majority of respondents were females (66%) and 69% of participants were in the age group 31-50 with mean age of 39.5 (SD= 5.5). The study showed that the average adherence rates were 98 % by self-reports and 96% by pharmacy refill pill count record. It was also found that alcohol abuse and HIV-related stigma had greatly reduced among antiretroviral (ARV) users. Chi-squared tests and two-way analysis of variance (Two-way ANOVA) showed that the ART adherence of participants reporting low levels of alcohol consumption and low stigma concerns was comparable to that of individuals not reporting experiences of stigma or alcohol consumption in the twelve months preceding the study. This was supported by the responses of the health providers and ARV users during interviews and focus group discussions. These findings suggest that any interventions to reduce stigma and alcohol abuse should be incorporated into the existing ART adherence improvement programme.