HELEN STRUTHERS: With antiretrovirals, it means that people have to take 19 out of 20 doses, on time, in the correct way, every single day of their lives.

KHOPOTSO: For many people this can be a challenge. Some can do it better than others. On surface, it would seem that most people are adherent to antiretrovirals, but there are no studies to indicate what adherence levels there are to AIDS treatment in South Africa. As Helen Struthers, a researcher at the Perinatal HIV Research Unit continues, for a person to successfully take their medication, involvement of others is necessary.

HELEN STRUTHERS: You need support from people around you’€¦ Being isolated can be a real problem. There are some organisations that insist that you have a treatment buddy – you have disclosed to, at least, one person who will help you with the medication.

KHOPOTSO: Speaking from her ninth floor office at the Old Nurses’€™ Home building at Chris Hani Baragwanath Hospital in Soweto, the bespectacled Struthers adds that helping a person on antiretrovirals should not be the sole responsibility of a friend or a close family member.

HELEN STRUTHERS: We’€™re taking a team approach to adherence, where we look at everybody on the team, which includes doctors, nurses, the receptionist, the person themselves, their friends, their family and try and include everyone in keeping the person on the drugs and being adherent to the drugs’€¦ Every time someone drops into the clinic someone needs to ask how they’€™re doing. If people seem to be becoming depressed, then, we need to deal with the depression. You need to look at the person as a whole, not just as a person who takes medication.                                        

KHOPOTSO: There are cases, however, where people become tired of taking antiretrovirals over a prolonged period of time and they, ultimately, stop taking their medicines or take them in a haphazard manner.      

PETER BUSSE: I’€™m not that compliant with my taking of my ARVs, which I should be’€¦ I just take it when I have breakfast and that can be anytime from, like, 05h00 a.m. until noon – some times even later.

KHOPOTSO: A confession by the late AIDS activist and educator, Peter Busse, who braved HIV infection over 20 years.

This attitude towards taking medicine, warns Struthers, can lead to the development of what is known as drug resistance, a situation where the drugs cease being effective because of irregular use by the patient.

HELEN STRUTHERS: Resistance develops when there isn’€™t enough medication in the body to stop the virus from multiplying. And it will multiply in such a way that it changes its form over a period of time. And then, the medication will no longer be able to suppress the new virus that has developed.

KHOPOTSO: As more people start to need antiretrovirals, Struthers advises that they should seek information to ensure good health once they are on the medication. These are usually a combination of three drugs from different classes of antiretrovirals, which target the virus in separate ways.              

HELEN STRUTHERS: People need counselling; people need to know about their treatment; they need to be educated about the risks of not taking the treatment properly; of the side effects; they need to be educated prior to even going onto treatment. Once they’€™re on treatment they need to be able to go to support groups; they need to be able to get information when they require it. If they’€™re having problems or side effects from the treatment they need to know who to access. What’€™s really, really important is that people know about the virus, about the treatment and where to get help.                                  

KHOPOTSO: That is necessary to encourage stricter adherence to ARV treatment. Adherence means taking the required dosage of pills every day, at the same times. That can help identify and deal with any related side-effects that may arise. Secondly, the risk of the medication not combating the virus in a person’€™s body can be spotted while there is still sufficient time to introduce more appropriate medication. Finally, it is important to note that for as long as a person lives they need to continue being on their antiretrovirals to suppress the virus. Although she has been taking antiretrovirals for just over two years, mother of two, Selinah Mashinini from Alexandra township, near the plush suburb of Sandton, Johannesburg, knows that only too well.

SELINAH MASHININI: Aah, for me, it’€™s like a thing that I’€™m getting used to’€¦ My body now is used to it. I feel that there is something that I must do now. Then, I will say, ‘€˜oh, it means it’€™s time for taking my medication’€™’€¦        

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