Erasmus, P. A.Van Rensburg, H. C. J.Serekoane, Motsaathebe2015-11-102015-11-102010-052010-052010-05http://hdl.handle.net/11660/1578English: Although antiretroviral (ARV) medicines do not provide a cure for HIV and AIDS and are associated with other problems such as side effects and drug resistance, they can increase the length and quality of life, as well as the productivity of patients on antiretroviral therapy (ART). Antiretroviral regimens have improved survival rates and lowered the incidence of opportunistic infections in people with AIDS. Strict adherence to ART is crucial in order to maintain a low viral load and to prevent the development of drug resistant strains of the virus. However, some patients do not return for follow-up on schedule and the likely outcome for such patients is sub-optimal adherence to prescribed ARV regimens and possible treatment failure. Anthropological studies have shown that patients‟ explanatory models are necessary additions to the treatment criteria used by health providers (Kleinman, 1980 & 1988; Nanda & Warms, 2002). Kleinman et al. (1978) introduced the concept of the explanatory model in applying anthropological insight to clinical practice. They maintain that, in the health care encounter, patients and practitioners may be working with different and competing models. If not properly managed, such divergent and incongruent models may result in ineffective treatment or non-compliance (cf. Jones et al., 1998). If Eisenberg‟s (1977) assumption that, „a patient suffers illnesses, and doctors diagnose and treat disease‟ is correct then Kleinman‟s (1980) pursuit to reconcile the social and medical constructs of ill health is a worthy endeavour. Unfortunately, such a comprehensive approach is for the most part, lacking in the literature. In line with Kleinman‟s view, this study argued that, HIV and AIDS, ARV medication adherence, prevention programmes and treatment readiness training cannot be studied and understood without taking into account the individual‟s explanatory models (situated within and constrained by social context), as well as how individuals construct an understanding of and imposes meaning on the world around them. Given the importance of proper adherence management, the aim of this study was to conduct an ethnographic inquiry into the nature and role of individuals‟ socio-cultural contexts in treatment adherence/non-adherence regardin antiretroviral treatment. In order to achieve this aim, three integrated ethnographic data collection methods, i.e., participant observation, in-depth interviews and focus group discussions were employed to better understand the socio-cultural context and experiential understanding of patients on ARV. The results reinforced several important facts related to HIV and AIDS, ARV medication adherence, prevention programmes and treatment readiness training, and shed additional light on other areas of patient social interaction that might add value to current discourse/practices. The study concluded that patients‟ socio-cultural context provides crucial information that can be used not only to identify causal reasoning, understanding of ill health, treatment readiness training, prevention programmes and adherence to treatment, but to assist in ascertaining the most effective means of intervention within a particular society or community.Afrikaans: Alhoewel antiretrovirale (ARV) medikasie nie genesing vir VIGS bring nie en dit met ander probleme soos newe-effekte en middelweerstand geassosieer word, kan dit die lewensduur verleng van pasiënte wat antiretrovirale (ARV) terapie ontvang, asook hulle lewensgehalte en produktiwiteit verhoog. Antiretrovirale leefstyle het oorlewingsyfers verbeter en die voorkoms van opportunistiese infeksies in mense met VIGS verlaag. Streng nakoming van ART is noodsaaklik om ‟n lae virale lading te handhaaf en die ontwikkeling van middelweerstandige stamme van die virus te voorkom. Sommige pasiënte keer egter nie vir geskeduleerde opvolgbesoeke terug nie en die waarskynlike uitkoms vir sodanige pasiënte is sub-optimale nakoming aan voorgeskrewe ARV-behandeling, asook moontlike mislukte behandeling. Antropologiese studies toon dat pasiënte se verklarende modelle nodige aanvullings is tot die behandelingskriteria wat deur gesondheidsverskaffers gebruik word (Kleinman, 1980 & 1988; Nanda & Warms, 2002). Kleinman et al. (1978) het die konsep van die verklarende model bekendgestel deur antropologiese insigte in kliniese praktyk toe te pas. Hulle beweer dat pasiënte en praktisyns in die gesondheidsorg-ontmoeting met verskillende en kompeterende modelle kan werk. Indien dit nie behoorlik bestuur word nie, kan sulke uiteenlopende en inkongruente modelle ondoeltreffende behandeling of nie-nakoming tot gevolg hê (vgl. Jones et al., 1998). Indien Eisenberg (1977) se veronderstelling dat „„a patient suffers illnesses, and doctors diagnose and treat disease‟‟ waar is, is Kleinman (1980) se strewe om die sosiale en mediese konstrukte van siekte te versoen, ‟n waardige onderneming. Ongelukkig word so ‟n uitgebreide benadering grotendeels nie in die literatuur aangetref nie. In lyn met Kleinman se siening, is hierdie studie van mening dat MIV en VIGS, nakoming van ARV-medikasie, voorkomingsprogramme en behandelingsgereedheid-opleiding nie bestudeer en verstaan kan word sonder om die individu se verklarende modelle (binne-in en beperk deur sosiale konteks) in ag te neem nie, asook hoe individue begrip konstrueer en betekenis aan die wêreld rondom hulle heg. Op grond van die belangrikheid van behoorlike nakomingsbestuur, is die doel van die studie om ‟n etnografiese ondersoek te doen in die aard en rol van individue se sosio-kulturele kontekste in nakoming/nie-nakoming van behandeling ten opsigte van antiretrovirale behandeling. Om hierdie doel te bereik, is drie geïntegreerde etnografiese dataversamelingsmetodes, nl. deelnemende observasie, indiepte-onderhoude en fokusgroepbesprekings, gebruik om die sosio-kulturele konteks en ervaringsbegrip van pasiënte op ARV beter te verstaan. Die resultate het verskeie belangrike feite wat verband hou met MIV en VIGS, nakoming van ARV-medikasie, voorkomingsprogramme en behandelingsgereedheid-opleiding versterk, en addisionele lig gewerp op ander areas van pasiënte se sosiale interaksie wat waarde tot huidige diskoers/praktyke kan toevoeg. Die studie het tot die gevolgtrekking gekom dat pasiënte se sosio-kulturele kontekste kritieke inligting verskaf wat gebruik kan word nie slegs om oorsaaklike redenering, begrip van swak gesondheid, behandelingsgereedheid-opleiding, voorkomingsprogramme en nakoming van behandeling te identifiseer nie, maar om ook te help om die doeltreffendste maniere van intervensie binne ‟n spesifieke samelewing of gemeenskap te bepaal.enAIDS (Disease) -- Social aspects -- South Africa -- PetrusburgAIDS (Disease) -- Treatment -- South Africa -- PetrusburgMedical anthropologyCommunity health services -- South Africa -- PetrusburgDissertation (M.A. (Anthropology))--University of the Free State, 2010DissertationUniversity of the Free State