Community participation in HIV and ARV services.

This chapter highlights some of the findings of a qualitative research study which was undertaken in four areas in the provinces of KwaZulu-Natal and Limpopo. The study collected information on some of the critical barriers to community participation in HIV and antiretroviral services. One urban and one rural community or municipality was chosen in each province for the study. Respondents included health care workers at clinic and hospital level community workers people living with HIV traditional healers community leaders nongovernmental organisations and community based organisations in the geographic area clinic committees and support groups. Findings indicate that poverty and stigma operate as significant barriers to accessing HIV and AIDS care and treatment services in the public health sector. Women and youth face particular challenges in participating and accessing services and bear a disproportionate burden of the HIV epidemic. Socio-economic constraints (e.g. travel costs) coupled with perceptions that access to treatment is fraught with difficulties and delays were cited as compelling barriers at facility level which impact on uptake of treatment. Human resource shortages contribute to the poor acceptability and responsiveness of health services. Social security for people living with HIV is inequitable and the current eligibility criteria for disability grants can result in unintended outcomes. Nutritional support and food insecurity have a powerful impact on adherence and treatment stability. Sustained gains in broadening access to treatment and care are likely to remain elusive without the full support and participation of communities. NGOs have a key role to play in assisting communities to identify their strengths and available resources as well as areas of need. Transparent and credible mechanisms such as forums for dialogue and discussion between communities and other stakeholders must be created at local level. Finally successful models of community involvement must be disseminated and popularised. (authors)