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‘My Tablets are on Top of the Fridge’: The Roles of Relationship Desire and Medical Mistrust in ART Adherence for HIV-Positive MSM and Transgender Women Living in Rural South Africa

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Abstract

Given the high HIV prevalence for men who have sex with men (MSM) and transgender women in South Africa, there is limited understanding of social determinants that influence antiretroviral treatment (ART) adherence. Although universal testing and treatment (UTT) is available, ART adherence remains suboptimal. We conducted focus groups with MSM and transgender women in order to understand factors influencing their ART adherence in Mpumalanga, South Africa. All focus groups were audio-recorded, transcribed and translated for analysis using a constant comparison approach, guided by the concept of Therapeutic Citizenship. We found there is medical mistrust of ART based on differing interpretations of HIV cure that may influence treatment adherence behaviors within social networks, and relationship desire had a significant influence on optimal ART adherence. Our findings suggest that clinics must provide interventions that integrate HIV disclosure and relationship skill-building to support optimal ART adherence for MSM and transgender women under UTT.

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Acknowledgements

This research was made possible through funding via the following grants: Center for HIV Identification, Prevention, and Treatment National Institutes of Mental Health grant MH58107, University of California, Los Angeles (UCLA) Center for AIDS Research grant 5P30AI028697, and the T32 Post-Doctoral Training Program in Global HIV/AIDS Prevention at UCLA, T32MH080634.

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Authors and Affiliations

  1. Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Science, 1731 E. 120th St, Los Angeles, CA, USA

    Joseph Daniels

  2. Anova Health Institute, Johannesburg, South Africa

    Helen Struthers, Kabelo Maleke & James McIntyre

  3. University of Cape Town, Cape Town, South Africa

    Helen Struthers & James McIntyre

  4. Equal International, San Francisco, CA, USA

    Tim Lane

  5. UCLA Center for World Health at the David Geffen School of Medicine, Los Angeles, CA, USA

    Tom Coates

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  1. Joseph Daniels
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Correspondence to Joseph Daniels.

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Daniels, J., Struthers, H., Maleke, K. et al. ‘My Tablets are on Top of the Fridge’: The Roles of Relationship Desire and Medical Mistrust in ART Adherence for HIV-Positive MSM and Transgender Women Living in Rural South Africa. AIDS Behav 23, 2849–2858 (2019). https://doi.org/10.1007/s10461-019-02628-z

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