Issue

Vol. 19 No. 2 (2015): African Sociological Review

3 - Between the Clinic and the Community: Temporality and Patterns of ART Adherence in the Western Cape Province, South Africa1

https://doi.org/10.57054/asr.v19i2.3728
Larkan Fiona
https://orcid.org/0000-0002-7308-3922
van Wyk B
https://orcid.org/0000-0003-2869-4377
Stevens P
Saris A.J.

Corresponding Author(s) : Saris A.J.

noreply@codesria.org

African Sociological Review, Vol. 19 No. 2 (2015): African Sociological Review

Abstract

In an ethnographic study conducted over thirty months in South Africa’s Western Cape
Province ending in 2012, we explored ART adherence amongst almost 200 patients attending
three clinics. This setting contained significant political, structural, economic and socio-cultural
barriers to the uptake of, and adherence to, treatment. Such barriers certainly impacted patient
drug use and the labelling of clients as ‘adherent’ or ‘non-adherent’. Yet, as our fieldwork
developed, it became apparent that these labels also bore little relationship to the amount and
regularity of drug consumption outside the clinic. Indeed, the people that we knew moved
through these labels in ways that could not simply be explained by brute socio-economic
circumstances, poor understanding of the functions of the drugs, or varying levels of family
and community support, which themselves often changed over time. This paper presents four
on-going ‘patterns of adherence’, which are clearly discernible in the communities in which
we worked. Each pattern is demonstrated through the life of an ‘index patient’ whose case
is seen to be representative of the range of experiences and practices observed under the terms
‘adherent’ and ‘non-adherent’. We argue that such terms are deeply contextual and, crucially,
temporally situated. The complex intertwining of political, economic, socio-cultural, gender,
and biological factors that constitute the lives of participants exists in time and we call for a
focus on evolving lives in relationship to changing health systems that can follow (and respond
to) such developments to better deliver both information and services.

Keywords

ART adherence community health systems socio-cultural barriers drug consumption
Larkan Fiona, van Wyk B, Stevens P, & Saris A.J. (2015). 3 - Between the Clinic and the Community: Temporality and Patterns of ART Adherence in the Western Cape Province, South Africa1. African Sociological Review, 19(2), 26–52. https://doi.org/10.57054/asr.v19i2.3728
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Author Biographies

Larkan Fiona

centre for Global Health, Trinity College Dublin, Ireland.

van Wyk B

Library and Information Manager with substantial experience in library management, information specialist work, and research data librarianship in an academic environment. I am currently employed by the University of of Pretoria Library as Assistant Director Research Data Management (RDM) where I have been responsible for doing a needs analysis and status report on data management practices at the University. I have also been involved in the development of a new Research Data management Policy for the University, and were involved in the evaluation process for a data repository for the University. Currently I am also involved in a project to train library staff and researchers in the fundamentals and essentials of RDM. I am also currently the Chair of the Network of Data and Information Curation Communities (NeDICC), a national network representing higher education institutions and research councils in South Africa, focusing on the management of research data. I also manage the Digitisation Unit of the Department of Library Services at the University, and has been instrumental in the current roll-out of a Digitisation-on-Demand Service.
Previous work experience includes the Management of the Faculty Library for Education at the Groenkloof Campus of the University of Pretoria from 2002 to 2013
I am Interested in digital scholarship, innovation in libraries, library management, e-Research, Research Data Management, Web 2.0, and Virtual Research Environments in Higher Education.

Stevens P

Department of Anthropology & Sociology, University of the Western Cape, South Africa

Saris A.J.

Department of Anthropology, Maynooth University, Kildare, Ireland (corresponding author)

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