Magister Public Health - MPH / Background: South Africa has one of the most severe HIV epidemics globally, with an estimated 737,000 AIDS related deaths annually and over a million children rendered orphans due to AIDS in 2006. However in 2007, the South African government made a giant commitment to dealing effectively with the AIDS epidemic by implementing a National Strategic Plan (NSP), which had as one of its principal objectives the provision of antiretroviral medications to 80% of all people in need of the treatment by 2011. By the end of June 2011, the rollout of antiretroviral therapy continued to be successful with 1.4 million persons started on antiretroviral therapy and treatment initiation rates reaching 30, 000 per month. Patients have to subject to an uncompromising adherence of taking at least 95% of antiretroviral medication as prescribed, because poor adherence to ART leads to treatment failure, viral mutations and the development of drug resistance. Of major concern to ART programmes are the current obstacles that patients’ face in lieu of treatment. Aim: The aim of this study was to explore the barriers to adherence to antiretroviral treatment among patients in a public ART programme in Vredenburg, Western Cape. Methodology: An explorative qualitative study was conducted where data was collected through interviews with 18 patients receiving treatment from the Vredenburg hospital. Data was audio-tape recorded, transcribed in full and thematic content analysis done. Results: The study identified awareness of HIV status, disclosure, unemployment, lack of transport,insufficient feeding, disability grants, alcohol and alternative forms of therapy as well as stigma as major barriers to adherence. Whereas inadequate follow ups, recklessness in the way patients’ HIV results were handled, long waiting times and the fear of picking up other types of infections from other patients in the OPD also came under major criticisms from patients. Finally, the sharing of experiences at clinic visits, good healthcare provider’s patient relationships, believing in the treatment, good treatment literacy, being a parent and having children to take care of, the use of pill boxes, social and spiritual support from family members and friends were identified as factors that positively influenced adherence. Conclusion: HIV/AIDS has been a stigmatized illness since its onset in the early 1980s and, these results highlight that such stigma has yet to dissipate in Vredenburg. Therefore, stigma and disclosure must remain at the forefront of the ART programme implementation in Vredenburg; while long term projects that can support ART users economically should be created through partnerships with non-governmental organizations and the government of South Africa to optimize adherence in the community.

PURPOSE. Confocal laser scanning ophthalmoscopy (HRT; Heidelberg retinal tomograph II) and scanning laser polarimetry (GDx-variable corneal compensator [VCC]) were used to investigate whether early indicators of retinal nerve fiber layer (RNFL) thickness loss could be observed in patients infected with the human immunodeficiency virus (HIV) that had no associated retinopathy or optic neuropathy and were concomitantly receiving antiretroviral medications. METHODS. HRT and GDx-VCC parameters obtained from a group of 13 HIV-positive subjects (n = 26 eyes) on antiretroviral therapy examined with HRT, with a subgroup of six subjects (n = 12 eyes) examined with both HRT and GDx-VCC, were compared with those of a matched HIV-negative control cohort (13 subjects, n = 26 eyes) examined with HRT, with a subgroup of five subjects (n = 10 eyes) examined with both HRT and GDx-VCC. We employed generalized estimating equations for statistical analysis. RESULTS. Reduced mean values for the HRT height variation contour (p < 0.045) and HRT mean RNFL thickness (p < 0.023) were observed in HIV-positive subjects controlling for age, sex, and race. A significantly reduced mean value corresponding to the GDx-VCC superior maximum (p < 0.014) and inferior maximum (p < 0.016) were also observed for the HIV-positive cohort analyzed controlling for age, sex, and race. CONCLUSION. HRT and GDx-VCC indicators of RNFL thickness appear to be significantly reduced in HIV-positive subjects without retinopathy or optic nerve disease using antiretroviral medication, suggesting RNFL loss occurs in this population of HIV-positive patients. The lack of correlation between CD4 counts, viral load, number of antiretroviral medications used, or years from diagnosis of HIV and RNFL thinning, suggests that possibly other factors associated with HIV infection may contribute to the apparent RNFL thickness loss.