How can antiretroviral treatment (ART) have an impact in South Africa if it fails to reach those who need it most? What are the chances of success if people do not know what ART is or where to get it? Even worse, how can ART be of help if only a handful test for HIV in a country besieged by the epidemic?

These are crucial questions at a time when scaling up ART is the global strategy to extend the lives of those with HIV/AIDS in developing countries. The answers are complex, but one thing is clear: the outcome of any ART program depends on how communities make sense of ART. 

To get this insight, CIET did a community-based study in Free State province in 2004. We surveyed 4,444 people, held 96 focus groups and interviewed health workers in 67 health facilities. The study also provided a baseline for monitoring the rollout of the ART programme in the Free State.

Summary of results

• Only half of respondents had heard of ART and focus groups revealed confusion around the word “antiretroviral”.
• Among those who had heard of ART, most had inaccurate information:Two out of ten believed ART should be taken “before you are HIV positive”, “when pregnant”, “when raped” or “anytime”.
• Six out of ten thought people should receive ART as soon as they know they are HIV positive, when in fact the therapy is indicated whenever body defenses are too low.
• One half said they never spoke about ART in their households.

Among all respondents (whether they had heard of ART or not):

• Only a third believed that ART can help someone with AIDS.
• Most view HIV/AIDS as very threatening.
• Five out of ten knew what caused AIDS. However, many focus groups blamed women for using contraceptives, or blamed sexual intercourse during menstruation, backstreet abortions, not following traditional rituals, and/or prostitution.
• One in six believed that condoms caused AIDS.
• Most people knew about HIV/AIDS from media, while most would prefer to learn from health care sources.

CIET channelled the findings into a 15 minute audio episode for use free-of-charge in small groups and community radio stations. For more on this, see “On the air: life experience meets evidence on ART in South Africa.” in the Library. In addition, CIET has presented the findings at numerous conferences, seminars and workshops throughout South Africa.

For the 2007 follow-up to this baseline survey, click here.

The International Development Research Centre (IDRC) of Canada funded the project through their Governance, Equity and Health (GEH) programme  (Centre File: 102770-003