Obligation to care? HIV/AIDS and Tuberculosis treatment in South Africa

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 16. Global Health

Abstract

South Africa has made tremendous gains in mitigating the concomitant infectious diseases of HIV/AIDS, Tuberculosis, and Multidrug resistant Tuberculosis through a large public intervention based on first and second line biomedical treatment. This paper is part of a larger book project Outsourcing Obligation: the Organization of South African AIDS care. The book follows the historical development of South Africa’s national HIV/AIDS antiretroviral therapy program from politically contested origins to becoming one of the largest antiretroviral therapy treatment programs globally. However, in keeping with other countries in both the Global North and South this program has seen mixed outcomes. Patient HIV testing rates are commendable, but drug adherence and rates of viral suppression are low. Demographic and epidemiological studies primarily concentrate on individual factors that impact patient adherence, in this paper I consider the structural factors embedded in the health system that make it possible for patients to fall through the cracks. Field notes and interviews with 43 emergency physicians and nurses from June – July 2017 form the evidentiary basis for this paper. Key findings include patients who present with infectious disease in the emergency department are sicker and higher risk of mortality, many of these patients are frequent users of the emergency center and their cases reveal breakdown in coordination between the primary and secondary health system as well as between public and private agencies involved in HIV/AIDS and tuberculosis testing and treatment.

Author

• Catherine van de Ruit, Ursinus College