Background: HIV/AIDS affects the health of millions of people world wide. According to the
Joint United Nations Program on HIV/AIDS [UNAIDS], the number of people living with HIV
globally has risen from 26 million in 2001 to 33.2 million in 2007. It is estimated that 2.5
million people were newly infected with HIV in 2007. The introduction of anti-retroviral
therapy [ART] has brought hope to millions of people living with HIV and AIDS. More
recently, the increased availability of treatment in many countries including Namibia has
dramatically improved survival rates and lowered the incidence of opportunistic infections
among HIV patients. Adherence to antiretroviral therapy (ART) is a fundamental attribute of
excellent clinical HIV care and a key aspect in determining the effectiveness of treatment. Strict
adherence to ART is vital to maintain low viral load and to prevent the development of drug
resistant virus. Poor adherence is one of the key obstacles to successful ART for HIV positive
patients. Literature has shown that there are various factors that hinder adherence to ART such
as patient, service, community, family, socio-economic and work-related factors.
Aim: This study aimed to describe the experiences of patients in the ART programme at
Katutura State Hospital, Communicable Disease Clinic (CDC), in the Khomas region of
Namibia and to explore factors that contribute to poor adherence.
Study Design: An explorative qualitative study was conducted among ART patients, who were
identified as poor adherents by the health care team.

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Data collection: Data was collected using three techniques namely: unstructured observations,
key informant interviews and in depth interviews. Data on patients’ experiences of living with
HIV and AIDS as well as factors influencing ART adherence were collected.
Data Analysis: Thematic and content analysis of transcribed data was done. Findings from
patient interviews were triangulated with findings from key informant interviews and
unstructured observations of the clinic setting.
Results: The study results indicate that poor adherence to ART treatment is a key problem
facing the Katutura State Hospital CDC. Poor adherence can be attributed to factors such as
service, patients, socio-economic, community and family factors. The study indicated that
patient- level factors such as patient’s negative perceptions about the effectiveness of the
treatment may affect the level of adherence to ART. Alcohol Abuse was identified as a major
socio-economic factor that affects optimal ART adherence. The study further revealed that
family factors such as stigmatization and discrimination by family members are barriers to ART
adherence. Long distances to health facilities were identified as one of the major health service
factors influencing treatment adherence.
Conclusion: Adherence to ART should be addressed as a national priority. At national level the
ART programme should develop practical guidelines for implementing adherence strategies.
These should include guidelines for continuous adherence counselling, roll out of ART to clinics
closer to the community in catchment areas and strengthening of outreach services to reduce the
long distances travelled by patients. Strengthen the existing system for tracing ART defaulters to
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carefully monitor and treat defaulters to prevent possible drug resistance. Reporting and
monitoring of ART and adherence should be done through integration of a recording and
reporting-system into existing health information systems.