AIDS and Behavior

, Volume 23, Issue 10, pp 2849–2858 | Cite as

‘My Tablets are on Top of the Fridge’: The Roles of Relationship Desire and Medical Mistrust in ART Adherence for HIV-Positive MSM and Transgender Women Living in Rural South Africa

  • Joseph DanielsEmail author
  • Helen Struthers
  • Kabelo Maleke
  • Tim Lane
  • James McIntyre
  • Tom Coates
Original Paper


Given the high HIV prevalence for men who have sex with men (MSM) and transgender women in South Africa, there is limited understanding of social determinants that influence antiretroviral treatment (ART) adherence. Although universal testing and treatment (UTT) is available, ART adherence remains suboptimal. We conducted focus groups with MSM and transgender women in order to understand factors influencing their ART adherence in Mpumalanga, South Africa. All focus groups were audio-recorded, transcribed and translated for analysis using a constant comparison approach, guided by the concept of Therapeutic Citizenship. We found there is medical mistrust of ART based on differing interpretations of HIV cure that may influence treatment adherence behaviors within social networks, and relationship desire had a significant influence on optimal ART adherence. Our findings suggest that clinics must provide interventions that integrate HIV disclosure and relationship skill-building to support optimal ART adherence for MSM and transgender women under UTT.


HIV ART Treatment adherence South Africa Relationships Medical mistrust 



This research was made possible through funding via the following grants: Center for HIV Identification, Prevention, and Treatment National Institutes of Mental Health grant MH58107, University of California, Los Angeles (UCLA) Center for AIDS Research grant 5P30AI028697, and the T32 Post-Doctoral Training Program in Global HIV/AIDS Prevention at UCLA, T32MH080634.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Joseph Daniels
    • 1
    Email author
  • Helen Struthers
    • 2
    • 3
  • Kabelo Maleke
    • 2
  • Tim Lane
    • 4
  • James McIntyre
    • 2
    • 3
  • Tom Coates
    • 5
  1. 1.Department of Psychiatry and Human BehaviorCharles R. Drew University of Medicine and ScienceLos AngelesUSA
  2. 2.Anova Health InstituteJohannesburgSouth Africa
  3. 3.University of Cape TownCape TownSouth Africa
  4. 4.Equal InternationalSan FranciscoUSA
  5. 5.UCLA Center for World Health at the David Geffen School of MedicineLos AngelesUSA

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