HIV Care: Prevailing Trends, Barriers and Paradoxes

Abstract

This chapter investigates black South African women's opportunities to access health and HIV care as a minimum requirement of justice. It reviews South Africa's national HIV policy framework; goals and progress in meeting these; and investigates access to and provision of health and HIV care in the public health system. Using the socio-ecological framework, primary barriers to HIV care and factors that influence HIV care linkage, drop out, adherence and retention are identified along four dimensions: intrapersonal; interpersonal; health systems; and structural. A number of key gaps in both the policy and the health system response in relation to HIV in women are brought to light. The analysis reveals that health and HIV care, together with the policy framework, comprise layers within a multi-tiered, larger edifice of enabling or disabling conditions and locations that determine and support women's health. These, however, offer an inadequate base from which to gain in-depth insight into HIV positive women's prospects for health and wellbeing and justice in health. I conclude that gaining such insight requires investigation into this population's opportunities to be healthy or their `capabilities'.