Skip to main content

Table 3 Opportunities for community-based decentralized treatment provision of ART

From: Opportunities and considerations for the design of decentralized delivery of antiretroviral therapy for female sex workers living with HIV in South Africa

Opportunities

Illustrative Quotes

Time is money…

… to reduce time away from work

… taking treatment is not a problem. The issue is leaving work in order to collect treatment… My clients will also find me easily because I would be collecting my treatment nearby. I won’t lose any client and I won’t default. (Kim, Hotel-based FSW)

Delivering ART is a good idea… Especially to where we work. Let’s put an example like your [clinic] date is there on Friday and Friday you know is a busy day [for sex work]. No, I’ll go on Monday. So at least when they come on Friday you just take your pills and put it in your room. (Lindiwe, Hotel-based FSW)

…to remove cost associated with attending the clinic

Sometimes you run out of money and find that it is your date to go to the clinic and your test is money because there is nothing you can do if there is no money. (Mpintshi, outdoor-based FSW)

Leaving home to get to the clinic costs money. I also need to use money to go to work. I need to budget accordingly. Sometimes I end up not going to the clinic because I don’t have money to get there. But if medication is delivered to me at work, one trip is saved because they will find me there. (Stacey, home-based brothel FSW)

Safety net…

… to address mental incapacitation

Even in your high states of mind, when you’re high if you see the clinic it will bring back memory, hey, I’m supposed to do this. I’m suppose to do that. (Dione, outdoor-based FSW)

It will help me a lot because I’m a very forgetful person I always forget my dates…at least that is going to help me to remind me. (Melisa, outdoor-based FSW)

…to address FSW mobility

You can’t say like you haven’t seen [the mobile van] because it is everywhere. (Dione, outdoor-based FSW)

…[DTP] can be of much help since we are unable to use local clinics because they want proof of residence and we don’t have since we live in these [temporary] houses… So it will help us because they [DTP implementors] will not want all these things that we don’t have. (Ayanda, outdoor-based FSW)

Confidentiality…

…to address unintended HIV status disclosure at clinic

People are afraid to go to clinics because neighbors will judge them. Like myself, I decided to collect my treatment far away from my local clinic. If you use the mobile clinic then no one will know what you are doing there because there is only one queue to enter. (Brenda, outdoor-based FSW)

… to protect confidentiality through service integration

No I am not afraid [a client will see me accessing the mobile van] because he may not be sure. He will think that I went to the mobile just to ask about something else, maybe I am on my periods, maybe I’m pregnant or I have something else. (Natasha, hotel-based FSW)

I do not care if the clients know, but I think they should ask me so that I can explain what is happening because it is a mobile clinic which does not mean it is for people living with HIV. There are many things the mobile clinics offer like, condoms, lubricators, pills and to cure STIs even if you had a condom burst with the client, they also help you with check-ups. It is important to explain to clients about the mobile because it also helps them, and it is important to know your status. (Lungo, hotel-based FSW)

It is more discrete. When she comes to the mobile it is not like she’s coming for treatment because they [FSW] all come to the mobile when we come to a [sex work] site; whether you’re negative or positive. You could be coming for a retest, you could be coming for family planning, you could be coming for a whole lot of reasons. When they walk out with condoms they’re walking out with a plastic packet. (Female, FSW program staff)