"Only Two Months Destroys Everything": A Case Study of Communication About Nonadherence to Antiretroviral Therapy in a South African HIV Pharmacy Context

Adherence to antiretroviral treatment (ART) is a complex phenomenon and patients do not always adhere for a variety of reasons. The quality of communication and the therapeutic relationship between health professionals and patients have an important influence on adherence, as do contextual and environmental factors. Little qualitative research exists that examines health care interactions in the context of adherence counselling. This article presents a case study of a discussion about nonadherence between a pharmacy assistant and a patient in a South African HIV context. A hybrid analytical approach revealed various themes such as how the topic of nonadherence is addressed, participants' responses to the patient's nonadherence, and the process of negotiating a new commitment to adherence. The case provides insight into the impact of contextual factors on the interaction and challenges involved in discussing nonadherence-in particular, the patient's attempts to save face, the pharmacy assistant's irritation and anger, and the patient's expressed regrets. This case raises questions around issues of patient agency. Health professionals are encouraged to consider the influence of context, lifeworld, and culture on patients' ability to adhere to treatment regimens. By working to improve communication processes and strengthen the therapeutic relationship, patients may be empowered to achieve better adherence levels.