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Soc Sci Med. 2007 Feb;64(4):954-64. Epub 2006 Nov 30.

Hope is the pillar of the universe: health-care providers' experiences of delivering anti-retroviral therapy in primary health-care clinics in the Free State province of South Africa.

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  • 1University of Cape Town Lung Institute, Knowledge Translation Unit, George Street, Mowbray, Cape Town, Western Cape 7700, South Africa. <>


South Africa is experiencing one of the largest HIV/AIDS epidemics in the world. A national, publicly funded anti-retroviral therapy (ART) programme has recently been launched. This paper describes the findings from a qualitative study of the views of health-care professionals, especially nurses, regarding the ART roll-out in the Free State province of South Africa, where nurses are responsible for most of the care delivered to AIDS patients. The study highlights the hope provided by the new programme and the motivation it has engendered among nurses. Apart from long waiting lists for ART, these professionals saw the main programme challenge as the integration of a holistic model of patient-centred care, inclusive of psycho-social support, into an under-resourced primary health-care system. By comparison, neither the increasing clinical responsibilities borne by nurses, nor the ability of patients to adhere to ART, were seen as key problems. This study suggests that the ART programme has mobilised health workers to assume responsibility for providing high-quality care in an under-resourced setting.

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