Table 2.

Quotes related to socioeconomic factors (Theme 3.4) and perspectives on ART (Theme 3.5).

3.4.1 Poverty, unemployment, and lack of resources
Quote 3.4.1, #1	“He was the only one working, bringing food. Now this patient has to go and collect treatment while at home there is nothing, nothing. This patient does not know what to do. He does not know how he is going to travel to get to the clinic. He was the one providing for the family…You [as the CHW] get disappointed and you wonder what is going to happen. You tell the person that `On this date I would like you to please go and collect your treatment.' The patient just tells you that `I do not have anything. When you look at the [cooking] pots there is nothing.' The mother of the patient has to go out and try, sometimes she will borrow the money on the patient's behalf so that the patient can go to the hospital …The doctor will not refer the patient for a sick pension (disability grant). Sometimes when the doctor refers the patient for the pension, he will give an [appointment] date that is far so all the while the patient would be struggling to survive.”
Quote 3.4.1, #2	“As the homebased caregivers we are encouraging the patient to take tablets. If the patient does not have anything to eat, you have to go to your house and get something for the patient or you go to the clinic and ask for the porridge. Sometimes they do not have it in stock, and the patient has to take the treatment. Those are the challenges that we come across in the community … challenges of hunger.”
Quote 3.4.1, #3	“We started going to the clinic. At the clinic they said it was too much for them, the patient needs to go to the hospital …I was forced to take the last money [from] my pocket and stop the cars that were passing by to assist me with this patient. There is a problem even here at [the nearest clinic] if the patient is critically ill, it is very far.”
3.4.2 Substance abuse
Quote 3.4.2, #1	“They will stop the ART treatment and carry on with the glue even if their parents are telling them to quit it. They think they are older than their parents because of this glue.”
Quote 3.4.2, #2	“[For] others it is the Marijuana … it is mostly the youth. Maybe the time is about 4:00 and the person has to take medication at 7:00. At around 4:00 the person will go and chill with his friends, maybe they are meeting in the shop and smoking marijuana …It [becomes] a habit…[He] will remember the following day that he did not take the treatment.”
Quote 3.4.2, #3	“Some have a problem of not wanting to quit taking alcohol. At the time when the person is supposed to be taking treatment, he is drunk. That person will forget the time of taking treatment, the following day will be the same problem.”
Quote 3.4.2, #4	“Some people who are having problems are those that are drinking alcohol, and taking a lot of drugs. People who cannot stay away from alcohol. The person will start well on their treatment but when meeting friends he will drink again and decide to stop [treatment] and join his friends in drinking. At the end, some commit suicide.”
Quote 3.4.2, #5	“In Johannesburg nowadays they do not just give treatment if the patient does not have the [clinic] referral letter- they said that people are selling treatment and making drugs (whoonga).”
Quote 3.4.2, #6	“After the child passed away, she came out and said, `That is why I am not getting any better. It was because my child was hitting me and taking my ART to make drugs.'”
3.5 Perspectives on lifelong ART and side effects
Quote 3.5, #1	“The first [reason] will be, `I was told that I am ready to start, but I am not going to start because they said when I start I have to take it for the rest of my life, so I am not going to start.'”
Quote 3.5, #2	“After testing, they will tell the person that `You can now start taking the treatment.' The person will say 'No, because I am still fine, I am not going to start immediately. I have no pains in my body so let me leave it.'”
Quote 3.5, #3	“Some [men] develop breasts like a girl. Some say, `I am not going to continue with this treatment because of the side effects. I cannot have breasts like a woman.'”
Quote 3.5, #4	“A woman will change at the back of the legs and the top body part will be big. So when somebody else is sick [with HIV] like the neighbour or in the family, the person will [say to] themselves …`Okay, as I am sick, now I need to start this treatment. [But] that means I will also become like that person as they look now. I [would] rather stop taking [or not take] this treatment than become like that.'”
Quote 3.5, #5	“Other people do come up with those stories, saying, `They did not identify my disease well, that is why this medication is making me sick – they falsely identified my disease. I would not be this sick if it was the right disease.'”
Quote 3.5, #6	“They will say, `I have decided to stop taking treatment because it is not going well at home with my wife, she is going away. I am not able to satisfy her sexually.' He will tell you that he has decided to stop because he can see that he is going to be single now.”
Quote 3.5, #7	“Others are encouraged to continue [ART] by looking at their CD4 count results when they are coming to collect treatment and getting the results showing that the CD4 count is high. The patient can see that the [health] status is getting better.”
Quote 3.5, #8	“Others, when they get better due to taking treatment, they decide never to stop as they can see that they are now well.”