Diverting income towards substance use activities
numb, overdose, pain
At least in 8 of the 13 selected households, members living with HIV reported that, in addition to conventional expenses, they diverted some of their incomes to addictive substance use activities such as buying illicit drugs, which many participants noted would negatively impact their ability to access or adhere to ART. For instance, Dayson (34) was living with his father (71) in an RDP one-roomed house. Both men were living with HIV and depended on the financial support of relatives to ‘get by’. Dayson reported why he could not initiate ART immediately after his HIV diagnosis, despite being eligible for treatment:When you start using [illicit] drugs then you don’t care about anything. Every [bit of] money you get you spend it on drugs and ignore everything, even your own health, like you ignore taking [ART] medication (Dayson, 34, Male).In some instances, PLHIV reported that they would spend money on alcohol to ‘numb the pain of knowing about their HIV diagnosis’. Zonke (28, Female), whose main source of income in their household was sex work, was living with her partner. When we asked about HIV treatment, she reported that:We just buy alcohol and drink. I will drink and get drunk now and tomorrow the stress [of living with HIV] is still there, you see? I’m getting sicker, but I haven’t taken treatment yet (Zonke, 28, Female).Consuming alcohol would also interrupt the treatment adherence of people who already initiated ART care. Nolubabalo (42, Female) explained to us how her estranged husband, Fezile (living with HIV), would miss prescribed times of taking his ARV doses when he consumed alcohol and would try to ‘catch-up later’.He would drink alcohol the whole weekend and ignore taking his medication. When he is sober, he would take all the doses he missed over the weekend all at once. But that’s overdose because he’s taking a lot [of pills] in a short time frame (Nolubabalo (42, Female).In summary, these participants did not explicitly choose to use their resources for substance use activities above spending them on HIV care-related costs. Rather, people would spend their limited income on addictive substances, which negatively affected their ability to initiate or remain on treatment.