TY - JOUR T1 - Working in a primary care based antiretroviral team in KwaZulu-Natal, South Africa JF - British Journal of General Practice JO - Br J Gen Pract SP - 33 LP - 36 DO - 10.3399/bjgp12X616391 VL - 62 IS - 594 AU - Jean Beckley Y1 - 2012/01/01 UR - http://bjgp.org/content/62/594/33.abstract N2 - The antiretroviral (ARV) team is designed to support isolated rural primary care clinics in administering the South African National HIV and AIDS and TB Programme. Its remit is to move HIV treatment from hospital into the South African primary care system. I have been working as the ‘roving doctor’ in this team and have had the pleasure to rove alongside my ever-smiling and unruffled nurse mentor, Busie, and our most talented driver Mkhaliphi. Mkhaliphi is so adept at avoiding potholes on dirt track roads, that he applies the same strategies to avoiding speed humps on more conventional roads.Together we traversed the province, reaching remote rural clinics, where lone nursing sisters struggled to cope with the demand. You may feel busy and overworked in your NHS job but I want you to picture the following: a clinic many miles from any town, where the waiting room is so stacked with people it spills outdoors, under the sun, with people standing stoically in a twisting conga line of need. If you nip outside to go to the toilet all eyes follow you, a collective moan goes up from the patients as they think you are leaving!The medical contextHIV is a global epidemic and unlike flu, it’s a chronic disease. In South Africa the overall prevalence rate is around 18% of the whole population.1 If we zoom in to focus on women between 15–49 years (those of child-bearing age), the prevalence is estimated at 29.4%. If we look at the province of KwaZulu-Natal, things get even worse with 39.5% prevalence in this group.2 This represents a challenging burden of disease in a developing country and contrasts sharply with 0.2% prevalence in the UK.1 HIV is the root cause of the majority of primary care presentations.Why does HIV treatment need to be administered in primary care?KwaZulu-Natal is a large province, … ER -