# Perceived Determinants of Excellent Self-Rated Health Among HIV Virally Suppressed Adults in the Eastern Cape Province, South Africa

## TL;DR

This study explores factors that contribute to excellent self-rated health among HIV-positive adults in South Africa who have achieved viral suppression.

## Contribution

The study identifies context-specific determinants of excellent self-rated health among virally suppressed HIV patients in the Eastern Cape.

## Key findings

- Excellent self-rated health is linked to self-system factors like pain discounting and adherence to healthy behaviors.
- Income and healthcare access are essential prerequisites for maintaining good health and healthy behaviors.
- Context-based interventions can improve both physical and mental well-being beyond viral suppression.

## Abstract

The goal of antiretroviral therapy (ART) is to achieve viral suppression and improve the quality of life in people living with HIV (PLWH). Targeting the determinants of self-rated health in virally suppressed PLWH could significantly contribute towards sustaining the quality of life and health gains from ART. A qualitative study was conducted to investigate the determinants of excellent self-rated health in PLWH who are virally suppressed in the Eastern Cape province. A descriptive cross-sectional study using qualitative approach was conducted among 26 consenting adults living with HIV who have achieved viral load suppression in the rural province of the Eastern Cape using in-depth interviews. Themes were generated from the qualitative data using thematic analysis in NVivo 13®. All participants described what they perceived as excellent quality of life as mostly determined by self-system (downward counterfactual thinking and pain discounting), perceived improved health, and adherence to recommended healthy behaviours (ART, diet, physical activity, and non-use of tobacco and alcohol products). Income/financial support availability and good healthcare access emerged as indispensable prerequisites for achieving and maintaining good health or adherence to healthy behaviours. Targeting the determinants of Self-Rated Health (SRH) has the potential to greatly improve physical and mental well-being of PLWH beyond viral suppression. Interventions can be more effective by drawing from evidence generated from context-based research.