They do it in order to support

other new patients… I would have wished this support to continue, because most of the patients are too weak and it is going to be difficult for them to survive without this service.’ C2 facility G, age 24, patient’s brother Other ways of providing support were also reported, Inhibitors,research,lifescience,medical including kitchen gardening initiatives and cooperative income generation. One man, who was running a small shop selling vegetables he had grown, explained how the service had helped him: ‘[Service staff] advise[d] us to make a group of around 10 people and contribute some little money as members concerned, so

that Inhibitors,research,lifescience,medical when you are in need you go there then get something, or else [they] just teach us some skills–farming, bead making, hand crafts–so that when you are in need of money you either sell cabbages, tomatoes or you just sell your hand crafts as they Inhibitors,research,lifescience,medical taught you.’ P5 facility H, age 38, not on ART 3. Spiritual distress a. Description of spiritual distress Illness was often experienced by patients through the lens of their spiritual or religious beliefs: ‘After some time I started getting serious drug side effects

Inhibitors,research,lifescience,medical [interviewee breaks down in tears]. I could not overcome the drug side effects and I was tempted to stop, probably by an evil spirit. But with prayers I continued taking the drugs.’ P7 facility G, female, age 56, on ART Enzalutamide Although the supportive role of spiritual practices and beliefs was described, patients experienced existential despair and hopelessness and questioned God: ‘My biggest worry is about my future. I have no child Inhibitors,research,lifescience,medical enough and my dreams are shuttered down and it hurts lots. It is an innermost pain which I can’t explain to anybody. When you see people who have died because of this disease and yet they have been on ARVs and yet they die mysteriously… I feel weighed down and lose hope most often.’ P3 facility L, male, age 36, on ART This was reiterated by staff: ‘At times when people get sick you realise that there is that tension or tendency of saying that God is away from me because if it were true that God is alive then he would not have let me fall sick in the way that I am. So you will find that there is that kind of antagonism between him and his God.