Paper long abstract:

During an ongoing ethnographic study in South Africa's West Coast region, health service providers report a general off-label trade in ARVs, which is seen a barrier to adherence for many of their patients whose medication is traded to, or stolen by, drug users. While anecdotal evidence is emerging, there has been little hard evidence thus far of the existence of a recreational market for ARVs.

There is speculation that a crisis of confidence in the health system has seen HIV+ patients buy their ARVs from the black market rather than attending public clinics. In addition, there are rumours that Efivarenz is used in the manufacture of crystal methamphetamine (locally 'tik'). This paper explores the off-label trade of ARVs which is gaining currency in the social imagination of health and social care workers, which in turn could precipitate a real crisis in the Government's public rollout programme.