AIDS and Behavior

, Volume 20, Issue 9, pp 2151–2163 | Cite as

The Experience of Antiretroviral Treatment for Black West African Women who are HIV Positive and Living in London: An Interpretative Phenomenological Analysis

  • Johanna SpiersEmail author
  • Jonathan A. Smith
  • Elizabeth Poliquin
  • Jane Anderson
  • Rob Horne
Original Paper


Antiretroviral therapy (ART) offers a powerful intervention in HIV but effectiveness can be compromised by inadequate adherence. This paper is a detailed examination of the experience of medication in a purposively selected group of people living with HIV. In-depth interviews were conducted with 10 HIV positive, West African women of black heritage living in London, UK. This group was of interest since it is the second largest group affected by HIV in the UK. Interviews were subjected to interpretative phenomenological analysis, an idiographic, experiential, qualitative approach. The paper details the women’s negative experience of treatment. ART can be considered difficult and unrelenting and may be disconnected from the women’s sense of health or illness. Participants’ social context often exacerbated the difficulties. Some reported an improvement in their feelings about the medication over time. These findings point to some intrinsic and social motivators which could act as spurs to adherence.


Qualitative Medication Adherence Stigma 



This research was funded by the National Institute for Health Research (NIHR) in the UK.


  1. 1.
    Bulteel N, Bansi-Matharu L, Churchill D, Dunn D, Bibby D, Hill T, et al. The emergence of drug resistant HIV variants at virological failure of HAART combinations containing efavirenz, tenofovir and lamivudine or emtricitabine within the UK Collaborative HIV Cohort. J Infect. 2014;68(1):77–84.CrossRefPubMedGoogle Scholar
  2. 2.
    Cohen M, Chen Y, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    MacDonell K, Naar-King S, Murphy D, Parsons J, Harper G. Predictors of medication adherence in high risk youth of color living with HIV. J Pediatr Psychol. 2010;35(6):593–601.CrossRefPubMedGoogle Scholar
  4. 4.
    Fogarty L, Roter D, Larson S, Burke J, Gillespie J, Levy R. Patient adherence to HIV medication regimens: a review of published and abstract reports. Patient Educ Couns. 2002;46:93–108.CrossRefPubMedGoogle Scholar
  5. 5.
    Horne R, Cooper V, Gellaitry G, Leake Date H, Fisher M. Patients’ perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence. Epidemiol Soci Sci. 2007;45(3):334–41.Google Scholar
  6. 6.
    Hill S, Kavookjian J. Motivational interviewing as behavioural intervention to increase HAART adherence in patients who are HIV-positive: a systematic review of the literature. AIDS Care. 2012;24(5):583–92.CrossRefPubMedGoogle Scholar
  7. 7.
    England PH. Sexual and reproductive health in England: A guide to local and national data. 2015.Google Scholar
  8. 8.
    Watt M, Maman S, Earp J, Eng E, Setel P, Golin C, et al. It’s all the time in my mind: facilitators of adherence to antiretroviral therapy in a Tanzanian setting. Soc Sci Med. 2009;68(10):1793–800.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Williams I, Churchill D, Anderson J, Boffito M, Bower M, Cairns G, et al. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012. HIV Med. 2014;15(S1):1–6.Google Scholar
  10. 10.
    Adewuya A, Afolabi M, Ola B, Ogundele O, Ajibare A, Oladipo B, et al. The effect of psychological distress on medication adherence in persons with HIV infection in Nigeria. Psychosomatics. 2010;51(1):68–73.CrossRefPubMedGoogle Scholar
  11. 11.
    Doyal L, Anderson J. My fear is to fall in love again… How HIV-positive African women survive in London. Soc Sci Med. 2004;60:1729–38.CrossRefGoogle Scholar
  12. 12.
    Flowers P, Davis M, Hart G, Rosengarten M, Frankis J, Imrie J. Diagnosis and stigma and identity amongst HIV positive Black Africans living in the UK. Psychol Health. 2006;21(1):109–22.CrossRefGoogle Scholar
  13. 13.
    Doyal L, Anderson J, Paparini S. ‘You are not yourself’: exploring masculinities among heterosexual African men living with HIV in London. Soc Sci Med. 2009;68(10):1901–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Burns F, Imrie J, Nazroo J, Johnson A, Fenton K. Why the (y) wait? Key informant understandings of factors contributing to late presentation and poor utilization of HIV health and social care services by African migrants in Britain. AIDS Care. 2007;19(1):102–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Stutterheim S, Bos A, Shiripinda I, de Bruin M, Pryor J, Schaalma H. HIV-related stigma in African and Afro-Caribbean communities in the Netherlands: manifestations, consequences and coping. Psychol Health. 2012;27(4):395–411.CrossRefPubMedGoogle Scholar
  16. 16.
    Vervoot S, Borleffs J, Hoepelman A, Grypdonck M. Adherence in antiretroviral therapy: a review of qualitative studies. AIDS. 2007;21:271–81.CrossRefGoogle Scholar
  17. 17.
    Sankar A, Luborsky M, Schuman P, Roberts G. Adherence discourse among African-American women taking HAART. AIDS Care. 2002;14(2):203–18.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Chaiyachati K, Ogbuoji O, Price M, Suthar A, Negussie E, Barnighausen T. Interventions to improve adherence to antiretroviral therapy: a rapid systematic review. AIDS. 2014;28(S2):187–204.CrossRefGoogle Scholar
  19. 19.
    Smith J, Flowers P, Larkin M. Interpretative phenomenological analysis: theory, method and research. London: Sage; 2009.Google Scholar
  20. 20.
    Skinta M, Brandrett B, Schenk W, Wells G, Dilley J. Shame, self-acceptance and disclosure in the lives of gay men living with HIV: an interpretative phenomenological analysis approach. Psychol Health. 2014;29(5):583–97.CrossRefPubMedGoogle Scholar
  21. 21.
    Brocki J, Wearden A. A critical evaluation of the use of interpretative phenomenological analysis (IPA) in health psychology. Psychology and Health. 2005;21(1):87–108.CrossRefGoogle Scholar
  22. 22.
    Glaser B, Strauss A. The discovery of grounded theory: strategies for qualitative research. New York: Aldine; 1967.Google Scholar
  23. 23.
    Glaser B. Emergence vs forcing: basics of grounded theory analysis. Mill Valley: Sociology Press; 1992.Google Scholar
  24. 24.
    Crossley M. Narrative Analysis. In: Lyons E, Coyle A, editors. Analysing qualitative data in psychology. London: Sage; 2007.Google Scholar
  25. 25.
    Giorgi A. Description versus interpretation: competing alternative strategies for qualitative research. J Phenomenol Psychol. 1992;23(2):119–35.CrossRefGoogle Scholar
  26. 26.
    Sandelowski M. One is the liveliest number: the case orientation of qualitative research. Res Nurs Health. 1996;19:525–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Malcolm S, Ng J, Rosen R, Stone V. An examination of HIV/AIDS patients who have excellent adherence to HAART. AIDS Care. 2003;15(2):251–61.CrossRefPubMedGoogle Scholar
  28. 28.
    Remien R, Hirky A, Johnson M, Weinhardt L, Whittier D, Le G. Adherence to medication treatment: a qualitative study of facilitators and barriers among a diverse sample of HIV+ men and women in four US cities. AIDS Behav. 2003;7(1):61–72.CrossRefPubMedGoogle Scholar
  29. 29.
    Erwin J, Peters B. Treatment issues for HIV+ Africans living in London. Soc Sci Med. 1999;49(11):1519–28.CrossRefPubMedGoogle Scholar
  30. 30.
    Penn C, Watermeyer J, Evans M. Why don’t patients take their drugs? The role of communication, context and culture in patient adherence and the work of the pharmacist in HIV/AIDS. Patient Educ Couns. 2011;83(3):310–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Joglekar N, Paranjape R, Jain R, Rahane G, Potdar R, Reddy K, et al. Barriers to ART adherence & follow ups among patients attending ART centres in Maharashtra, India. Indian J Med Res. 2011;134(6):954.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Gonzalez J, Penedo F, Llabre M, Durán R, Antoni M, Schneiderman N, et al. Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence. Ann Behav Med. 2007;34(1):46–55.CrossRefPubMedGoogle Scholar
  33. 33.
    Kawuma R, Bernays S, Siu G, Rhodes T, Seeley J. Children will always be children’: exploring perceptions and experiences of HIV-positive children who may not take their treatment and why they may not tell. African J AIDS Res. 2014;13(2):189–95.CrossRefGoogle Scholar
  34. 34.
    Boehme A, Davies S, Moneyham L, Shrestha S, Schumacher J, Kempf M. A qualitative study on factors impacting HIV care adherence among postpartum HIV-infected women in the rural southeastern USA. AIDS Care. 2014;26(5):574–81.CrossRefPubMedGoogle Scholar
  35. 35.
    Di Matteo M. Variations in patients adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42(3):200–9.CrossRefGoogle Scholar
  36. 36.
    Rosen S, Fox MP, Gill CJ. Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. PLoS Med. 2007;4(10):e298.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Psychological SciencesBirkbeck, University of LondonLondonUK
  2. 2.Practice & Policy, School of PharmacyUniversity College LondonLondonUK
  3. 3.The Centre for the Study of Sexual Health and HIVHomerton University HospitalLondonUK

Personalised recommendations