Advertisement

AIDS and Behavior

, Volume 7, Issue 1, pp 61–72 | Cite as

Adherence to Medication Treatment: A Qualitative Study of Facilitators and Barriers Among a Diverse Sample of HIV+ Men and Women in Four U.S. Cities

  • Robert H. RemienEmail author
  • A. Elizabeth Hirky
  • Mallory O. Johnson
  • Lance S. Weinhardt
  • David Whittier
  • Giang Minh Le
Article

Abstract

Most studies examining HIV antiretroviral medication treatment adherence involve quantitative surveys. Although these studies have identified factors associated with medical adherence, no single variable or combination of variables is sufficiently consistent to apply to any individual or group of people. Using qualitative methods, an ethnically diverse sample (N = 110) of HIV+ women, men who have sex with men, and male injecting drug users in four U.S. cities were interviewed in depth to elicit their experiences, perspectives, and life contexts regarding knowledge, attitudes, beliefs, and experiences with HIV medication adherence. Most described multiple influences on medication-taking behavior, describing adherence as a dynamic phenomenon that changes over time with their changing beliefs, attitudes, emotions, and daily and larger life events. Prevalent themes include ambivalence toward HIV medication and intentional nonadherence, usually to address physical side effects. Factors from different domains (e.g., cognitive, emotional, interpersonal) can have compensatory influences on behavioral outcomes. Findings are discussed in terms of social action theory, contributing to our theoretical understanding of the phenomenon of adherence.

Antiretroviral medication adherence AIDS/HIV qualitative multisite 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alonzo, A. A., and Reynolds, N. R. (1995). Stigma, HIV and AIDS: An exploration and elaboration of a stigma trajectory. Social Science and Medicine, 41, 303-315.Google Scholar
  2. Bartos, M., and McDonald, K. (2000). HIV as identity, experience or career. AIDS Care, 12, 299-306.Google Scholar
  3. Bogart, L. M., Catz, S. L., Kelly, J. A., Gray-Bernhardt, M. L., Hartmann, B. R., Otto-Salaj, L. L., Hackl, K. R., and Bloom, F. R. (2000). Psychosocial issues in the era of new AIDS treatments from the perspective of persons living with HIV. Journal of Health Psychology, 5, 500-516.Google Scholar
  4. Catz, S. L., Kelly, J. A., Bogart, L. M., Benotsch, E. G., and McAuliffe, T. L. (2000). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19, 124-133.Google Scholar
  5. Chesney, M. A. (2000). Factors affecting adherence to antiretroviral therapy. Clinical Infectious Diseases, 30, S171-S176.Google Scholar
  6. Chesney, M. A., and Smith, A. W. (1999). Critical delays in HIV testing and care: The potential role of stigma. American Behavioral Scientist, 42, 1162-1174.Google Scholar
  7. Chesney, M. A., Ickovics, J., Hecht, F. M., Sikipa, G., and Rabkin, J. (1999). Adherence: A necessity for successful HIV combination therapy. AIDS, 13(Supplement A), S271-S278.Google Scholar
  8. Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., and Wu, A. W. (2000a). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care, 12, 255-266.Google Scholar
  9. Chesney, M. A., Morin, M., and Sherr, L. (2000b). Adherence to HIV combination therapy. Social Science and Medicine, 50, 1599-1605.Google Scholar
  10. Crespo-Fierro, M. (1997). Compliance/adherence and care management in HIV disease. Journal of the Association of Nurses in AIDS Care, 8, 43-54.Google Scholar
  11. David, E. (1999). HAART attack: Metabolic disorders during long-term antiretroviral therapy. BETA, 12, 10-14.Google Scholar
  12. Dunbar-Jacob, J., and Sereika, S. (2001). Conceptual and methodological problems. In E. Lora, E. Burke, E. Ira, and S. Ockene (Eds.), Compliance in healthcare and research (pp. 93-104). Armonk, NY: Futura.Google Scholar
  13. Ewart, C. K. (1991). Social action theory for a public health psychology. American Psychologist, 46, 931-946.Google Scholar
  14. Gordillo, V., del Amo, J., Soriano, V., and Gonzalez-Lahoz, J. (1999). Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS, 13, 1763-1769.Google Scholar
  15. Hecht, F. M., Colfax, G., Swanson, M., and Chesney, M. A. (1998). Adherence and effectiveness of protease inhibitors in clinical practice. In Program and abstracts of the Fifth Conference on Retroviruses and Opportunistic Infections, Chicago, Il (Abstract #151/Session 24). Available at http://www.retroconference.org; accessed July 21, 2001.Google Scholar
  16. Horne, R. (2000, November). Take HAART?: Self-regulation and adherence to highly active anti-retroviral therapy (HAART). Paper presented at the Integrating Psychology and Medicine Conference, Auckland, New Zealand.Google Scholar
  17. Kalichman, S. C., Ramachandran, B., and Catz, S. (1999). Adherence to combination antiretroviral therapies in HIV patients of low health literacy. Journal of General Internal Medicine, 14, 267-273.Google Scholar
  18. Kastrissios, H., Suárez, J. R., Hammer, S., Katzenstein, D., and Blaschke, T. F. (1998). The extent of non-adherence in a large AIDS clinical trial using plasma dideoxynucleoside concentrations as a marker. AIDS, 12, 2305-2311.Google Scholar
  19. Kelly, J. A., Murphy, D. A., Bahr, G. R., Koob, J. J., Morgan, M. G., Kalichman, S. C., Stevenson, L. Y., Brasfield, T. L., Bernstein, B. M., and St. Lawrence, J. S. (1993). Factors associated with severity of depression and high-risk sexual behavior among persons diagnosed with human immunodeficiency virus (HIV) infection. Health Psychology, 12, 215-219.Google Scholar
  20. Leigh, B. C., and Stall, R. (1993). Substance use and risky sexual behavior for exposure to HIV: Issues in methodology, interpretation, and prevention. American Psychologist, 48, 1035-1045.Google Scholar
  21. Malow, R. M., Baker, S. M., Klimas, N., Antoni, M. H., Schneiderman, N., Penedo, F. J., Ziskind, D., Page, B., McMahon, R., and McPherson, S. (1998). Adherence to complex combination antiretroviral therapies by HIV-positive drug abusers. Psychiatric Services, 49, 1021-1022.Google Scholar
  22. Molaghan, J. B. (1997). Adherence issues in HIV therapeutics. Introduction: The situation. Journal of the Association of Nurses in AIDS Care, 8, 7-9.Google Scholar
  23. Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., Wagener, M. M., and Singh, N. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133, 21-30.Google Scholar
  24. Patton, M. Q. (1990). Humanistic psychology and humanistic research. Person-Centered Review, 5, 191-202.Google Scholar
  25. Proctor, V. E., Tesfa, A., and Tompkins, D. C. (1999). Barriers to adherence to highly active antiretroviral therapy as expressed by people living with HIV/AIDS. AIDS Patient Care and STDs, 13, 535-544.Google Scholar
  26. Pryor, J. B., Reeder, G. D., and Landau, S. (1999). A social-psychological analysis of HIV-related stigma: A two-factor theory. American Behavioral Scientist, 42, 1193-1211.Google Scholar
  27. Remien, R. H. (1998). Adhering to HIV combination therapy: The role of the pharmacist. Pharmacy Times, 1998(May), 28-37.Google Scholar
  28. Remien, R. H., and Rabkin, J. G. (2001). Psychological aspects of living with HIV disease: A primary care perspective. Journal of Western Medicine, 175, 332-335.Google Scholar
  29. Remien, R. H., Carballo-Dieguez, A., and Wagner, G. (1995). Intimacy and sexual risk behavior in serodiscordant male couples. AIDS Care, 7, 429-438.Google Scholar
  30. Roberts, K. J. (2000). Barriers to and facilitators of HIV-positive patients' adherence to antiretroviral treatment regimens. AIDS Patient Care and STDs, 14, 155-168.Google Scholar
  31. Roca, B., Gómez, C. J., and Arnedo, A. (1999). Stavudine, lamivudine and indinavir in drug abusing and non-drug abusing HIV-infected patients: Adherence, side effects and efficacy. Journal of Infection, 39, 141-145.Google Scholar
  32. Roca, B., Gómez, C. J., and Arnedo, A. (2000). Adherence, side effects and efficacy of stavudine plus lamivudine plus nelfinavir in treatment-experienced HIV-infected patients. Journal of Infection, 41, 50-54.Google Scholar
  33. Rodriguez Rosado, R., Jimenez Nacher, I., and Soriano, V. (1998). Virological failure and adherence to antiretroviral therapy in HIV-infected patients. AIDS, 12, 1112-1113.Google Scholar
  34. Sorensen, J. L., Mascovich, A., Wall, T. L., DePhilippis, D., Batki, S. L., and Chesney, M. (1998). Medication adherence strategies for drug abusers with HIV/AIDS. AIDS Care, 10, 297-312.Google Scholar
  35. Strauss, A., and Corbin, J. M. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  36. Wagner, G., Remien, R. H., Carballo-Dieguez, A., and Dolezal, C. (2002). Correlates of adherence to combination antiretroviral therapy among HIV+ members of HIV mixed status couples. AIDS Care, 14, 105-109.Google Scholar
  37. Wahl, L. M., and Nowak, M. A. (2000). Adherence and drug resistance: Predictions for therapy outcome. Proceedings of the Royal Society of London. Series B. Biological Sciences, 267, 835-843.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Robert H. Remien
    • 1
    Email author
  • A. Elizabeth Hirky
    • 1
  • Mallory O. Johnson
    • 2
  • Lance S. Weinhardt
    • 3
  • David Whittier
    • 1
  • Giang Minh Le
    • 1
  1. 1.HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute and Columbia UniversityNew York
  2. 2.Center For AIDS Prevention StudiesUniversity of CaliforniaSan Francisco, San Francisco
  3. 3.Center for AIDS Intervention ResearchMedical College of WisconsinMilwaukee

Personalised recommendations