AIDS and Behavior

, Volume 8, Issue 2, pp 199–206

Medication Compliance and Satisfaction with Treatment for HIV Disease in a Sample of African-American Crack Cocaine Smokers

  • Beth R. Crisp
  • Mark Williams
  • Sandra Timpson
  • Michael W. Ross


The development of treatment regimes for African-American HIV-infected crack cocaine users has often been based on assumptions about compliance with medication regimes rather than evidence. This study sought to obtain baseline information on the adherence to antiretroviral medications by members of this important risk population in Houston, Texas. It was found that for only 5 of a range of 16 antiviral medications was there a significant correlation between levels of compliance reported by respondents and their beliefs as to how effective these medications are. Medication compliance was also found not to be associated with frequency of crack cocaine use in the month prior to interview. Furthermore, irrespective of both gender and their reported extent of medication compliance, the respondents tended to report positive relationships with their treating physician, with higher levels of satisfaction reported by women. These results suggest that the majority of African-American crack cocaine users are able to comply with HIV treatment regimes, with more than half (53%) claiming full compliance for one or more medications, and a further one third (31%) claiming compliance more than half the time. Moreover, these findings suggest that they will continue to take antiretroviral medications even if they have doubts about the effectiveness of these medications.

African Americans crack cocaine medication compliance HIV treatments 


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  1. Andersen, R., Bozzette, S., Shapiro, M., and St Clair, P. (2000). Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. Health Services Research, 35, 389-416.Google Scholar
  2. Arnsten, J. H., Demas, P. A., Farzadegan, H., Grant, R. W., Gourevitch, M. N., Chang, C. J., Buono, D., Eckholdt, H., Howard, A. A., and Schoenbaum, E. E. (2001). Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: Comparison of self-report and electronic monitoring. Clinical Infectious Diseases, 33, 1417-1423.Google Scholar
  3. Avants, S., Warburton, L., Hawkins, K., and Margolin, A. (2000). Continuation of high-risk behavior by HIV-positive drug users: Treatment implications. Journal of Substance Abuse Treatment, 19, 15-22.Google Scholar
  4. Bangsberg, D. R., Perry, S., Charlebois, E. D., Clark, R. A., Robertson, M., Zolopa, A. R., and Moss, A. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS, 15, 1181-1183.Google Scholar
  5. Booth, R., Kwiatkowski, C., and Weissman, G. (1999). Health-related service utilization and HIV risk behaviors among HIV-infected injection drug users and crack smokers. Drug and Alcohol Dependence, 55, 69-78.Google Scholar
  6. Broers, B., Morabia, A., and Hirschel, B. (1994). A cohort study of drug users' compliance with zidovudine treatment. Archives of Internal Medicine, 154, 1121-1127.Google Scholar
  7. Camacho, L. M., Williams, M. L., Vogtsberger, K. N., and Simpson, D. D. (1995). Cognitive readiness of drug injectors to reduce AIDS risks. American Journal on Addictions, 4, 49-55.Google Scholar
  8. Carpenter, C., Fischl, M., Hammer, S., Hirsch, M., Jacobsen, D., Katzenstein, D., Montaner, J., Richman, D., Saag, M., Schooley, R., Thompson, M., Vella, S., Yeni, P., and Volberding, P. (1998). Antiretroviral infection for HIV infection in 1998: Updated recommendations of the International AIDS Society-USA panel. Journal of the American Medical Association, 280, 78-86.Google Scholar
  9. 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
  10. Celentano, D., Vlavov, D., Cohn, S., Shadle, V., Obasanjo, O., and Moore, R. D. (1998). Self-reported antiretroviral therapy in injection drug users. Journal of the American Medical Association, 280, 544-546.Google Scholar
  11. Chitwood, D., McBride, D., French, M., and Comerford, M. (1999). Health care need and utilization: A preliminary comparison of injection drug users, other illicit drug users and nonusers. Substance Use and Misuse, 34, 727-746.Google Scholar
  12. Cockerham, W. C. (1997). Lifestyles, social class, demographic characteristics and health behavior. In D. S. Gochman (Ed.) Handbook of health behavior research. New York: Plenum Press.Google Scholar
  13. Crystal, S. (1992). Health-care barriers and utilization patterns among intravenous drug users with HIV disease. AIDS and Public Policy Journal, 7, 187-198.Google Scholar
  14. Cunningham, W., Hays, R., Ettl, M., Dixon, W., Liu., R., Beck, K., and Shapiro, M. (1998). The prospective effect of access to medical care on health-related quality of life outcomes in patients with symptomatic HIV disease. Medical Care, 36, 295-306.Google Scholar
  15. Eldred, L. J., Wu, A. W., Chaisson, R. R., and Moor, R. D. (1998). Adherence to antiretroviral and pneumocystis prophylaxis in HIV disease. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18, 117-125.Google Scholar
  16. Fleishman, J., Hsia, D., and Hellinger, F. (1994). Correlates of medical service utilization among people with HIV infection. Health Services Research, 5, 527-548.Google Scholar
  17. Fogarty, L., Roter, D., Larson, S., Burke, J., Gillespie, J., and Levy, R. (2002). Patient Education and Counseling, 46, 93-108.Google Scholar
  18. Freeman, R. C., Rodriquez, G. M., and French, J. F. (1996). Compliance with AZT treatment regimen of HIV-seropositive injection drug users: A neglected issue. AIDS Education and Prevention, 8, 58-71.Google Scholar
  19. Frick, P. A., Gal, P., Lane, T. W., and Sewell, P. C. (1998). Antiretroviral medication compliance in patients with AIDS. AIDS Patient Care and STDs, 12, 463-470.Google Scholar
  20. Gebo, K. A., Keruly, J., and Moore, R. D. (2003). Association of social stress, illicit drug use, and health beliefs with nonadherence to antiretroviral therapy. Journal of General Internal Medicine, 18, 104-111.Google Scholar
  21. Gerbert, B., Maguire, B., Bleecker, T., Coates, T., and McPhee, S. (1991). Primary care physicians and AIDS: Attitudinal and structural barriers to care. Journal of the American Medical Association, 266, 2837-2842.Google Scholar
  22. Janssen, R. S., Holtgrave, D. R. Valdiserri, R. O., Shepherd, M., Gayle, H. D., and De Cock, K. M. (2001). The serostatus approach to fighting the HIV epidemic: Prevention strategies for infected individuals. American Journal of Public Health, 91, 1019-1024.Google Scholar
  23. Jeffe, D. B., Meredith, K. L., Mundy, L. M., and Fraser, V. J. (1998). Factors associated with HIV-infected patients' recognition and use of HIV medications. Journal of Acquired Immune Deficiency Syndromes, 19, 350-360.Google Scholar
  24. Kwiatkowski, C., and Booth, R. (1998). HIV-seropositive drug users and unprotected sex. AIDS and Behavior, 2, 151-159.Google Scholar
  25. Mor, V., Fleishman, J., Dresser, M., and Piette, J. (1992). Variation in health service use among HIV-infected patients. Medical Care, 30, 17-29.Google Scholar
  26. Muma, R., Ross, M., Parcel, G., and Pollard, R. (1995). Zidovudine adherence among individuals with HIV infection. AIDS Care, 7, 439-447.Google Scholar
  27. Nannis, E., Temoshok, L., Smith, M., and Jenkins, R. (1993). Perceptions of AZT: Implications for adherence to medical regimens. Journal of Applied Biobehavioral Research, 1, 39-54.Google Scholar
  28. O'Connor, P., Molde, S., Henry, S., Shockcor, W., and Schottenfeld, R. (1992). Human immunodeficiency virus infection in intravenous drug users: A model for primary care. American Journal of Medicine, 93, 382-386.Google Scholar
  29. O'Connor, P., Selwyn, P., and Schottenfeld, R. (1994). Medical care for injecting drug users with human immunodeficiency virus infection. New England Journal of Medicine, 33, 450-459.Google Scholar
  30. Palella, K., Delaney, K., Moorman, A., Loveless, M., Fuhrer, J., Satten, G., Aschman, D. J., and Holmberg, S. D. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection: HIV outpatient study investigators. New England Journal of Medicine, 338, 853-860.Google Scholar
  31. Perry, S., Ryan, J., Ashman, T., and Jacobsberg, L. (1992). Refusal of zidovudine by HIV-positive patients. AIDS, 6, 514-516.Google Scholar
  32. Reiber, C., Ramirez, A., Parent, D., and Rawson, R. A. (2002). Predicting treatment success at multiple timepoints in diverse patient populations of cocaine-dependent individuals. Drug and Alcohol Dependence, 68, 35-48.Google Scholar
  33. Sadiq, S. T., Taylor, S., Kaye, S., Bennett, J., Johnstone, R., Byrne, P., Copas, A. J., Drake, S. M., Pillay, D., and Weller, I. (2002). The effects of antiretroviral therapy on HIV-1 RNA loads in seminal plasma in HIV-positive patients with and without urethritis. AIDS, 16, 219-225.Google Scholar
  34. Sambamoorthi, U., Warner, L., Crystal., S., and Walkup, J. (2000). Drug abuse, methadone treatment and health services use among injection drug users with AIDS. Drug and Alcohol Dependence, 60, 77-89.Google Scholar
  35. Samet, J., Libman, H., Steger, K., Dhawan, R., Chen, J., Shevitz, A., Dewees-Dunk, R., Levenson, S., Kufe, D., and Craven, D. (1992). Compliance with zidovudine therapy in patients infected with human immunodeficiency virus type 1: A cross-sectional study in a municipal hospital clinic. American Journal of Medicine, 92, 495-502.Google Scholar
  36. Selwyn, P., Budner, N., Wasserman, W., and Arno, P. (1993). Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program. Public Health Reports, 108, 492-500.Google Scholar
  37. Siegal, K., and Gorey, E. (1997). HIV-infected women: Barriers to AZT use. Social Science and Medicine, 45, 15-22.Google Scholar
  38. Simpson, D. D., Knight, K., and Ray, S. (1993). Psychosocial correlates of AIDS-risk drug use and sexual behaviors. AIDS Education and Prevention, 5, 121-130.Google Scholar
  39. Simpson, D. D., Camacho, L. M., Vogtsberger, K. N., Williams, M. L., Stephens, R. C., Jones, A., and Watson, D. D. (1994). Reducing AIDS risks through community outreach for drug injectors. Psychology of Addictive Behaviors, 8, 86-101.Google Scholar
  40. Singh, N., Squier, C., Sivek, C., Wagener, M., Hong Nguyen, M., and Yu, V. L. (1996). Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance. AIDS Care, 8, 261-269.Google Scholar
  41. Smith, P. C., and Page, J. B. (1996). Medication therapy among intravenous drug users (IDUs) with HIV infection. AIDS Patient Care and STDs, 10, 101-110.Google Scholar
  42. Smith, S., and Kirking, D. (1999). Access and use of medications in HIV disease. Health Services Research, 34, 123-144.Google Scholar
  43. Solomon, L., Frank, R., Vlahov, D., and Astemborski, J. (1991). Utilization of health services in a cohort of intravenous drug users with known HIV-1 status. American Journal of Public Health, 81, 1285-1290.Google Scholar
  44. Sorensen, J. L., Mascovich, A., Wall, T. L., DePhillipis, D., Batki, S. L., and Chesney, M. (1998). Medication adherence strategies for drug abusers with HIV/AIDS. AIDS Care, 10, 297-312.Google Scholar
  45. Stein, M. D., Piette, J., Mor, V., Wachtel, T. J., Fleishman, J., Mayer, K. H., and Carpenter, C. J. (1991). Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons. Journal of General Internal Medicine, 6, 35-40.Google Scholar
  46. Strathdee, S. A., Palepu, A., Cornelisse, P. G. A., Yip, B., O'Shaughnessy, M. V., Montaner, J. S. G., Schecter, M. T., and Hogg, R. S. (1998). Barriers to use of free antiretroviral therapy in injection drug users. Journal of the American Medical Association, 280, 547-549.Google Scholar
  47. Weatherby, N. L., Needle, R., Cesari, H., Booth, R., McCoy, C.B., Watters, J. K., Williams, M., and Chitwood, D. D. (1994). Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach. Evaluation and Program Planning, 17, 347-355.Google Scholar
  48. Williams, M., Bowen, A., Ross, M., Freeman, R., and Elwood, W. (2000). Perceived compliance with AZT dosing among a sample of African American drug users. International Journal of STD and AIDS, 11, 57-63.Google Scholar
  49. Williams, M., Timpson, S., Crisp, B., Bowen, A., Ross, M., and Keel, K. B. (2002). Final report: An investigation of condom use by HIV-positive African American crack cocaine smokers. Houston: School of Public Health, University of Texas Health Science Center at Houston.Google Scholar
  50. Zhang, H., Dornadula, G., Beaumont, M., Livornese, L., Van Uitert, B., Henning, K., and Pomerantz, R. J. (1998). Human immunodeficiency virus type 1 in the semen of men receiving highly active antiretroviral therapy. New England Journal of Medicine, 399, 1803-1809.Google Scholar

Copyright information

© Plenum Publishing Corporation 2004

Authors and Affiliations

  • Beth R. Crisp
    • 1
  • Mark Williams
    • 2
  • Sandra Timpson
    • 2
  • Michael W. Ross
    • 2
  1. 1.Department of Social WorkUniversity of GlasgowGlasgow
  2. 2.School of Public HealthUniversity of TexasHouston

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