Academic journal article Social Work

A Qualitative Investigation of Adherence Issues for Men Who Are HIV Positive

Academic journal article Social Work

A Qualitative Investigation of Adherence Issues for Men Who Are HIV Positive

Article excerpt

Antiretroviral medications have given new hope to individuals with HIV fortunate enough to have access to them. In the United States, deaths as a result of AIDS declined in 1996 for the first time by 25 percent, and age-adjusted death rates from HIV infection declined by 47 percent from 1996 to 1997, reaching the lowest rate since 1987 (Centers for Disease Control and Prevention [CDC], 2001; National Center for Health Statistics, 1998). Those declines, in large part, have been a result of advances in combination antiretroviral drug therapy. However, these drugs require strict adherence to complicated dosing schedules and dietary conditions in addition to management of distressing side effects.

Social workers who provide services to HIV-positive individuals have a responsibility not only to understand and communicate how antiretroviral medications work and why adherence is so crucial, but also to be prepared to help individuals improve their levels of adherence. Because nonadherence can lead to drug resistance, the benefits of adherence extend beyond the individual to the public health. Even partial adherence creates the potential for development of mutant strains of the virus (Bangsberg et al., 2000; Roberts, 1995).

This article reports findings of a qualitative study of HIV-positive men who have struggled with adherence issues endemic to antiretroviral treatment. The findings should be useful to social workers as they strive to design and provide effective interventions to help individuals increase their adherence to antiretroviral therapy.

Antiretroviral Treatment for HIV

In 1983 medical researchers determined the viral cause of AIDS, but it was not until 1987 that the first antiretroviral drug was developed--the nucleoside reverse transcriptase inhibitor zidovudine, more commonly known as AZT. In 1996 physicians began triple combination therapy ("drug cocktails") with varying combinations of antiretroviral drugs, to which were added the newly developed protease inhibitors. Currently, 23 drugs are used in the treatment of HIV infection, 10 of these developed and approved within the past the years (Carpenter et al., 1997; Gallant, 2002; Gorman, 1997).

The clinical use of viral load testing in 1996 further enhanced treatment. Combination therapy, also known as highly active antiretroviral therapy, is designed to decrease viral load and allow CD4 cells to increase, strengthening the individual's immune system and prolonging life (Feinberg, 1996). There are three drawbacks to this medical breakthrough, however: side effects, long-term toxicities, and the burden of the regimen. Side effects include diarrhea, abdominal pain, nausea, vomiting, fatigue, anemia, a metallic taste, gastrointestinal distress, loss of appetite, numbness around the mouth, peripheral neuropathy, pancreatitis, oral ulcers, myopathy, and kidney stones. Long-term toxicities include liver toxicity, increased fats in the blood, and blood glucose abnormalities leading to development of diabetes. More recently, attention has focused on "protease paunch" (truncal obesity or a rapid increase in waist size) and "buffalo hump" (development of a fatty mass at the base of the neck). Of most importance for the social worker to understand is the burden imposed by the multidrug regimen. Although advances in the past year have produced medicines with fewer pills per dose and less frequent dosing (for example, once a day for Reyataz), an antiretroviral combination is still necessary, and side effects remain.

Anyone who has struggled to complete one antibiotic regimen over seven to 14 days should be able to appreciate the difficulties in adherence faced by people who are on antiretroviral therapy, a regimen they must be committed to following every day for their entire lives. It is no small feat when taking an antibiotic to remember to pack the midday dose, to remember to take the midday dose in spite of the day's distractions, to wake in the middle of the night for another dose, and to contend with the unpleasant and often unpredictable side effect of diarrhea. …

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