Academic journal article International Electronic Journal of Health Education

Strategies for Living with the Challenges of HIV and Antiretroviral Use in Zambia

Academic journal article International Electronic Journal of Health Education

Strategies for Living with the Challenges of HIV and Antiretroviral Use in Zambia

Article excerpt

Introduction

Recent health surveys indicate HIV prevalence is 19.7% in urban areas in Zambia. (1) The progression of disease in persons living with HIV/AIDS has dramatically altered with the advent of ARV medications; in Zambia, the aim of HIV/AIDS management has shifted from palliative care to strategies to promote access to antiretroviral (ARV) medication and provide support for long-term adherence to medication and treatment. (2) Zambia has been cited for significant increases in antiretroviral treatment access (3); as of September 2007, 122,700 people were receiving no-cost ARVs (4) and high rates of HIV medication adherence in resource limited settings have been documented. (5) However, while controlled clinical trials of ARV therapy have demonstrated viral suppression below detectable limits when adherence reaches 95% or greater, (6) studies of long term use in clinical settings in the US report that adherence rates may be as low as 50%. (7) Viral resistance to ARVs is the most significant limiting factor in the long-term efficacy of HIV pharmacotherapy and is a predictable consequence of substantial but imperfect adherence (8) and may also be associated with ethnicity. (9) Growing concerns about the potential for the development of resistant virus has lead to increased resistance testing across sub-Saharan Africa during 2008 (personal communication CDC, 2008). At present, only 2 lines of variable generic ARV combinations are available in Zambia for low income patients. Thus, it is essential to establish adherence health behaviors at the time of introduction of ARV medication.

Challenges to ARV medication adherence in sub-Saharan Africa include stigma, lack of confidentiality, gastric side effects in already undernourished, weakened patients (10-12) and travel or migration for work which may interfere with access to medication and adherence. (13) In the US, individual characteristics, aspects of the provider and patient provider relationship, factors related to illness or regimen, and contextual/environmental factors have also been related to non-adherence to ARVs. (14) These individual factors may facilitate or reduce adherence; (15-18) e.g., beliefs about medication toxicity or effectiveness, (5,19) provision of care to HIV seropositive family members and neglect of personal health. In Africa, stigma and negative attitudes in community and health care settings, both perceived and enacted, may serve as challenges to HIV medication adherence, (5,20) e.g., healthcare may be perceived as supportive or stigmatizing and inaccessible, family members may blame and ostracize members with HIV. (21) Contextual factors such as poverty and food shortages, experienced by 68% of Zambia's population, may also contribute to ARV non-adherence. (22) While a healthy diet rich in vitamins and nutrients maximizes the benefits of anti-HIV drugs, inhibits disease progression, maintains CD4 T-cells, and decreases viral load, (23,24) in Africa, the effects of lack of food in combination with ARVs may outweigh, or even reverse their benefit. (22) However, social support can improve the quality of life of people living with HIV/AIDS and has been associated with HIV support group attendance, taking vitamins, and receiving counseling. (25)

Cultural and social context may influence interventions and assessment of factors associated with adherence. Qualitative reports play an important role in validating culturally appropriate health education interventions. (26) Factors such as medication concerns and beliefs, healthcare and community stigma, poor access to nutrition and lack of social support can be challenges to adherence and treatment, (27) and developing health education interventions to respond to these issues can be a strategy for ensuring the establishment of long term medication adherence behaviors early in medication prescription. (28) This study sought to assess experiences with HIV and antiretroviral use in new medication users in Zambia. …

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