Published in FAMA Five Borough AIDS Mental Health Alliance, V. 3 No.2, Spring 2001
Medication adherence, also known as "compliance," is of key importance in fending off drug resistance. In other words, taking HIV medication as prescribed is necessary to the success of the drugs. And while it may seem like no big deal to stick to treatment plans, taking medications as prescribed has long been recognized as problematic for nearly all types of conditions and treatments.
In order to achieve a better understanding of protease inhibitor use among clients, Gay Men's Health Crisis (GMHC), (1997-1998) conducted pilot studies, which sought to assess the extent of, reasons for, and predictions of, non-adherence to combination therapy. Approximately three-quarters of the participants in the focus group segment reported missing doses of their protease inhibitor in the previous six months, and nearly one-third had missed a dose in the past week. The following were the mostly widely reported reasons for non-adherence among gay men, as well as heterosexual men and women.
Being away from home without the medications
Forgetting to take a dose due to timing
Fatigue
Conflict with eating
Running out of medication
While practical considerations seem to be paramount, for gay men, mental health issues such as underlying depression, anxiety or other emotional problems exacerbates adherence challenges.
An additional barrier to adherence is alcohol and drug use. Large numbers of gay men of all antibody statuses, choose to "party." Sometimes this consists of going to a bar or on a date and drinking or getting high on a "recreational chemical." There is a specific phenomenon that thousands of gay men all around the country participate in known as a "Circuit Party." A "Circuit Queen" refers to a man who attends circuit parties, either infrequently or as often as once a month. Circuit parties are weekend long happenings whose locations vary around North America, and now includes the Gay Mardi Gras in Sydney, Australia. These events are built around a dance party that can go on for over 12 hours, where there is a lot of alcohol and drug use with a corresponding high level of sexual activity.
Being under the influence of drugs or alcohol can definitely affect an individual's ability to remember to take a dose of his medication. Furthermore, if an individual is high and partying, the last thing he may want to do is to be reminded of being HIV positive, and may deliberately choose not to bring doses of his medications with him. One aspect of partying is meeting people for sex, either one on one or at a specific "sex party." I have heard numerous clients report that the last thing they were going to do in front of a hot guy they had just met, or in the midst of a sex party was take their HIV medications.
The GMHC study found the following factors improved a person's ability to adhere to the treatment schedule: believing in the effectiveness of treatment; evidence that the regimen was working; success in minimizing side effects; and support from family and friends. Another key factor was the level of trust in the health provider. Although all the participants in the GMHC study reported having discussed combination treatment with their doctors, almost a quarter felt their doctors did not clearly explain drug interactions, and almost one-fifth felt that their doctors had not clearly explained side effects or the consequences of non-adherence. Complex treatment decisions that can help lead to the strict adherence necessary in order to achieve long-term viral suppression and durable clinical effectiveness, must be driven by personal preference, common sense, rapidly accumulating data, changes in community prescribing patterns, and perhaps most important, a comfort with uncertainty. In addition, people with HIV can maximize adherence by identifying cues that help remind them to take medications, and anticipating changes in daily patterns that will pose a difficulty to taking the medications as prescribed.
References
Gay Men's Health Crisis (Winter 1997/1998). Treatment Issues' Second Survey of Physicians' Treatment Practice. Treatment Issues: Newsletter of Experimental AIDS Therapies. V.12, No.1.
Key Words: HIV, AIDS, Medication Adherence,