Recorded presentation

Norma C. Ware, PhD, Monique A. Wyatt, and Toni Tugenberg, MEd, LICSW. Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, 617-432-2554, norma_ware@hms.harvard.edu

Background: Research on factors affecting adherence to antiretroviral therapy for HIV has generally stopped short of examining the significance of social context. Methods: Results from a qualitative, descriptive study of social influences on adherence to HAART among illegal drug users are reported. Fifty-two individuals participated in multiple, in-depth interviews (Total = 212) focusing on experiences of taking medication and the relationship between adherence and drug use. Results: The group was mostly male (73%), heterosexual (60%) and either African-American (38%) or white (48%). Most were poor. Drugs of choice were crack cocaine (65%), cocaine (62%), and heroin (40%). Results point to the social consequences of stigma as an impediment to adherence. Lapses in adherence to HAART often occurred in social situations (parties, workplaces, homeless shelters), where being seen taking pills meant risking disclosure as being HIV-positive or otherwise, “ill.” Participants feared exposure because of the stigma associated with HIV/AIDS and the resulting anticipation of rejection by others, who, they believed, might “shy away from” someone who “has something wrong with him.” Adherence can mean social exclusion, which is even more daunting for those already isolated by personal losses accumulated through the HIV epidemic, and marginalized by drug use, sexual preference, poverty, and/or social inequalities. Rather than jeopardize potential friendships or opportunities for intimacy by “outing” oneself through pill-taking, many participants skipped doses. Conclusions: Stigma represents a barrier to adherence. Planning and implementation of adherence interventions should be informed by an appreciation of the hierarchy of social motives influencing adherence to HAART.

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