What HIV-positive men who have sex with men think is important to treatment adherence: A content analysis

Background: HIV medication requires 95% adherence to be fully effective. Many HIV-positive persons fail to meet this standard. Adherence for HIV-positive men who have sex with men (MSM) is related to psychosocial variables and practical skills and constraints. Interventions targeting these variables to increase HIV-treatment adherence have been relatively unsuccessful.

Methods: The Treatment Advocacy Program (TAP) is a behavioral intervention designed to decrease sexual risk and increase treatment adherence for HIV-positive MSM. The experimental group (N=202) received individually-tailored peer counseling and education via motivational interviewing. We performed a content analysis of the counseling session notes to glean themes most important to adherence for MSM, with an eye toward future intervention development.

Results: Preliminary analyses reveal that MSM most cited the psychosocial variables of depression and social support as factors associated with treatment adherence. In addition, MSM indicated substance use and medication side effects impact adherence. Adherence skills, such as using a pillbox, and practical constraints, such as lacking social services, emerged in the content analysis but were cited less frequently than psychosocial variables.

Conclusions: HIV-treatment adherence is related to both practical and psychosocial variables. We found concrete adherence skills were cited by MSM as important to adherence, but less commonly than psychosocial factors, substance use, and medication side effects. Future research should further elucidate the role of practical skills and constraints, psychosocial variables, and other active ingredients on MSM treatment adherence, keeping in mind the goals of increasing adherence, informing intervention design, and fostering healthier HIV-positive lifestyles for MSM.