Why do people living with HIV/AIDS delay, decline, or discontinue antiretroviral therapy?: A mixed-methods exploration
Methods. African American and Latino adult PLHA-DDD (N=95) were recruited through clinics and peer referral in 2012-2013. Participants engaged in a structured assessment with reliable/valid measures on health and ART history. A subset (N=34) was purposively sampled for maximum variation for qualitative interviews on barriers to ART initiation.
Results. Most participants (61.1%) were male; with low socio-economic status (97.0%); African American (76.8%; [23.2% Latino]); aged 48.0 years (SD=8.88 years) on average; and most had seen an HIV provider in the past 6 months (71.6%). Half (56.8%) had taken ART previously. Quantitative data indicated the main reasons for stopping ART were side effects (68.3%), life circumstances changed (54.9%), adherence (47.1%), and substance use (45.1%). Qualitative analyses revealed six factors inhibiting ART initiation/continuation: (1) distrust of the medical establishment; (2) misconceptions about ART; (3) fears of side effects; (4) fears of unintended disclosure; (5) selling ART to unscrupulous pharmacies; and (6) suboptimal relationships with the health care system.
Conclusions. A set of complex and intersecting factors, many of which are grounded in poverty and racial/ethnic minority status, inhibit ART initiation/continuation. Interventions to ameliorate these barriers are sorely needed to improve ART initiation for PLHA-DDD.
Learning Areas:Chronic disease management and prevention
Diversity and culture
Implementation of health education strategies, interventions and programs
Social and behavioral sciences
Define the health and socio-demographic characteristics of persons living with HIV/AIDS who delay, decline, or discontinue antiretroviral therapy Identify the reasons why persons living with HIV/AIDS may delay, decline, or discontinue antiretroviral therapy Describe barriers to antiretroviral initiation that can be ameliorated in interventions
Keyword(s): HIV/AIDS, Treatment
Organization/institution whose products or services will be discussed: NA
Qualified on the content I am responsible for because: I am the PI of this study. I am responsible for its design and execution. I wrote the abstract. I led the data analysis team.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.