title: Medication practice and feminist thought: a theoretical and ethical response to adherence in HIV/AIDS.
abstract: Accurate self-administration of antiretroviral medication therapy for HIV/AIDS is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional influences on behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/AIDS as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals' medication-taking behaviour, speaks to the inherent power inequities in the patient-provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals' situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidiminsional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient-centred interventions.
authors.affiliation: University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA. lmb18@pitt.edu
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Broyles
authors.forename: Alison M
authors.initials: AM
authors.lastname: Colbert
authors.forename: Judith A
authors.initials: JA
authors.lastname: Erlen
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023801:Directly Observed Therapy; D004358:Drug Therapy / Q000523:psychology; D019513:Feminism; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D008962:Models, Theoretical; D026706:Paternalism / Q000941:ethics; D010349:Patient Compliance / Q000523:psychology; D026684:Personal Autonomy; D011369:Professional-Patient Relations; D012941:Social Responsibility
chemical_list: D019380:Anti-HIV Agents