title: To take or not to take: decision-making about antiretroviral treatment in people living with HIV/AIDS.
abstract: Knowledge is limited regarding decision-making about antiretroviral treatment (ART) from the patient's perspective. This substudy of a longitudinal study of psychobiologic aspects of long-term survival, conducted in 2003, compares the rationales of HIV-positive individuals (n = 79) deciding to take or not to take ART. Inclusion criteria were HIV/AIDS symptoms, or CD4 nadir less than 350, or viral load greater than 55,000. Those not meeting any criteria for receiving ART (2/2003 U.S. DHHS treatment guidelines) were excluded. Diagnosis was on average 11 years ago; 36% were female, 42% African American, 28% Latino, 24% white, and 6% other. Qualitative content analysis of semistructured interviews identified 10 criteria for the decision to take or not to take ART: CD4/viral load counts (87%), quality of life (85%), knowledge/ beliefs about resistance (66%), mind-body beliefs (65%), adverse effects of ART (59%), easy-to-take regimen (58%), spirituality/worldview (58%), drug resistance (41%), experience of HIV/AIDS symptoms (39%), and preference for complementary/alternative medicine (17%). Participants choosing not to take ART (27%) preferred complementary/alternative medicine (r = 0.43, p = 0.001)1, perceived a better quality of life without ART (r = 0.32, p < 0.004), and weighted avoidance of adverse effects of ART more heavily (r = 0.24, p < 0.030) than participants taking ART (73%). Demographic characteristics related to taking ART were having a partner (r = 0.31, p < 0.008) and having health insurance (r = 0.26, p< 0.040). Decisions to take or not to take ART depend not only on patient medical characteristics, but also on individual beliefs about ART, complementary/alternative medicine, spirituality, and mind-body connection. HIV-positive individuals declining treatment place more weight on alternative medicine, avoiding adverse effects and perceiving a better quality of life through not taking ART.
authors.affiliation: Department of Psychology, University of Miami, Miami, Florida, USA. HKremer@miami.edu
authors.forename: Heidemarie
authors.initials: H
authors.lastname: Kremer
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
authors.forename: Martin
authors.initials: M
authors.lastname: Hautzinger
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D000529:Complementary Therapies / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D005431:Florida / Q000453:epidemiology; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000523:psychology* / Q000821:virology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D018454:Spouses; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents