title: The relationship of acceptance or denial of HIV-status to antiretroviral adherence among adult HIV patients in urban Botswana.
abstract: Adherence to antiretroviral therapy among HIV patients is the most important patient-enabled factor related to virological failure and can lead to drug resistance. It is important to avoid virological failure, especially in resource-limited settings where treatment options are limited and the effects of treatment failure are profound. This qualitative study aimed to identify the psycho-social factors related to adherence behaviour in Gaborone, Botswana, a high prevalence setting in southern Africa. One-to-one, in-depth interviews were conducted with adult antiretroviral patients in the private and public health sectors who had been on antiretroviral therapy for a minimum of 6 months. A grounded theory approach was adopted and patients were selected purposively and theoretical sampling determined the final sample size. Thirty-two patients were interviewed, 22 from the public-sector, the mean age was 9.5 years and 53% were women. We found that acceptance of HIV-status, the ability to avoid internalising stigmatising attitudes and identification of an encouraging confidante were key factors related to good adherence. Encouraging confidantes (including clinicians) and contributed to promoting hope and acceptance of HIV-status, enabling patients to develop a positive therapeutic relationship with their antiretrovirals and make lifestyle changes that promoted adherence. Active participation in a social network and a desire to avoid being thin and visibly identifiable as HIV-positive were also adherence-motivating factors. Conversely, participants who expressed some degree of denial about their HIV-status tended to express emotions associated with depression, and internalised stigma that inhibited the development of a relationship with a confidante. We feel it is important to identify individuals with HIV who are still in some degree of denial about their status and to identify depression among patients on antiretrovirals. This will enable more targeted, individualised support in the management of individuals' HIV disease.
authors.affiliation: London School of Hygiene and Tropical Medicine, Infectious Diseases Epidemiology Unit, Keppel Street, London WC1E &HT, UK. sara.nam@lshtm.ac.uk
authors.forename: Sara L
authors.initials: SL
authors.lastname: Nam
authors.forename: Katherine
authors.initials: K
authors.lastname: Fielding
authors.forename: Ava
authors.initials: A
authors.lastname: Avalos
authors.forename: Diana
authors.initials: D
authors.lastname: Dickinson
authors.forename: Tendani
authors.initials: T
authors.lastname: Gaolathe
authors.forename: P Wenzel
authors.initials: PW
authors.lastname: Geissler
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001902:Botswana; D003717:Denial, Psychological; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010361:Patients / Q000523:psychology*; D014505:Urban Population
chemical_list: D044966:Anti-Retroviral Agents