title: Adherence to HAART: processes explaining adherence behavior in acceptors and non-acceptors.
abstract: In order to explore and clarify the underlying processes which lead to (non)-adherence behavior in patients treated with highly active antiretroviral therapy (HAART), a qualitative study was conducted. Thirty-seven in-depth interviews were held with 30 Caucasian HIV-positive patients. Additional data were collected by diaries kept by some participants. The analysis took place in a cyclic process; selection of themes was alternated with input of new material. Adherence to HAART is mainly influenced by the experience of being HIV positive. Acceptance or non-acceptance of HIV leads to one of two basic stances toward adherence: "being determined to be adherent" or "medication is subordinate to other priorities in life". This stance determines the commitment to therapy and influences how patients cope with adherence. Patients who are determined to be adherent find solutions to adherence problems. Patients who are not determined to be adherent solve problems only if the solution does not compromise important aspects of their lives. Insight is provided into the manner in which prevalent themes; "start of HAART", "attitude toward medication", "HAART in daily life", "contextual factors", "health and HAART" and "being informed", influence adherence behavior. Before starting HAART the focus should be on helping the patient to accept HIV as a part of life. The findings need to be taken into account in adherence-promoting interventions.
authors.affiliation: Department of Internal Medicine & Infectious Diseases, University Medical Centre, Utrecht, The Netherlands. s.vervoort@umcutrecht.nl
authors.forename: Sigrid C J M
authors.initials: SC
authors.lastname: Vervoort
authors.forename: Mieke H F
authors.initials: MH
authors.lastname: Grypdonck
authors.forename: Annelies
authors.initials: A
authors.lastname: de Grauwe
authors.forename: Andy I M
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: Jan C C
authors.initials: JC
authors.lastname: Borleffs
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D001294:Attitude to Health; D001530:Belgium; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015438:Health Behavior; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic; D012944:Social Support