title: A Social-Ecological View of Barriers and Facilitators for HIV Treatment Adherence: Interviews with Puerto Rican HIV Patients.
abstract: OBJECTIVE
  To identify perceived barriers and facilitators for HAART adherence among people living with HIV/AIDS in Southern Puerto Rico using a Social Ecological framework.
  
  
  METHODS
  Individual in-depths interviews were conducted with 12 HIV patients with a history of HAART non-adherence. Interviews were audio-taped and transcribed. Content analysis was performed for each transcribed interview by three independent coders using a codebook. Using Atlas TI, super-codes and families were generated to facilitate the categorization tree as well as grounded analyses and density estimates.
  
  
  RESULTS
  Most participants reported a monthly income of $500 or less (n = 7), a high school education level (n = 7), being unemployed (n = 9) and being recipients of government health insurance (n = 11). Three out of six women reported living alone with their children and most men informed living with their parents or other relatives (n = 4). For the grounded analyses, the top four sub-categories linked to high number of quotations were mental health barriers (G = 32) followed by treatment regimen (G = 28), health system (G = 24) and interpersonal relations (G = 16). The top four sub-categories linked to high number of codes are treatment regimen (D = 4), health status perception (D = 3), interpersonal relations (D = 3) and health system (D = 3).
  
  
  CONCLUSIONS
  The results of this study suggest the interconnection of HIV treatment adherence barriers at various system levels. Future studies on HIV treatment barriers should explore these interactions and investigate the possible synergistic effect on non-adherent behavior.
authors.affiliation: Clinical Psychology Programs, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico, United States of America; Psychiatry Department, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico, United States of America.
authors.forename: Eida M
authors.initials: EM
authors.lastname: Castro
authors.affiliation: University of Puerto Rico Medical Science Campus School of Nursing, San Juan, Puerto Rico, United States of America.
authors.forename: Lydia E
authors.initials: LE
authors.lastname: Santiago
authors.affiliation: Clinical Psychology Programs, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico, United States of America.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Jiménez
authors.affiliation: Clinical Psychology Programs, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico, United States of America.
authors.forename: Daira
authors.initials: D
authors.lastname: Dávila-Vargas
authors.affiliation: University of Massachusetts Medical School, Worcester, Division of Preventive and Behavioral Medicine, Massachusetts, United States of America.
authors.forename: Milagros C
authors.initials: MC
authors.lastname: Rosal
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011647:Puerto Rico / Q000453:epidemiology; D036301:Qualitative Research; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult