title: Pill aversion in HIV-infected pregnant women: Theory to practice.
abstract: In our perinatal HIV cohort, we have observed difficulty swallowing pills as a frequent and significant barrier to adherence to highly active antiretroviral therapy. We refer to this problem as pill aversion and define it as difficulty swallowing pills with no persistent medical or structural cause as well as the anxiety and physical symptoms associated with pill swallowing. By applying cognitive behavioral theory to behavioral patterns within our pregnant HIV-infected population, we seek to better understand the development and reinforcement of pill aversion behavior. On the basis of this theory, our experience, and the pediatric pill-swallowing literature, we propose a conceptual framework for understanding the multiple causes of pill aversion and applying therapeutic interventions to a perinatal population. In a theoretical discussion, we address the roles of classical conditioning and cognitive theory in the development and experience of pill aversion in an HIV-infected pregnant population. We propose future steps for characterizing these behaviors and testing theories and interventions.
authors.affiliation: Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Dorman
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Yee
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Sutton
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003214:Conditioning, Classical; D003679:Deglutition; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D055118:Medication Adherence / Q000523:psychology*; D011247:Pregnancy / Q000523:psychology; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011574:Psychoanalytic Theory; D013607:Tablets / Q000008:administration & dosage*
chemical_list: D013607:Tablets