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Adherence, stereotyping and unequal HIV treatment for active users of illegal drugs

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  • Ware, Norma C.
  • Wyatt, Monique A.
  • Tugenberg, Toni

Abstract

Adherence to antiretroviral therapy promotes viral suppression and extends the lives of individuals with HIV, yet illegal drug users are underrepresented among eligible persons receiving HIV treatment. One explanation for this is the assumption that drug users are less capable than others of adhering to complicated medication regimens. This paper investigates this assumption by making explicit a number of its underlying propositions and examining them in light of data collected from 52 active drug users living in and around Boston, USA, who were taking highly active antiretroviral therapy for HIV (HAART). The propositions are: (1) drug users lead "chaotic" lives; (2) active drug users are always using drugs; (3) being under the influence of drugs precludes taking medications as prescribed; and (4) drug users are intrinsically different from non-users in the lives they lead and the problems they face. Data collection consisted of a series of qualitative interviews with each participant. An analytic approach informed by grounded theory was used to construct thematic content categories from the data. Results revealed stability and control as well as "chaos" in the lives of study participants. Frequency of drug use varied considerably. Using did interfere with adherence, but not in every circumstance or all cases. Not "carrying" medications, competing priorities, and re-defining regimens were the most salient of a number of non-drug-use-related obstacles observed. Documentation of patterns of variation in corresponding data highlights the stereotypical quality of the propositions. Stereotyping risks overemphasis on drug use as a barrier to adherence for active users, and underemphasis on non-drug-use-related obstacles. Adherence capabilities of users, in contrast to inadequacies, are also obscured through stereotyping. As a medium for stigmatization, stereotyping may contribute to unequal treatment for drug users and other populations living with HIV.

Suggested Citation

  • Ware, Norma C. & Wyatt, Monique A. & Tugenberg, Toni, 2005. "Adherence, stereotyping and unequal HIV treatment for active users of illegal drugs," Social Science & Medicine, Elsevier, vol. 61(3), pages 565-576, August.
    • Handle: RePEc:eee:socmed:v:61:y:2005:i:3:p:565-576
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    References listed on IDEAS

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    1. Parker, Richard & Aggleton, Peter, 2003. "HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action," Social Science & Medicine, Elsevier, vol. 57(1), pages 13-24, July.
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    1. Szu‐Szu Ho & Rosie Stenhouse & Aisha Holloway, 2020. "Understanding HIV‐positive drug users’ experiences of taking highly active antiretroviral treatment: Identity–Values–Conscious engagement model," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(9-10), pages 1561-1575, May.
    2. Fraser, Suzanne & Moore, David, 2008. "Dazzled by unity? Order and chaos in public discourse on illicit drug use," Social Science & Medicine, Elsevier, vol. 66(3), pages 740-752, February.
    3. Peretti-Watel, P. & Spire, B. & Schiltz, M.A. & Bouhnik, A.D. & Heard, I. & Lert, F. & Obadia, Y., 2006. "Vulnerability, unsafe sex and non-adherence to HAART: Evidence from a large sample of French HIV/AIDS outpatients," Social Science & Medicine, Elsevier, vol. 62(10), pages 2420-2433, May.
    4. Valerie Møller & Ida Erstad & Dalinyebo Zani, 2010. "Drinking, Smoking, and Morality: Do ‘Drinkers and Smokers’ Constitute a Stigmatised Stereotype or a Real TB Risk Factor in the Time of HIV/AIDS?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 98(2), pages 217-238, September.

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