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The relationship of acceptance or denial of HIV-status to antiretroviral adherence among adult HIV patients in urban Botswana

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  • Nam, Sara L.
  • Fielding, Katherine
  • Avalos, Ava
  • Dickinson, Diana
  • Gaolathe, Tendani
  • Geissler, P. Wenzel

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.

Suggested Citation

  • Nam, Sara L. & Fielding, Katherine & Avalos, Ava & Dickinson, Diana & Gaolathe, Tendani & Geissler, P. Wenzel, 2008. "The relationship of acceptance or denial of HIV-status to antiretroviral adherence among adult HIV patients in urban Botswana," Social Science & Medicine, Elsevier, vol. 67(2), pages 301-310, July.
    • Handle: RePEc:eee:socmed:v:67:y:2008:i:2:p:301-310
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    References listed on IDEAS

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    1. Stein, Joanne & Lewin, Simon & Fairall, Lara, 2007. "Hope is the pillar of the universe: Health-care providers' experiences of delivering anti-retroviral therapy in primary health-care clinics in the Free State province of South Africa," Social Science & Medicine, Elsevier, vol. 64(4), pages 954-964, February.
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    Cited by:

    1. Horter, Shona & Thabede, Zanele & Dlamini, Velibanti & Bernays, Sarah & Stringer, Beverley & Mazibuko, Sikhathele & Dube, Lenhle & Rusch, Barbara & Jobanputra, Kiran, 2017. "“Life is so easy on ART, once you accept it”: Acceptance, denial and linkage to HIV care in Shiselweni, Swaziland," Social Science & Medicine, Elsevier, vol. 176(C), pages 52-59.
    2. Beth S Rachlis & Edward J Mills & Donald C Cole, 2011. "Livelihood Security and Adherence to Antiretroviral Therapy in Low and Middle Income Settings: A Systematic Review," PLOS ONE, Public Library of Science, vol. 6(5), pages 1-15, May.
    3. Salem Gugsa & Katy Potter & Hannock Tweya & Sam Phiri & Odala Sande & Pascal Sikwese & Janet Chikonda & Gabrielle O’Malley, 2017. "Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-18, June.
    4. Watt, Melissa H. & Maman, Suzanne & Earp, Jo Anne & Eng, Eugenia & Setel, Philip W. & Golin, Carol E. & Jacobson, Mark, 2009. ""It's all the time in my mind": Facilitators of adherence to antiretroviral therapy in a Tanzanian setting," Social Science & Medicine, Elsevier, vol. 68(10), pages 1793-1800, May.
    5. Russell, Steven & Seeley, Janet, 2010. "The transition to living with HIV as a chronic condition in rural Uganda: Working to create order and control when on antiretroviral therapy," Social Science & Medicine, Elsevier, vol. 70(3), pages 375-382, February.

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