Antiretroviral therapy (ART) is more available than ever before. In prior years, many individuals in developing regions were unable to afford or gain access to ART for the treatment of HIV. In fact, the number of people who are on ARTs in developing countries has increased from approximately 400,000 to over 8 million in just ten years. This increase is a positive step in the treatment and prevention of HIV.
However, many people still do not adhere to their ART regimen, which can lead to resistance, infection, and even death. In the United States, psychological issues such as anxiety, stress, and trauma have all been shown to be deterrents to adherence. In developing countries, financial, religious, and geographical restrictions may continue to present barriers to treatment.
Kathryn Whetten of the Center for Health Policy at the Duke Global Health Institute at Duke University in North Carolina wanted to capture a better picture of what factors impeded adherence to residents of developing countries. In a recent study, Whetten assessed surveys from 468 individuals with HIV living in Tanzania. The participants first completed the surveys during 2008 and were followed-up three years later.
Whetten found that the participants who remained most vigilant to their treatment protocols were those who had been on them the longest. This suggests that they may have developed a level of trust with their doctors, or perhaps been especially motivated to begin ART from the beginning.
“Similar to findings from our studies in the U.S., people reporting incomplete adherence endorsed prior exposure to more types of childhood potentially traumatic experiences, notably childhood sexual abuse,” said Whetten. Other factors that impeded treatment were death of a family member in childhood, depression, and abuse. Further, childhood traumas in general seemed to decrease the likelihood of adherence in this sample. But childhood sexual abuse had the largest impact. Additional factors that emerged were financial and religious barriers and stigma.
Whetten pointed out that contrary to the assumption that increased availability to medication will increase adherence, these results suggest that increased availability and ease of access may actually produce higher nonadherence rates. She believes that individuals with HIV would benefit greatly from psychosocial interventions that address psychological concerns, thus increasing their chances of ART adherence.
Whetten, K., Shirey, K., Pence, B.W., Yao, J., Thielman, N., et al. (2013). Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS ONE 8(10): e74771. doi:10.1371/journal.pone.0074771
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