An Investigation of the Determinants of Adherence to Highly Active Anti-Retroviral Therapy (HAART) in Aboriginal Men in the Downtown Eastside (DTES) of Vancouver

Chongo, Meck; Lavoie, Josée G.; Hoffman, Ross; Shubair, Mamdouh
December 2011
Canadian Journal of Aboriginal Community-Based HIV/AIDS Research;Winter2011, Vol. 4, p32
Academic Journal
The eradication of HIV is not yet possible; therefore persons undergoing treatment must take highly active antiretroviral therapy (HAART) regularly. In British Columbia (BC), antiretrovirals are distributed at no cost but the HIV-related annual mortality rate stands at 9% (Vancouver Native Heath Society [VNHS], 2009). The Aboriginal population in BC alone makes up 13% of new HIV infections, many of whom are less likely to engage in effective care (Lima et al., 2006; Tu et al., 2008). The purpose of this study was to investigate the determinants of adherence to HAART in Aboriginal men in the Downtown Eastside (DTES) of Vancouver and to offer culturally sensitive recommendations aimed at improving access to HAART and reducing deaths due to HIV/AIDS. This research was a phenomenological study applying the methods of the Vancouver School of Doing Phenomenology. Recruitment was through purposive and snowball sampling. Data were collected from twenty-two participants using interviews and a focus group. Five main themes emerged from the analysis: patient factors; inter-personal factors; support structures; history of trauma/ residential school; and medication-related factors. A host of psychological and socioeconomic factors affect adherence. The presence of stigma and discrimination and a negative patient/care-provider relationship reduce adherence. Various support structures improved adherence. A history of trauma contributed to reduced adherence or led to development of survival skills. Finally, a complex treatment regimen and development of medication side effects reduced adherence. Some of the adverse determinants may be overcome by providing better education about HIV/AIDS, stigma and discrimination, Aboriginal history, the need for adherence, professional and lay support, and encouraging patients to follow traditional ways of living.


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