Adherence practices among people living with HIV

This paper offers a critique of patient-deficit models of adherence by examining the articulation of dosing schedules and food prohibitions with the structure of everyday lives. Interviews with 31 men and 4 women taking HAART show that doses associated with regular daily life events are most consistently taken, but many individuals rework official dosing guidelines around timing and food consumption. Barriers to adherence often arise from conflicting demands imposed by work schedules, different medications, food prohibitions, and even outright discrimination as in the case of US immigration policy. Adherence may be the outcome of compromises made in an effort to solve contradictory demands, and may be situational and related to the qualities of particular drugs, as much as to personality traits. Autobiographical narratives that give order to one's sense of self provide foundations upon which adherence decision making occurs. Finally, perceptions of drug effectiveness may lead to self-reinforcing adherence practices.