active antiretroviral therapy (HAART) has dramatically improved the life
expectancy of HIV-positive individuals. Its ability to lower viral levels in
genital fluids is also having an impact on transmission. But these salutary outcomes
assume that a person at risk for HIV is tested and takes these drugs. And
that’s not always easy. Failure to adhere to a medication regimen has severe
implications, including development of drug-resistant strains, but 95 percent
adherence to even a simple twice daily regimen requires missing no more than
three doses per month. At least one-third of HIV-positive individuals on
treatment in the U.S. fail to do so.
grantee Scott Rhodes, working at Wake Forest University, sought to identify
limits to medication adherence among one particularly hard-hit group, immigrant
Latinos. Writing in the December issue of Patient
Education and Counseling, he and colleagues at Wake Forest and George
Washington University note that, in general, demographic and environmental factors
such as poverty and unstable housing, psychosocial factors such as substance
abuse and depression, and treatment-related issues such as drug side effects
and complex dosing schedules all contribute to failure of medication adherence.
makes adherence a challenge for immigrant Latinos specifically?
Latinos—especially those born in Mexico and Central America─are more likely
than non-Latino African-Americans and Caucasians to receive an AIDS diagnosis
only a short time after being identified as HIV-positive, indicating a delay in
testing and seeking treatment.
Spanish-speaking immigrant Latinos, 20 of whom were HIV-positive, were
recruited from a North Carolina hospital and an AIDS service organization for
this study. They were interviewed in-depth about HIV testing, treatment
initiation, and adherence. None reported being tested before their present HIV
diagnosis. Concerns about healthcare itself were not an issue. All 25 expressed
high levels of confidence in U.S. physicians and HIV medicines.
subjects also reported beliefs that perceived side-effects of HAART, such as
losing weight and “feeling drugged,” made adherence problematic. Poor
communication due to language barriers with healthcare providers, appointment
scheduling challenges, being reminded of their diagnosis each time they took
their medications, lack of transportation, and fear of deportation were other
impediments. In terms of HIV testing, increased risk of deportation as a result
of accessing the health system and risk of social isolation if found to be HIV-positive
were key issues.
might be done to improve HIV testing rates and medication adherence among
immigrant Latinos? The importance of overcoming communication problems and
easing structural barriers, including transportation, inflexible appointment
scheduling, unemployment, and immigration status, were stressed. Equally
significant to study participants were the involvement of family, partner, or
spouse, with participants emphasizing the importance of “having someone to live
for” and their desire to harness “familismo.”