Toni Tugenberg, MEd, LICSW, Monique A. Wyatt, and Norma C. Ware, PhD. Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, 617-432-6019, monique_wyatt@hms.harvard.edu

Background: Constructive relationships between health care providers and patients treated for HIV/AIDS are critical to treatment success. As-yet unexamined, however, is the impact of the urgency patients sense in their providers concerning proper adherence to antiretroviral medications. Methods: Qualitative interviews (Total: 212) from a descriptive study of adherence to HAART for active illegal drug users (N=52) provided data for the analysis. Among other topics, interviews examined patients’ perspectives on relationships with their providers. Results: Consistent with current standards of care, providers conveyed to study participants the importance of strict adherence to HAART for viral suppression and long-term health. However, participants did not always share the goal of perfect adherence. Other priorities competed for their attention, e.g., housing, work, children, court cases, jail. Some individuals opted for immediate, attainable improvements in “quality of life” over possible long-term health benefits – deciding to forego medications so as to gain relief from side effects, increase control over health, or break free of the constant reminder of being HIV-positive. Placing immediate interests ahead of medication-taking often led to apprehensions about disappointing providers. Though most participants desired to be honest with providers, the fear of disapproval and/or rejection frequently resulted in withholding information, missing clinic appointments, or dropping out of treatment altogether. Conclusion: Insistence on strict adherence can unwittingly run the risk of alienating patients, paradoxically undermining the very behavior it is intended to promote. Urgency of focus on adherence may need to be tempered in the interest of preserving long-term therapeutic alliances.

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