AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #98 - The social production of non-adherence : From an identification of the process towards a renewed response An example from Kayes (Mali)
Authors: Presenting Author: Ms Carillon Severine - UMR CEPED
Additional Authors:
Aim: The major clinical and public health implications of non-adherence to HIV care among persons living with HIV/AIDS (PLHA) underscores the importance of analysing the process which drives individuals to miss clinic appointments.
Method / Issue: An anthropological study was carried out in Kayes, in Mali, in 2008. Observations were made in hospitals and organisations associated with HIV care. In-depth interviews were conducted with PLHA who had interrupted follow up (24), as well as with health workers (10), persons from community-based organisations (7) and international institutions (3) involved in HIV patient management and care.
Results / Comments: The circumstances leading to interruptions in care are represented through three inter-related levels : Individual : PLHA adopt a variety of strategies to enable them to secretly attend follow up appointments, without disclosure to their family members and friends, when faced with difficulties in terms of the expectations and restrictions associated with attending regular appointments or those in the wider social, economic and cultural environment. These strategies are rarely robust, and often break down over time, resulting in interruptions in care over the long-term. Relational : the unequal distribution of power in patient-provider relationships in the context of managing chronic illnesses compromises patients’ involvement in, and responsibility for their own care. Organisational: Long and complicated care circuits at each appointment represent an additional barrier to adhering to appointment schedules among PLHA. A lack of doctors able to prescribe ART further contributes to the inability of health workers to provide ongoing care to the ever growing number of PLHA.
Discussion: The social production of adherence demonstrates the need to move beyond its consideration as an individual behaviour, but rather as a reflection of an ineffective system within which patients and providers are operating, as well as an outcome of dysfunctional and poorly adapted procedures to provide care. These findings highlight the shared responsibility of different actors for interruptions in regular patient follow up, and questions the relevance of current responses to poor adherence to care - such as treatment literacy programmes - which by only focusing on patients, fail to address the relationship and organisational issues which are integral to adherence.
Go Back