To take or not to take

Decision-making about antiretroviral treatment in people living with HIV/AIDS

Heidemarie Kremer, Gail Ironson, Neil Schneiderman, Martin Hautzinger

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Knowledge is limited regarding decision-making about antiretroviral treatment (ART) from the patient's perspective. This substudy of a longitudinal study of psychobiologic aspects of long-term survival, conducted in 2003, compares the rationales of HIV-positive individuals (n = 79) deciding to take or not to take ART. Inclusion criteria were HIV/AIDS symptoms, or CD4 nadir less than 350, or viral load greater than 55,000. Those not meeting any criteria for receiving ART (2/2003 U.S. DHHS treatment guidelines) were excluded. Diagnosis was on average 11 years ago; 36% were female, 42% African American, 28% Latino, 24% white, and 6% other. Qualitative content analysis of semistructured interviews identified 10 criteria for the decision to take or not to take ART: CD4/viral load counts (87%), quality of life (85%), knowledge/beliefs about resistance (66%), mind-body beliefs (65%), adverse effects of ART (59%), easy-to-take regimen (58%), spirituality/worldview (58%), drug resistance (41%), experience of HIV/AIDS symptoms (39%), and preference for complementary/ alternative medicine (17%). Participants choosing not to take ART (27%) preferred complementary/alternative medicine (r = 0.43, p < 0.001)1, perceived a better quality of life without ART (r = 0.32, p < 0.004), and weighted avoidance of adverse effects of ART more heavily (r = 0.24, p < 0.030) than participants taking ART (73%). Demographic characteristics related to taking ART were having a partner (r = 0.31, p < 0.008) and having health insurance (r = 0.26, p < 0.040). Decisions to take or not to take ART depend not only on patient medical characteristics, but also on individual beliefs about ART, complementary/alternative medicine, spirituality, and mind-body connection. HIV-positive individuals declining treatment place more weight on alternative medicine, avoiding adverse effects and perceiving a better quality of life through not taking ART.

Original languageEnglish
Pages (from-to)335-349
Number of pages15
JournalAIDS Patient Care and STDs
Volume20
Issue number5
DOIs
StatePublished - May 1 2006

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Decision Making
Acquired Immunodeficiency Syndrome
HIV
Complementary Therapies
Therapeutics
Spirituality
Quality of Life
Viral Load
United States Dept. of Health and Human Services
Health Insurance
Hispanic Americans
Drug Resistance
African Americans
Longitudinal Studies
Demography
Guidelines
Interviews
Weights and Measures

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Leadership and Management
  • Nursing(all)

Cite this

To take or not to take : Decision-making about antiretroviral treatment in people living with HIV/AIDS. / Kremer, Heidemarie; Ironson, Gail; Schneiderman, Neil; Hautzinger, Martin.

In: AIDS Patient Care and STDs, Vol. 20, No. 5, 01.05.2006, p. 335-349.

Research output: Contribution to journalArticle

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