The Process of Adherence to Treatment in People Living with HIV

Abstract

The purpose of this chapter is to review the concept of adherence and analyze its implications for the social construction of the patient as a subject, since this affects the relationship established with the health services for the maintenance of care. The facilitators and barriers to adherence reported in the literature are presented, based on studies focused on the perspective of people living with HIV. At the end of the chapter, the individual elements that promote adherence to treatment are shown, according to the experience of highly adherent patients. In addition, individual and contextual barriers to the adherence process are identified in the pharmacological and nonpharmacological dimensions.

<p>Self-Report for Measuring and Predicting Medication Adherence: Experts’ Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics</p>

“…16 It is assumed that psychiatric patients are able to choose; act rationally, intentionally, and responsibly; and make decisions in terms of costs and benefits. 17 However, patients with severe mental illnesses such as schizophrenia, bipolar disorder, and major depression can go through phases in which their awareness of illness is impaired; this lack of insight, or anosognosia, represents the most significant reason for treatment refusal when they are acutely ill. 18 Therefore, adherence is a process that requires time for its proper development, where people suffering a psychiatric disorder need to identify as patients, develop awareness of their mental illness, participate in their mental health care, and establish a relationship of trust and collaboration with mental health professionals. Adherence to prescribed psychiatric medication in severe mental illness is a dynamic variable and there are major differences between in-and outpatient treatments.…”