A review of socio-behavioural studies on adherence to antiretroviral treatments: beyond biomedical models?

This paper, based on a review of the literature of socio-behavioural resear ch in this field, shows how the AIDS epidemic has renewed traditional appro aches to patients behaviour toward medical treatment by substituting the no tion of adherence for the traditional one of compliance. It shows how this issue of patients adherence has come to the forefront of HIV care with the recent diffusion of highly active antiretroviral therapeutics (HAART), beca use inadequate adherence has profound implications for the individual and p ublic heath effectiveness of these therapeutic advances. The paper argues t hat two alternatives and indeed conflicting, approaches to adherence to tre atment in HIV infection however persist. The aim of the first approach rema ins to predict and correct non-adherent behaviour in certain patients and s ometimes suggests that such predictions may provide justification far denyi ng individuals treatment. This "predictive" approach focuses on identificat ion of individual barriers to "good" adherence and calls on social science research to help improve the "acceptability" of prescribed regimens for pat ients. An alternative "empathic" approach focuses more on encouraging and s upporting all HIV-infected patients medically eligible for HAART to devise appropriate individualised plans that cart facilitate management of their t reatment in their daily life. This latter approach more willingly learn fro m social science research which recognises the patient's subjective experie nce of illness as a central concern. In the future, the respective contribu tions of these two alternative approaches will have to be judged on the bas is of their capacity to analyse both the factors which influence HIV-infect ed patients' initial adherence to antiretroviral treatment and those, poten tially quite different which interfere with adherence on the long term. The y will also be judged for their capacity to inspire effective psychological and socio-behavioural interventions aimed at facilitating patients adheren ce.