"I will start treatment when I think the time is right": HIV-positive gay men talk about their decision not to access antiretroviral therapy

In a qualitative study, 20 HIV-infected Australian gay men were interviewed about their decision not to access antiretroviral drug therapy. The main r easons given for the decision were fear of side effects; fear of long-term damage to body organs; the inconvenience of the treatment regimens; belief that the regimen's demands would be a threat to morale; and belief that the re was no reason to start therapy in the absence of AIDS-related symptoms. Actions taken by the men to monitor and maintain their health included seei ng a doctor regularly; having regular T-cell and viral load tests; and tryi ng to maintain a positive outlook by not letting HIV/AIDS 'take over' their lives. Almost half the men considered they had been subjected to unreasona ble pressure to access therapy and there was considerable pride at having r esisted this pressure. The findings suggest that the men disagreed with the biomedical model for managing HIV/AIDS only on the question of if and when to access therapy. They also suggest that underlying the men's dissent fro m the biomedical model was a different mode of thinking than is required by the model: while the model demands thinking that is abstract, the men focu sed strongly on factors close to the 'here and now' of immediate experience . The practical implications of the findings are explored.