BACKGROUND:
Drug
use poses significant challenges to medical management of HIV infection.
Although most research has focused on the influence of intoxication on
unintentional adherence to HIV treatment, drug use may also lead to intentional
nonadherence, particularly when individuals believe that mixing medications
with drugs is harmful. This study examined whether interactive toxicity beliefs
predict nonadherence to antiretroviral therapy (ART) over a prospective period
of adherence monitoring.
METHODS:
Men and
women living with HIV who screened positive for drug use and were being treated
with ART (n = 530) completed computerized self-interviews and 3 prospective
unannounced pill counts to measure ART adherence and provided urine specimens
for drug screening and HIV viral load results from medical records.
RESULTS:
Results
showed that 189 (35%) participants indicated that they intentionally miss their
ART when they are using drugs. These participants also reported common beliefs
regarding the perceived hazards of mixing HIV medications with alcohol and
other drugs. Multivariable models controlled for demographic and health
characteristics and frequency of alcohol use showed that intentional
nonadherence predicted poorer ART adherence over the prospective month and also
predicted poorer treatment outcomes as indexed by unsuppressed HIV viral load.
CONCLUSIONS:
These
findings extend previous research to show that interactive toxicity beliefs and
intentional nonadherence play a significant role in medication nonadherence for
a substantial number of people living with HIV and should be actively addressed
in HIV clinical care.
1Department of Psychology, University of Connecticut.
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