23.5.1  What personal, family or community factors influence adherence?

Barriers to adherence arising from the patients themselves include personal, family or community factors. Examples of personal circumstances that negatively influence adherence are patients that repeatedly forget to take their medication, patients that travel away from home without medication, and patients who develop mental health issues, or who have a history of drug or alcohol abuse that may interfere with their ability to take drugs as prescribed. Economic problems, such as lack of money for transportation to the healthcare provider can also negatively affect adherence. Other issues are related to low literacy or lack of understanding of the treatments a patient should be taking. Religious beliefs should also be taken into account in the context of adherence. For instance, fasting during daytime is a common religious practice for many Ethiopians, and may therefore interfere with the frequency of daily doses to be taken for ART.

At the family or community level, stigma and/or discrimination may make it difficult for a patient to adhere to ART due to the absence of a supportive environment. Another example involves pressure from others to comply with certain practices (i.e. travelling to Holy Water or other local rituals) that may negatively influence adherence (Figure 23.3).

Figure 23.2  Travelling may influence adherence negatively. PLHIV have to plan ahead for changes in their routine to promote adherence to ART. (Photo: Ignacio Romero)

By contrast, other factors can help your patients to take their treatments properly. The ability of your patients to make their medication a routine part of their life is the first step in good adherence practice. Most patients use reminders to take their treatment at the right time. Some may use alarms, and others may use routine activities such as prayer time as reminders. You may have to help your patients find the right reminder, based on their individual circumstances.