Adherence to HAART and to self-care behaviours:quantitative and qualitative data from a national survey in Argentina

PECHENY MARIO; MANZELLI HERNÁN

México

Congreso; AIDS 2008 • XVII International AIDS Conference • 3-8 August 2008, Mexico City; 2008

International AIDS Society

Background: HAART has been available in Argentina for a decade. The National and local AIDS Programs and the Global Fund project have implemented interventions in order to improve adherence. Three models of research and intervention are confronted to empirical (quanti-qualitative) data and discussed here: an individualistic-epidemiological, a cultural-anthropologic and a structural- socio-political model. Methods: In September-November 2006, we conducted a national survey (n=841; multi-stage sampling) with PWHIV and 49 qualitative interviews with PWHIV and members of local AIDS programs in each province, including the following aspects: sociodemographic; employment and economic situation; sexuality, marital status and parenthood; illness history and current health status; healthcare and treatment; and discrimination and social support. Results: Challenges to adherence to treatment and to self-care behaviours are diverse. Income level and food needs; parenthood; secondary effects, treatment management and other biomedical aspects; health system aspects (coverage of CD4/viral load tests, bureaucratic problems, discrimination within health services); and networks were analyzed in correlation to adherence conditions. Consistent condom use in vaginal sex has been reported by 73% of heterosexual men, 66% of women and 51% of gays, bisexuals and transgender that had that practice last year (lower percentages for oral sex and higher for anal sex). Condom use can be approached from the first model, but the reasons given for not having used condoms show the need of intervene also on cultural and structural (resource-related) aspects. Data on gender and history of sex work, IDU, prison and sex with IDUs and with people who have been in prison, show situations of complex, structural vulnerability that is necessary to understand in order to implement adherence programmes. Conclusions: The three models are necessary and complementary to implement adequate, comprehensive and sustainable adherence programmes. Adherence is challenged at different levels: individual, social, cultural, institutional, and structural; and in relation to heterogeneous but intertwined vital aspects. Presenting author email: mpecheny@mail.retina.ar