“Now here come the pills that are going to save your life”: pharmacists' discussions of antiretroviral drugs in a context of life and death

Abstract

HIV/AIDS has associated cultural and social meanings which shape communication. The disease is closely linked to the concepts of life and death. Antiretroviral therapy (ART) has brought hope and life, but its success is heavily dependent on strict adherence. Research has shown that patients and health professionals often find it difficult to talk about these topics. However, there is little research available which focuses on health professionals’ and patients’ discussion of ART. This paper thus presents some exploratory discussion of extracts from pharmacy interactions in an HIV context which illustrate how pharmacists talk about antiretrovirals (ARVs) with patients with particular reference to the concepts of life and death. Data are taken from 26 video pharmacist–patient interactions recorded in a South African HIV/AIDS pharmacy. A hybrid qualitative analytic approach enabled identification of three types of references to ART, including the need to take ART “for the rest of your life”, ART as “saving your life” and ART as “making you better”. Explicit references to death were infrequent. These references were often emphatic and there are several potential reasons for this. The pharmacists' communication appears to be influenced by the urgency of the disease, a desire to give patients hope and a need to “normalise” discussions of death and HIV. The importance of ensuring understanding of ARV dosage instructions and discouraging patients from seeking traditional healing also appears to affect communication. The disease, societal and cultural contexts are thus shown to be significant influences which shape discussions of ART. This study has a number of practical implications, which are discussed.

Keywords:

• HIV/AIDS
• antiretroviral
• pharmacist
• qualitative
• interaction

Acknowledgements

The author would like to thank the patients and pharmacists who participated in this research. This study was supported by a grant from the National Research Foundation (NRF). Prof. Claire Penn's supervision of the study from which this data are drawn is gratefully acknowledged.