“Damaging what wasn't damaged already”: Psychological tension and antiretroviral adherence among HIV-infected methadone-maintained drug users

Abstract

Active drug use among HIV-infected persons is associated with poor adherence to highly active antiretroviral therapy (HAART) and suboptimal treatment outcomes. To understand adherence experiences among HIV-infected drug users, we conducted semistructured interviews with 15 participants in a randomized controlled trial evaluating the efficacy of directly observed HAART delivered in methadone maintenance clinics. Interviews were recorded, transcribed, and thematically analyzed. We identified negative and positive psychological themes associated with both drug use and adherence. Participants described tension between negative feelings (denial, shame, and perceived isolation) and positive feelings (acceptance, motivation, empowerment, and perceived connectedness), and they associated this tension with their own drug using and adherence behaviors. Sustained antiretroviral therapy adherence may require increased emphasis on understanding the psychological experience of HIV-infected drug users.

Keywords:

• substance abuse
• methadone
• adherence
• qualitative
• shame

Acknowledgements

The authors thank Elise Duggan, Uri Goldberg, and Amanda Carter for conducting the interviews. The trial was dependent on the cooperation of the medical providers, nurses, and patients at the Albert Einstein College of Medicine and Montefiore Medical Center Division of Substance Abuse. We also thank the Center for AIDS Research of the Albert Einstein College of Medicine and Montefiore Medical Center, and staff members at Melrose Pharmacy, Bendiner & Schlesinger, and Bio-Reference Laboratories. This work was supported by the National Institute of Drug Abuse at the National Institutes of Health (grants R01 DA015302 and R25 DA14551 to JHA, K23 DA021087 to KMB, and K23 DA022454 to AHL) and the Center for AIDS Research (grant P30 AI051519 to the Albert Einstein College of Medicine of Yeshiva University)[doi:10.1080/105504901750160501].