Social determinants and adherence to treatment among Colombian women living with HIV/AIDS

Background

There is a paucity of studies on the social determinants of adherence to antiretroviral therapy, especially in Latin American countries. The purpose of the study was twofold: to assess the relationship between antiretroviral adherence and social position among Colombian women with HIV/AIDS and to examine the possibility of expanding the medical concept of adherence to treatment including a “social determinants of health” perspective.

Method

A mixed method approach with a qualitative and quantitative sequential design was applied. In the phase of formative research semi-structured interviews were conducted with 7 national experts in the field. The qualitative component of the study included 10 focus groups with a total of 99 women; in-depth interviews were conducted with 14 of these participants. Another 269 women from five different cities completed a socio-demographic and clinical questionnaire, an adherence to treatment questionnaire, and a social position survey designed according to the Colombian socioeconomic structure. Content analyses were applied to analyze the qualitative data and logistic regressions were used to analyze the quantitative data.

Results

Significant statistical associations and qualitative patterns between adherence and social position were found. Women in a medium and high social position were more likely to present higher adherence behaviors than women in low social position. Also, healthcare system barriers, being a caregiver of children with HIV/AIDS, and individual coping styles were found as critical factors for adherence behaviors.

Conclusions

Adherence to treatment in Colombian HIV positive women is determined by their social position. Research on antiretroviral adherence and the concept of adherence itself should include a “social determinants of health” perspective in order to maximize the likelihood of obtaining better clinical outcomes. The findings of the study should also serve as a point of reference for reviewing current healthcare guidelines for people living with HIV/AIDS in Colombia.