Marseille 2007
Marseille 2007
Abstract book
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Abstract #388  -  Confidence in, adherence to and the social impact of HAART for patients followed over 6 years in Senegal
Session:
  24.2: Adherence (Parallel) on Monday @ 16.30-18.30 in HC Chaired by Ana Josefina Guell, Rahul Battcharya
Authors:
  Presenting Author:   Dr Khoudia Sow - CHU Fann, Senegal
 
  Additional Authors:   
Aim:
To analyze the evolution of confidence in, adherence to and the social impact of HAART treatment for patients who were treated for 6 years.
 
Method / Issue:
Results were drawn from a qualitative ethnographic survey through semi-directed interviews and discussion groups with 25 key patient-informants who had been followed since 1998. Approximately 100 semi-directed, in-depth, repeated interviews took place between 1998 and 2006. Six focus groups were conducted and family-tree diagrams were drawn up for the patient-informants. Among the 25 patients, 19 were treated with ARVs, and 6 who did not require ARV treatment received medical follow-up; 15 were alive in 2006. A new series of semi-directed in-depth interviews was conducted with these patients and 12 new patients in August 2006.
 
Results / Comments:
- The evolution of the representations of AIDS has been marked by demystification and minimization of the illness as well as disassociation of AIDS from death; we also noted the abandonment of the notions of guilty or victim, linked to condemned sexual behavior. - High levels of confidence in ARVs and high adherence were observed despite an increase in visible side effects (lipodystrophies). Nevertheless, voluntary therapeutic breaks in treatment, generally unknown to the prescriber, are frequent. These transitory breaks are experienced as periods of "purification and detoxification" that facilitate the return to and pursuit of treatments. - Free access to ARV treatments facilitates access to care, even if added costs are still considered excessive for the most impoverished. - Relations with doctors seem to be becoming increasingly technical; consultations are experienced as simple routine visits to renew prescriptions; the demand for psychological monitoring and support has decreased. - Sexual relations appear less guilt producing but patients attest to difficulties linked to using condoms and complain about the lack of precise information on the risks of HIV transmission associated with ARVs. - The proven effectiveness of ARVs on health, confirmed by the interpretation of exam results for viral loads that have become "undetectable," pushes many patients to minimize the risk of sexual transmission of HIV. - The desire to have a child is alive, and we observed an increase in the size of the families of patients on ARVs. "ARV babies" are described as proof of ARVs non-toxicity; this reinforces the normalization process that is in progress. - The study noted progressive disinterest in and disintegration of the interlinking ties to community structures with simultaneous strengthening of social ties to the family and social environment.
 
Discussion:
- Long-term positive impact of ARVs in patients lives with a process of strengthening social ties. - Discrepancy between living an increasingly normal existence with HIV/AIDS and the persistent pejorative social representations. - AIDS is being experienced more and more as a chronic disease. - There is a genuine risk that doctor contact for treatment is increasingly technical with less emphasis on patient support, despite the emergence of new needs to support patient adherence over the long term. - Our communication will discuss the necessity to redefine strategies to monitor and support PLWHA treated with HAART, while taking into account the treatment experiences of patients suffering from chronic diseases (diabetes, hypertension).
 
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