Social Position as a Structural Determinant of Adherence to Treatment in Women Living with HIV/AIDS

Adherence to treatment has been a matter of priority in the control of the HIV/AIDS epidemic. Due to the characteristics of the virus, adherence of at least 95% is necessary for the continuing suppression of the viral load, and to prevent the risk of AIDS progressing (Bangsberg et al., 2000). In view of the chronic nature of HIV/AIDS, and the benefits offered by antiretroviral therapy, a sufficient rate of adherence is essential for world public health. There have been many efforts to control the behavior of people who suffer from HIV, in order to ensure that they follow their treatment instructions carefully. Nevertheless, in the conceptualization, research and intervention on the field of adherence, determinants of a general nature which could affect it have been seen as a minor issue. Much of the research on HIV/AIDS adherence has been rooted in biomedical and behavioral approaches. Studied variables include age, gender, education (Carballo et al., 2004; Glass et al., 2006; Godin et al., 2005; Gordillo et al.,1999; Ickovics & Meade, 2002; Mocroft et al., 2001; Spire et al., 2002; Sternhell & Corr, 2002), health beliefs, coping styles, self-efficacy, control perception, stress, anxiety, depression (Chesney, 2000; Ingersoll, 2004; Turner-Cobb et al., 2002), pharmacological regimen, side effects, relationship with health care providers, geographical barriers, and social support (Burke et al., 2003; Chesney, Morin & Sherr, 2000). Despite wide research on this topic, studies have not reach conceptual explanations about the relation between adherence to treatment in people diagnosed with HIV and structural determinants such as social position. Drawn from the current vision studying adherence, its definition has been limited to the degree that patients complete behaviors like following healthcare provider’s instructions, taking antiretroviral medication and attending medical appointments. The gender perspective has also been restricted in spite of reports that compared to men, women face additional barriers including delays in medical attention, non-use of antiretroviral therapy, lack of financial support, poor quality of health care, and difficulties related to the doctor–patient relationship (Ickovics & Meade, 2002, Jia et al., 2004). To complement the current biomedical and psychosocial view to the study of adherence in HIV cases, this chapter presents an approach from the social determinants of health focus. In