amfAR, The Foundation for AIDS Research

Adhering to HAART: Challenges for Immigrant Latinos

by Jeffrey Laurence, M.D.

Highly active antiretroviral therapy (HAART) has dramatically improved the life expectancy of HIV-positive individuals. Its ability to lower viral levels in genital fluids is also having an impact on transmission. But these salutary outcomes assume that a person at risk for HIV is tested and takes these drugs. And that’s not always easy. Failure to adhere to a medication regimen has severe implications, including development of drug-resistant strains, but 95 percent adherence to even a simple twice daily regimen requires missing no more than three doses per month. At least one-third of HIV-positive individuals on treatment in the U.S. fail to do so.  

amfAR grantee Scott Rhodes, working at Wake Forest University, sought to identify limits to medication adherence among one particularly hard-hit group, immigrant Latinos. Writing in the December issue of Patient Education and Counseling, he and colleagues at Wake Forest and George Washington University note that, in general, demographic and environmental factors such as poverty and unstable housing, psychosocial factors such as substance abuse and depression, and treatment-related issues such as drug side effects and complex dosing schedules all contribute to failure of medication adherence.  

But what makes adherence a challenge for immigrant Latinos specifically? Latinos—especially those born in Mexico and Central America─are more likely than non-Latino African-Americans and Caucasians to receive an AIDS diagnosis only a short time after being identified as HIV-positive, indicating a delay in testing and seeking treatment.  

Twenty-five Spanish-speaking immigrant Latinos, 20 of whom were HIV-positive, were recruited from a North Carolina hospital and an AIDS service organization for this study. They were interviewed in-depth about HIV testing, treatment initiation, and adherence. None reported being tested before their present HIV diagnosis. Concerns about healthcare itself were not an issue. All 25 expressed high levels of confidence in U.S. physicians and HIV medicines.  

But subjects also reported beliefs that perceived side-effects of HAART, such as losing weight and “feeling drugged,” made adherence problematic. Poor communication due to language barriers with healthcare providers, appointment scheduling challenges, being reminded of their diagnosis each time they took their medications, lack of transportation, and fear of deportation were other impediments. In terms of HIV testing, increased risk of deportation as a result of accessing the health system and risk of social isolation if found to be HIV-positive were key issues.  

So what might be done to improve HIV testing rates and medication adherence among immigrant Latinos? The importance of overcoming communication problems and easing structural barriers, including transportation, inflexible appointment scheduling, unemployment, and immigration status, were stressed. Equally significant to study participants were the involvement of family, partner, or spouse, with participants emphasizing the importance of “having someone to live for” and their desire to harness “familismo.”