Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Danya Keene

Second Advisor

John Pachankis

Abstract

Worldwide, in 2012, there were about 35.3 million people living with HIV/AIDS (PLWHA).1 Antiretroviral (ARV) significantly improved the livelihood of PLWHA through virological suppression, which has reduced HIV related mortality rates, and decreased the risk of HIV transmission through vaginal and anal sex.2,3 Optimal ARV adherence, around 95%, is required to maintain virological suppression.29 In 2000, a review paper reported that nonadherence rates were around 50-70%.30 Suboptimal adherence can lead to increased mortality, HIV transmission, and ARV resistance.2,3 Global suboptimal illustrates the importance of identifying barriers and facilitators to ARV adherence.7 Research is urgently needed to determine important barriers and facilitators that are specific to developing countries.3 It is crucial to consider the unique ways local factors shape how PLWHA experience and understand their ARV medications.

The main objective of this qualitative study was to understand the ARV medication experiences of PLWHA in León, Nicaragua. 30 semi-structured, interviews were conducted in Spanish at the Hospital Escuela Oscar Danilo Rosales Arguello (HEODRA) Hospital in León, Nicaragua. A grounded theory approach was used to analyze interview transcripts. Religion emerged as a particularly salient aspect of the ARV medication experiences of HIV positive Nicaraguans. A close examination of the intersection of ARV and religious experiences may contribute to the understanding of major issues in PLWHA’s lives, which may contribute to ARV adherence. Interview data suggest that ARV medications were experienced in conflicting ways; namely as a source of life, and physical and social disruptions. Religion may reconcile this conflict by providing PLWHA with relief and resilience, which may reinforce their belief in ARVs’ life inducing qualities, in spite of physical and social disruptions. This mechanism may strengthen PLWHA’s commitment to their ARV medications, thus possibly facilitating ARV adherence. A notable exception emerged through religious faith and followers’ stigmatization of PLWHA.

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This is an Open Access Thesis.

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