The social realities of adherence to protease inhibitor regimens: substance use, health care and psychological states.

Adherence to HIV antiretroviral treatments is impacted by a variety of factors nested within the realities of people's lives. To understand this phenomenon, we undertook an investigation to assess HIV medication adherence in a community-based sample of 300 HIV seropositive men-who-have-sex-with-men (MSM). Using multiple measurement strategies (self-report, electronic monitoring, calendar-based assessments) we assessed factors related to medication adherence. Our findings indicate that adherence to protease inhibitor regimens are highly variable and are related to contextual, intrapersonal and behavioral factors, including access to health care, the use of specific recreational substances, self-efficacy toward adherence and avoidant coping strategies. These results suggest that a complex interaction between intrapsychic and socio-cultural realities may help to explain adherence to HIV treatment medications.