Sharing Strategies for HIV Adherency

I've been working with my host organization for two full weeks. I feel like I'm finally starting to get a feel for the place and develop a routine. The clinic is open from 8AM to 8PM, but most of the doctors work 4 hours shifts. I normally arrive a little after 3:30PM . This gives me a chance to chat with some of of the doctors hanging out in the kitchen before they work the last shift of the day. Everyone is very friendly and they LOVE drinking mate. (As a general rule, the easiest way to make friends in Argentina is to drink mate and talk about Futbol.) There are a variety of talented people that work in El Centro de Referencia. Besides the general doctors, there is also a Psychiatrist, a social worker, and an infectious disease researcher.

My supervisor, Dr. Cueto, usually arrives a little after 4 PM and gets started with his patients right away. I shadow him the entire time, occasionally leaving the room when patients want more privacy. I don't get offended when this happens; in fact I'm amazed that most patients are comfortable discussing very personal issues with me around. Shadowing Dr. Cueto for two weeks has helped me get to know a few of the returning patients who come in for HIV treatment. One of the biggest problems I have observed, and something I am becoming interested in, is the problem of adherency.

The municipality of Buenos Aires has a law that demands all HIV and AIDS medication to be administered free of charge. Unfortunately, this doesn't mean everyone who needs these medications will take them properly, or at all. For most Americans (myself included), it's hard to believe that free, life-sustaining medication would be willfully rejected with such frequency. But here in Argentina, a country accustomed to political and economic crisis, uncertainty is a way of life. In just the time I've been here, inflation has caused a 50 cent increase in the price of a bus ticket. Also, the Government recently decided to move up their October Senatorial election to June (much more on that in a later post.) This instability most affects those in or near poverty (like the majority of HIV patients), and it becomes a mindset they cannot escape from. If nothing is stable in your life, how do you learn dependability? Many do not and often fail to commit to a job, a family, or taking medication that will keep them alive.

The idea for my project is to identify patients who do not fit this trend. There must be several patients that manage, despite hard circumstances, to take their medications every single day. I want to know how these few patients do it, and then I want to help them share this information with others. My first task is to create a list of questions that will identify patients who successful adhere to their treatment. I need to keep in mind that many will not be truthful, so the questions should be detailed but not so detailed they become confusing. Then I will conduct the interviews. I will probably need to study vocabulary related to the questions and bring a a tape-recorder. Finally, I will hold a follow up session for patients who show strong adherency. I will have them discuss strategies for success and organize their responses into a pamphlet that I can publish and distribute. This will allow other patients to learn from their peers instead of doctors. It may even inspire them to work harder once they see that success brings positive attention.

I think this is a fairly manageable project, but as I said before, it is Argentina and I should expect the unexpected. One final point: last Friday confirmed how important the topic of adherency is, not just to the individual, but to public health. There was an AIDS patient who said he was taking his medications regularly, but was not responding to them. The doctors at the clinic ordered a genotyping analysis that was sent all the way to Stanford University. As it turns out, this patient developed a form of AIDS resistant to several drugs. Dr. Cueto is convinced this happened because he stopped taking his medication for a long periods of time. These expensive tests and the risk of unleashing drug resistant forms of the AIDS virus into the population would be unnecessary if this man simply took his medication everyday. But then again, it's never really that simple here.