Ethnography of Adherence to Plans of Care in the HIV Positive Patient

Human Immunodeficiency Virus (HIV) results in a decline in the body's ability to
fight infection as the illness progresses. Events contributing to disease progression
include the emergence of viral mutations and loss of T -helper cells. This results in a
decline in overall physical well-being. One explanation for this occurrence is lack of
adherence with recommended treatment plans that can result in viral mutations and
replication. The health care team establishes a plan to prevent or delay this decline in
health. Can clinicians expect absolute commitment to plans of care without their knowing
their effects on patients' life? This study was conducted to answer the research question,
"What is the culture of living with HIV as it shapes adherence to plans of care for
patients in south Florida?" in order to understand HIV positive patients' responses to
managing complex medical regimens. In an effort to understand the life-world and
experiences of patients who are HIV positive, an ethnographic study was conducted to explore how patients manage the daily demands of living with IDV. In addition,
environment of care was observed to determine if it influenced adherence to medications
and plans of care. Through the use of ethnography, interviews of IDV positive patients
were conducted, several of whom had significant adherence issues and one person who
might be considered an ideal patient. Several different settings were included in the
research to determine what impact environment had on patients' adherence to
medications and plans of care. Fear, trust, self-worth, literacy, financial and disease
specific themes emerged and lead to the development of a model for adherence to plans
of care for IDV positive patients. This model may enhance clinician/patient collaboration
to achieve maximized health and delay progression of mv disease.