**9. Acknowledgements**

The authors wish to thank the participants that gave up their time for the interview and the staff of Resource Center, Port Harcourt, Rivers State Nigeria. Dr Anja Krumeich of Maastricht University The Netherlands is also thanked for her contribution in the designing of the questionnaire.

## **10. References**


for HIV test and get effective treatment. Proper counseling goes a long way to help PLWHA to accept their status and prepares them to live with HIV. Clearly, PLWHA need psychological, medical and material support. Access to antiretroviral drugs remains a very important step in the care of HIV patients because when people have access to drugs, their health greatly improves and they are less prone to complications so they can go to work,

The government should, as suggested by some of the participants, support PLWHA whose positive HIV status is exposed through creating a protective work policy and providing them with free ART, as this will be a motivator for other people with positive HIV status to come forward for help. The government should help in providing micro credits for those trying to set-up a living and doing business. This is important for PLWHA who are poor and jobless to enable them pay their user fees, buy regular drugs, do laboratory

Government should continue with efforts to educate the population on HIV/AIDS-related stigma which, when reduced, will enable people to go for VCT and seek appropriate care in health-care institutions in an early stage. Furthermore, education of people about the

Government should continue to involve and commit stakeholders such as media, religious and community leaders in educating people about HIV/AIDS, stigma and HIV/AIDS care as that will help people in making appropriate care choices. Policymakers should also involve PLWHA at all levels of consultation to ensure that all their needs are well represented. Special attention should go to youths through special targeted HIV/AIDS programmes. In addition, effective gender-specific policies that protect women but include the role of men should be integrated into programmes to ensure full utilization and support such as protection of women who find out their positive HIV status in antenatal care. Finally, the national HIV strategies should involve and support the members of vulnerable groups such as the association networks of PLWHA which are important to continue efforts

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**8. Recommendations** 

**9. Acknowledgements** 

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**Social Position as a Structural** 

**in Women Living with HIV/AIDS** 

*Department of Public Health & Epidemiology* 

*Pontificia Universidad Javeriana Cali* 

Marcela Arrivillaga

*Colombia* 

**Determinant of Adherence to Treatment** 

Adherence to treatment has been a matter of priority in the control of the HIV/AIDS epidemic. Due to the characteristics of the virus, adherence of at least 95% is necessary for the continuing suppression of the viral load, and to prevent the risk of AIDS progressing (Bangsberg et al., 2000). In view of the chronic nature of HIV/AIDS, and the benefits offered by antiretroviral therapy, a sufficient rate of adherence is essential for world public health. There have been many efforts to control the behavior of people who suffer from HIV, in order to ensure that they follow their treatment instructions carefully. Nevertheless, in the conceptualization, research and intervention on the field of adherence, determinants of a

Much of the research on HIV/AIDS adherence has been rooted in biomedical and behavioral approaches. Studied variables include age, gender, education (Carballo et al., 2004; Glass et al., 2006; Godin et al., 2005; Gordillo et al.,1999; Ickovics & Meade, 2002; Mocroft et al., 2001; Spire et al., 2002; Sternhell & Corr, 2002), health beliefs, coping styles, self-efficacy, control perception, stress, anxiety, depression (Chesney, 2000; Ingersoll, 2004; Turner-Cobb et al., 2002), pharmacological regimen, side effects, relationship with health care providers, geographical barriers, and social support (Burke et al., 2003; Chesney, Morin

Despite wide research on this topic, studies have not reach conceptual explanations about the relation between adherence to treatment in people diagnosed with HIV and structural determinants such as social position. Drawn from the current vision studying adherence, its definition has been limited to the degree that patients complete behaviors like following healthcare provider's instructions, taking antiretroviral medication and attending medical appointments. The gender perspective has also been restricted in spite of reports that compared to men, women face additional barriers including delays in medical attention, non-use of antiretroviral therapy, lack of financial support, poor quality of health care, and difficulties related to the doctor–patient relationship (Ickovics & Meade, 2002, Jia et al.,

To complement the current biomedical and psychosocial view to the study of adherence in HIV cases, this chapter presents an approach from the social determinants of health focus. In

general nature which could affect it have been seen as a minor issue.

**1. Introduction** 

& Sherr, 2000).

2004).

Vlassoff, C & Ali, F. (2011). HIV-related stigma among South Asians in Toronto, Ethnicity & Health, PMID: 21259140 **2** 
