**5. The social determinants of adherence to treatment of HIV/AIDS**

Based on the evidence presented, adherence to treatment can be considered as a dynamic process, which moves in a continuum between critical processes related to general determinants and critical processes related to individual determinants.

The critical processes related to general determinants are illustrated in Figure 4 and include consideration of the *social position* as a structural determinant of adherence. In every society and socioeconomic context value must be placed on the characteristics which jointly make up and define the "place" or social stratum of the person living with HIV/AIDS. In the level of the *health system*, the health right to continuous and opportune treatment and comprehensive care by qualified health care providers are necessary conditions for adherence on the part of those who suffer from the virus. For its part, the "*mode of living*" (Almeida-Filho, 2000; Breilh 2003), represents a bonding category between general determinants and the complex behavior of treatment adherence. This category can be considered as a related group of practices connected especially with adherence, influenced by people's living conditions, socio historical processes, the dynamics of gender pertinence, and the influence of social position.

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The critical processes related to individual determinants of adherence cannot be understood isolated from the general determinants described above, but rather, subsumed in them. The life course trajectories taken through life lead to different forms of facing up to HIV/AIDS and its treatment, and also, gender roles and their impact on adherence must be taken into account.

Contrary to biomedical and individualistic traditions, and from an approach of the social determinants of health, which offers a framework of theoretical, epistemological and praxiological comprehension on the health-related processes of social life (Breilh, 2003), adherence to treatment can be considered as a *complex behavior promoting adaptation, psychological adjustment, appropriate health care, and quality of life during the HIV/AIDS infection process, determined by mode of living, social position, and the health care system.* With this concept of adherence it is possible to broaden the vision, and attend to the specific matters which are imposed by the general determinants such as individual influences. The critical processes described here, not only when conceptualizing but also when investigating and intervening adherence to HIV/AIDS treatment.
