Paradoxical effects of clinician emphasis on adherence to combination antiretroviral therapy for HIV/AIDS.

Constructive relationships between clinicians and patients being treated for HIV/AIDS are critical to treatment success. Trust, caring, and expertise have all been cited as important components of such relationships. As-yet unexamined, however, is the impact of the urgency patients sense in their clinicians concerning proper adherence to antiretroviral medications. Qualitative interviews (total, 214) from a study of adherence to highly active antiretroviral therapy (HAART) for active illegal drug users (n = 52) provided data for the analysis. Among other topics, interviews examined patients' perspectives on relationships with their providers. Study participants experienced their physicians as insisting on perfect adherence. Fearing disapproval if they disclosed missing doses, interviewees chose instead to conceal adherence information. Apprehensions about failing at perfect adherence led some to cease taking antiretrovirals over the course of the study. Well-intentioned efforts by clinicians to emphasize the importance of adherence can paradoxically undermine the very behavior they are intended to promote. Adherence can be approached in ways that inspire honesty and openness and build trust in the treatment relationship, laying the groundwork for a collaborative approach to solving problems in taking antiretroviral medications as prescribed.