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What If a Person Refuses to Take HIV Medications?
May 18, 2016

Hi B.Y, I have a female family member aged 20 was diagonised positive in June, 2015. Her CD4 was 200 and viral load 35, 000. Was started on ARV, but the major problem we have is that the patient smokes and on binge drinking thus consistence in taking medication is not there. In October 2015, CD4 dropped to 106 and viral load shot to 100, 000. Patient was spoken to by the family Doctor and started medication. In December 2015, the CD4 rose to 350, but viral load test was not done. Patient was given 3 months medication as she was going to College. Regrettably, in April 2016, the CD4 dropped to 76 and viral load shot to 445, 000. And it was learnt that the patient was actually not taking medication, continued her smoking, binge drinking and possible re-infections. At the moment, the patient does not show any signs of sickness, refuses to take medication, refuses to meet family Doctor for review. As the family, we are concerned and helpless. What should we do to pursuade meet the Doctor and continue taking medication?

Response from Dr. Young

Hello and thanks for posting.

This must be difficult for your family and family member. There are a lot of reasons why individuals choose not to take HIV medications, but let's start be being very, very clear. Today's HIV medications are remarkably well tolerated, straightforward to take (as simple as a single pill a day), and very clearly prevent disease and death. Even in people who have very advanced HIV disease with low CD4 counts, they can reverse the course of illness and restore immune health. Moreover, HIV medications (in people with treatment-induced viral suppression) prevent transmission of HIV to others. The failure to take medications, especially in people with very low CD4 counts, like your family member, risks their lives.

A few years ago, IAPAC convened an international panel of experts who developed a set of recommendations to improve entry into and retention in care as well as treatment adherence for people living with HIV. These guidelines recognize the unique challenges for young positive people.

Why your family member doesn't want to take medications deserves a tremendous amount of non-judgmental discussion to understand her reasoning, and support to help her understand the rationale behind treatment, and that treatment is very well tolerated. Perhaps her previous regimen wasn't so well tolerated (a small minority of people do develop significant side effects, but alternative treatments typically addresses this issue); perhaps there are other issues related to stigma, disclosure or having a trusting relationship with her care provider that need to be addressed. While time is critical, it's important to acknowledge her ability to self-determine her path, and that a decision not to take medications today doesn't eliminate the possibility that she will tomorrow. My immediate advice is to not necessarily link pill taking to care. Encourage her to engage in care on her terms. Smoking and drinking are not (IMHO) reasons why she wouldn't be welcomed into our clinic, nor reasons why she couldn't be prescribed, or adhere to life-saving HIV medications.

Best wishes, and please feel free to write me back at this Forum. BY

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