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November 06, 2015

Adherence and Managing HIV

Mornings are generally pretty routine. Most likely, I am waking up on the couch after making it less than 10 minutes into one of my ‘go-to bedtime movies’ the night before. Once stirring, I put the dog out and I shuffle up the stairs to dress. A relatively simple wardrobe of infinitely interchangeable pieces has removed any prolonged debates concerning what to wear. Back down, dog in and quick stop at the dining room table. I unscrew the bottle of Stribild and tip it into my hand to present an oblong muted minty colored tablet. The same happens with citalopram and a daily over-the-counter allergy medication. Soon, I am out the door and on my way to get my coffee and the uncertain part of my day is underway.

Preventing HIV Through Adherence

Why am I telling you this? In a word, adherence. If you have been living with HIV for any period of time, this is not a new concept. We have all been engaged in discussions with our pharmacists and prescribers about finding a regimen to fit our anatomy and life styles. If you’re not living with HIV, but are actively reducing risk by way of PrEP (pre-exposure prophylaxis) this concept is probably a little newer for you. Between them there is a common theme. Taken daily, HAART (highly active antiretroviral therapy) and PrEP both reduce the respective patient’s ability to transmit or contract HIV. This. Is. Huge! As a society living with those affected and infected, we’ve achieved the best-to-date methods of preventing the spread. Obviously not the cure, but arguably the closest thing we have. All of it achieved through adherence.

Referring back to my story about the placement of my medication on the dining room table, just for the record–that was not their first home. First, I tried put them in the bathroom. But then, I scratched the idea because the room was small and retained too much moisture. I was paranoid. Next, the kitchen. This too was short lived. As a single man, the kitchen is probably the room I spend the least amount of time in. Night stand, little keychain thingy, pillbox, shelf by the door…no, no, no and nope. Soon, in spite of voices warning against my clutter, I left them on the dining room table. After several months of not forgetting to take them, I will probably never keep them anywhere else.

Forgetfulness Happens

In spite of my overall success, I do forget to take my medication from time to time. Waking up late, getting distracted with an unexpected mess from pets or scrambling to hustle the garbage can to the curb are all among reasons I have forgotten to them. A pharmacist will read this and scowl, but it is okay. If you forget, don’t panic!

Just take it when you remember if it is still within 12 hours of your regular dose time. If more than 12 hours have passed, just take it the following day. Occasionally missed doses are not going to present a real threat. When we go multiple days without treatment, stop and start regimens without physician consultation and skip them altogether is when we open the window for the virus to mutate, adapt and multiply.

Our Struggles Are Unique

For others living with HIV, the struggle isn’t quite as suburban. Some are homeless. Others are in and out of dynamic life situations where mobility is key to survival, and burdening yourself with unnecessary things is a liability. Hardship is a prevailing theme among those living with HIV, which has a lot to do with why 7 in 10 HIV positive men and women are not engaged regularly in care. It’s hard to ask someone to be concerned about managing their HIV when they aren’t entirely sure when they will have their next meal.

So how do we cover the vast area which exists between “not at all” and “never missed a dose”? For those living with HIV, the answer is different for each of us. For me, it was moving the medication to the dining room table. For another it will be stable housing, secure income, access to insurance or providers. No one definite thing has proven to be a universal catalyst for engaging care. Our needs are as specific as a fingerprint, but across the spectrum of people living with HIV our basic needs are the same, as are our vehicles for success. Viral suppression is allowing HIV+ people to have robust and long lives. Pre-exposure preventative measures are allowing at-risk HIV negative people to drastically reduce likelihood of contracting the virus.

Medication alone is not the answer. All regimens are administered with guidance from professionals concerning potentially harmful behaviors and side-effects. But successfully managing HIV without medication is impossible, and the benefits of adherence ripple out into our community in the form of our aging members and long-time survivors.