This paper explores the Theory of Behaviour Change with a view to increasing adherence to antiretroviral medication for the treatment of Human Immunodeficiency Virus (HIV) within three specific populations. The target populations chosen include men who have sex with men (MSM), prisoners, sex workers, and youth below 29 years old. Theories of Behavior Change include the Health Belief Model, Social Cognitive (or Learning) Theory, Theory of Reasoned Action, and Stages of Change Modelwill provide the framework for discussion. Behavior change theory identifies specific strategies that enable individuals to identify behaviours that place them at risk, and strategies to adopt healthier behaviors (Longmire-Avital B, Golub A, & Parsons ,1).
Adherence is defined as taking the correct dose of a prescribed medication at the recommended time (1).In other words, HIV-infected patients need to adhere to the proscribed HIV medication that aims at ensuring enough level of drug within the body at all times. It is then that the body will be able to successfully halt the replication of HIV and suppress the viral load. In other words, effective treatment of HIV using antiretroviral therapy (ART) is measured by an individual having an undetectable HIV viral load and CD4 levels above 500 cells/mm3. (Drug resistance may occur within the blood of the patient in case the drug level in the blood goes below the recommended level (MacDonell, Jacques-Tiura, Naar, & Fernandez (2). The same study denotes that in case HIV drug resistance occur, the drugs used may fail to work properly hence limiting the future of treatment options for the patient. The behavior may as well be transmitted to other HIV-infected individuals making it harder for effective management of other infections in the body. Strict adherence to the use of HIV medication is essential to a sustained HIV suppression, overall health improvement, reduction in the risk of drug resistance, survival and quality of life as well as a decrease in the transmission of the disease Mountain et al (13). Quinn, Sanders, and Petroll (3) denote that poor adherence is the primary cause of therapeutic failure. The same study denotes that the adherence to ART medication is vital and a primary determinant of long-term outcome in patients living with HIV. For most chronic illnesses such as hypertension or diabetes, the regimens of drugs remain effective even when treatment is resumed after a period of interruption. For HIV infection, however, loss of virologic control due to lack of sufficient ARV load in the blood can result in the emergence of drug resistance as well as the loss of future treatment options. Therefore, ost of the patients initiating Antiretroviral Therapy or are taking therapy can maintain a consistent level of adherence depending on the resultant viral suppression, improved clinical outcomes, and CD4 recovery as pointed out by Giannattasio, Albano, and Guarino (4). Other patients, however, tend to have poor adherence from experience periodic lapses or onset of the treatment process and over the lifelong process of treatment. As a result, the identification of patients with adherence-related challenges who need attention and implementation of appropriate strategies that can help them in enhancing adherence is an essential role of every member of the treatment team.
From a patients’ perspective, Naar-King et al. (7) denote that nonadherence is a consequence of behavioral, psychosocial, and structural barriers. These include high alcohol consumption level– subjective), mental illness, low health literacy, stressful life events, low social support, and stigma among others. It is hence clear why the behavioral theory postulates that the behavior of an individual is influenced by the environment which in turn influences the healthy decision-making and action of the individual. In a systematic study, Hussen et al. (6) denote that adherence to HIV medication (tends to be) influenced by factors such as prescribed regime, the social situation of the individual, and patient-provider relationship. It is, however, essential to understand that information alone is not sufficient in ensuring a high level of adherence as patients also require being motivated to both initiate and maintain therapy.
Reducing the burden of diseases is a global health goal that requires the adoption of interdisciplinary perspectives. It is diseases and injuries whether inflicted by others, self-afflicted, or unintentional are all destructive, hence should be prevented to maintain a healthy body as pointed out by Kurti et al. (8). Therefore, engaging in behaviors which lead to violence and injuries such as rape and drug abuse can lead to disease infection and spread, hence is amenable to various preventive interventions. Theory of Behavior Change adoption is an essential part of a comprehensive disease prevention, management, and control.
Many studies on the adoption of the Theory of Behavior Change denote that behavioral theory, behavioral science application to injury prevention, disease management, and health awareness lagged behind other approaches towards the end of 20th century (1). Despite the recognition of the theory by medical professionals of the importance of behavioral skills on chronic disease management and control, behavioral solutions to managing these diseases were deemphasized for a long time. Nokes et al. (9) point out that scholarly attention has been given to evaluating and understanding the determinants of HIV management and control as well as how to initiate and sustain HIV control, management, and prevention such as proper adherence to HIV medication. Kurti et al. (8) report that more research needs to be done to demonstrate the positive impact of adopting the knowledge of theory of behavior change to sex workers, prisoners, and young people below age 29. Such studies will be essential in helping the HIV-infected individuals within this vulnerable population to understand how they can increase their level of adhering to HIV medication through a change in their behavior. The same studies can also shade more light in the reasons why most of the HIV-infected within the three targeted groups can adopt behavioral characteristics that will reduce their chances of adhering to the drugs. Strategies aiming at better health can then be adopted by health professionals in teaching them on the importance of adhering to HIV drugs to ensure reduced risk of transmission as well as a prolonged healthy life while living with the disease.
Songyuan et al. (10) point out that it is a challenge to ensure that a patient adheres to HIV-medication. The same study denotes that reaching the HIV-infected among this population is difficult as a result of various complexities that prisoners, sex workers, and the young people below 29 years experience. It hence requires creativity among the healthcare providers to be adopted to ensure that trust and mutual acceptance is built with the HIV-infected individuals. Building the trust will help the medical practitioners and the patients to set achievable goals and resolve challenging issues such as low self-esteem, stigma, and substance abuse among other mental health issues according to MacDonell et al. (2).
Hussen et al. (6) also assert that it is essential to identify friends, family, health team members of the HIV-infected who at the end will be vital in supporting the adherence goals. Once they are identified, there is a need for educating them on the critical role of HIV drugs adherence so that the HIV-infected individuals will be aware of the possible consequences that can affect them. Nokes et al. (9) point out that there is a need for every individual to understand the relationship between resistance and partial adherence as well as the possible impacts of the other drug regimen choices in the future. It is a strategy that will help in designing a treatment plan that both the family and the patient understands as well as they feel committed to achieve.
Sex workers-Female sex workers in Australia are among the populations at high risk of HIV infections, an aspect that requires effect monitoring of their ability to adhere to the use of HIV drugs. Therefore, they remain among the key population whose behaviors need to be studied to understand how it affects their adherence to HIV medication. Songyuan et al. (10) asserts that the prevalence of HIV among both male and female sex workers is documented to be disproportionately high despite the decade’s awareness and prevention activities in most countries. In Australia, however, sex workers have been known to practice safe sex more effectively than heterosexual Australians. HIV medical adherence, however, is still necessary irrespective of the practicing safe sex. The theory of behavior change adoption by medical practitioners with sex workers as the target population helps in designing more effective interventions aimed at promoting treatment adherence across various behavioral issues.
Young people below 29 years also require being well equipped with the knowledge and understanding that their behavior has an impact on their health status. Behaviors like excessive use of alcohol and other drug abuse issues are likely to reduce their ability to adhere to HIV-medication. For example, when an individual is too drunk to remember the right time for taking the medication, there is a high chance of not adhering to the effective use of the HIV-drugs. MacDonell et al. (2) point out that there is a need for community-based support strategies such as counseling to encourage young people below 29 years to adopt a behavior that will not limit them from effective use of the HIV-medication. Stigam is a big challenge for young people living with HIV, an aspect that requires the medical professionals to adopt strategies that will help the HIV-infected accept their health condition and live positively with the disease. These include encouraging them that there is still more in life to live for and they can still progress irrespective if the infection. Therefore, they need to take the HIV medication which they are required to adhere to as per the instructions provided by the medical professionals.
Men having sex with men- Social cognitive theory of behavior change postulates that additional self-influences are vital for a behavior change to occur despite the fact that the knowledge of benefits and health risks are a prerequisite to the same change. Beliefs that regards personal efficacy is a big influence mostly experienced by men having sex with men, an aspect that plays a vital role in their behavior change Mountain et al. (13). Social outcomes may also result from social disapproval or approval of an action. With the understanding of the theory, adherence to HIV-medication as a behavior can only enacted among the HIV-infected among this population perceive that they have control over the behavioral outcome. Men having sex with men have not fully gained social approval among the Australians. It is thus necessary for medical practitioners to ensure that this population understands the health risks behind lack of adherence to the HIV-drugs.
Succeeding in the use of HIV medication among the sex workers, young people below 29 years, and men having sex with men not only require a comprehensive approaches towards sexual risk reduction and amelioration of risk compensation. The process also requires an effective adherence to the HIV medication for the HIV-infected within this population. Adopting the theory of behavior change hence help in developing integrated behavioral integration aimed at improving adherence among the three populations. It means that failure in directly addressing the behavior of the HIV-infected and the impact it has on their HIV medication adherence will compromise the knowledge of the patient son risk behaviors, a factor that will undermine the effective use of HIV medication among individuals living with HIV among the sex workers, men having sex with men, and the young people below 29 years. Adopting the theory of behavior change among the three populations is hence vital in helping them to understand how any form of negative behavior such as excessive use of drugs can reduce their effective adherence to HIV medication.
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