ABSTRACT

In this chapter, we will show how HIV and AIDS have renewed interest in patients’ responses to medical treatment and, in particular, questions of adherence and compliance, the latter not being free of paternalistic (or even coercive) overtones. We will describe how issues of patient adherence came to the fore with the advent of highly active antiretroviral therapy (HAART), and will argue that two alternative and conflicting approaches persist. The first of these approaches aims to predict and correct non-adherent behaviour in patients, and sometimes suggests that such predictions may justify denying individuals treatment. The second, alternative, approach aims to offer support to all HIVinfected patients medically eligible for HAART through individualised plans to help facilitate the management of treatment in daily life. Both approaches encourage socio-behavioural researchers to increase their understanding of the determinants of adherence to treatment, but the demands they make on social science are quite different. The first ‘predictive’ approach mainly focuses on the identification of individual barriers to good adherence and calls for social interventions to help improve patients’ acceptance of prescribed regimens. The alternative ‘empathic’ approach emphasises the value of social science research in which patients’ subjective experience of illness is a central concern, and which aims to go beyond issues of adherence to promote a new type of physician/patient relationship based on shared decision making.