Comments on: Promising HIV Preventative Failed, It Turns Out, Because Patients Were Not Taking It

By: Lena

Lena — Fri, 23 Mar 2012 17:03:37 +0000

Geack, MSM is an acronym for “Men who Sleep with Men”.

By: Geack

Geack — Wed, 21 Mar 2012 16:01:28 +0000

@16,

What’s MSM?

By: R2

R2 — Tue, 20 Mar 2012 03:24:14 +0000

@2,15

Does it actually apply anywhere? MSM to Women, not just among MSM. The whole downlow thing seems a bit scarce on the evidence and high on the homophobia.

By: Geack

Geack — Mon, 19 Mar 2012 19:25:52 +0000

@2 NJEM,

Your assumption about “bi or gay male partners” doesn’t apply in Africa, where most HIV transmission is through hetero sex.

By: Arakiba

Arakiba — Sun, 18 Mar 2012 14:25:46 +0000

Their men didn’t want them or let them take the medicine, maybe?

By: Kayla R.

Kayla R. — Sun, 18 Mar 2012 02:48:23 +0000

Christine-
If you doubt that more education is what is needed, what exactly in your opinion would help these women see their error?

If it is as you say, and even highly educated people make poor decisions when the long term effects are uncertain, then wouldn’t you agree that at least in terms of those effects, they are NOT highly educated (in other words, people make poor decisions when they are not well educated about the consequences of those decisions)? So then, shouldn’t it follow that education about the consequences of not taking the pills faithfully should be improved?

The statement that making poor decisions in the face of uncertainty is “human nature” is actually in SUPPORT of better education.

By: John

John — Fri, 16 Mar 2012 19:15:02 +0000

In addition, study after study has shown that only about 50% of patients take their medication for anything – from high blood pressure to diabetes. Patients are more likely to take meds for acute conditions with ill effects – for example, taking antibiotics for a strep throat. For prevention, or illnesses with no ill effects, such as high blood pressure, the incidence of taking meds is even lower than 50%.

By: John

John — Fri, 16 Mar 2012 19:11:27 +0000

I am tired of the “better education” meme.
We need people to use the one proven effective preventative method – which most people on earth know about – condoms.

By: christine

christine — Thu, 15 Mar 2012 22:56:38 +0000

It would probably be easy to shake our head at these women, but, if I am frank with myself, I think I would probably lapse as well. These are healthy women who are simply not expecting to become HIV positive any more than you are I are expecting to become HIV positive. If there are any side effects whatsoever, they are probably thinking that the actual disadvantages outweigh the theoretical disadvantages. Let’s be honest – how many of us have faithfully adhered to our fish oil pill regime? I doubt that more education is what is needed, either. Highly educated people make very poor decisions when the long term effects are uncertain. That is human nature.

By: Katherine

Katherine — Thu, 15 Mar 2012 14:46:05 +0000

While I think the point about stigma is good, a description of the side effects might help explain some of the problems with medication adherence. (Many researchers and advocates prefer to use “adherence” which suggests the doctor and the patient are a team treating the disease instead of “compliance” which suggests the patient is subordinate to the doctor in managing their own body.)

Medication adherence is complicated and difficult: it involves issues of cost, access, stigma, time, scheduling, and managing side effects. That’s why medications in clinical trials are generally compared on intent-to-treat (who got what medication) not adherence or compliance (who took what medication) because an effective medicine is only effective if people can stand to take it. As scientists have discovered, blaming people who don’t take the medication is myopic, ignores contextual factors, and impedes medical progress.

Using the example in the article, side effects do help explain early discontinuation of TB medication–there can be severe gastrointestinal effects. People who miss their medications aren’t always just forgetting, they may be dealing with daily vomiting or other effects that can be hard to manage.