A narrative inquiry of socio-cultural influences on Antiretroviral treatment and medication experiences of African-born persons living with HIV in Minnesota

Abstract

Background: The number of new cases of HIV among African-born persons living in Minnesota continues to be disproportionate compared to other racial/ethnic groups. Consequent to the development of effective antiretroviral (ARV) medications, HIV is now a chronic and manageable disease. By implication, persons with HIV live much longer but also engage with healthcare continuously and need to be on medications. However, there is limited knowledge regarding HIV treatment and the medication experience of African-born persons living with HIV. Study Aims: The aims of this study were to - - Capture the lived experiences of African-born HIV positive patients’ who are taking ARV treatment (Aim 1); - Reveal the cultural and personal beliefs as well as socio-economic factors about medications of African-born HIV positive patients (Aim 2); - Understand the influence of these beliefs and impact of economic factors on their decisions to follow ARV treatment (Aim 3); and - Explore patients’ perception of clinical pharmacists’ roles in fostering adherence to ARV therapy (Aim 4). Methods: A qualitative approach was used for this study. African-born persons living with HIV (PLWH) in Minnesota were recruited from pharmacies and HIV treatment centers. Narrative Interviews with 14 participants lasting up to two hours were conducted over five months. All the interviews were audio-recorded and transcribed verbatim. Conventional Content Analysis was used to analyze the data. Dedoose, a qualitative software program was used to code the data. Results: Eight participants were female, and six were male. The participants were originally from seven different African countries. Analysis of interview data resulted in ten distinct themes that relate to the study aims. These included: Theme 1: Lack of awareness of symptoms of HIV Theme 2: Cruel News:” HIV-Oooooo! I wish I was dead” Theme 3: “This is my secret!” Theme 4: The impact of stigma: “Stigma and HIV are brother and sister” Theme 5: The power of spirituality and prayers Theme 6: The significance of taking ARV medications: “To exist I have to take the medicine” Theme 7: Barriers and Facilitators in taking ARV medications Theme 8: Accessing the U.S. healthcare system Theme 9: Role of Herbal Remedies in Their Treatment Theme 10: Interaction with pharmacists Conclusion: Findings from this study showed that lived medication experiences of African-born PLWH focused on “staying alive” and learning how to navigate an unfamiliar U.S. healthcare system. Cultural beliefs from their country of origin persisted and resulted in stigma at individual, familial, and societal levels. The most significant personal belief to help each participant was a strong belief in God. The participants highlighted their perspectives on the importance of adhering to the prescribed medications. This study also showed that participants were generally unaware of the potential roles that pharmacists could play in their ARV medication management. When interacting with African-born PLWH, pharmacists need to take into consideration the social and cultural factors that may significantly influence adherence to their ARV medications. Pharmacists also need to be aware of differences in healthcare policies and processes in the home countries of these patients and how these may shape their perceptions of HIV care, especially regarding confidentiality.