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Social Structural : Patterns of Inequality, e.g., stigma, gender inequality

A Social Model of Adherence for sub-Saharan Africa Ware and Bangsberg PLoS Medicine (in press). Relationships as resources to overcome economic obstacles to adherence. Adherence fulfills responsibility to helpers and preserve relationships as a resource. Social Capital.

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Social Structural : Patterns of Inequality, e.g., stigma, gender inequality

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  1. A Social Model of Adherence for sub-Saharan Africa Ware and Bangsberg PLoS Medicine (in press) Relationships as resources to overcome economic obstacles to adherence Adherence fulfills responsibility to helpers and preserve relationships as a resource Social Capital Improving Health Social Structural: Patterns of Inequality, e.g., stigma, gender inequality Individual: HIV knowledge Med side effects Cognitive function Mental health Alcohol Use Resource Scarcity Resource Scarcity Infrastructural: Few treatment sites Distance to care Cost/Availability of Transportation Cultural: Religious Beliefs Respect for Authority Importance of having children

  2. How to improve adherence • Patient factors: • Treatment preparedness; knowledge about HAART , encourage disclosure • Treat depression • Minimise alcohol / drug use • Food security • Pregnancy • Adolescence • Stigma • Medication factors: • No stock outs • Minimise no. of tablets and doses • Minimise diet restrictions & fluid requirements • Minimise adverse effects • Provider factors: • Maximise clinician experience • Supportive and caring programme • Monitor adherence and act on problems early • Clinics easily accessible (in place and time!) – cost to patient.

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