Treatment Adherence among Native Hawaiians Living with HIV

The treatment of HIV disease with highly active antiretroviral therapy (HAART) is credited with extending the life span of people living with HIV (Centers for Disease Control and Prevention, 1997). The multidrug regime is not a cure, but does allow HIV to be managed as a chronic, life-threatening condition, rather than a terminal one (Chesney, 1997). Treatment efficacy relies on strict adherence to the regime as prescribed, which has been challenging for many consumers to achieve (Lsinsk & Bonk, 1999, van Roon et al., 1999). The study discussed in this article focused on HAART adherence among Native Hawaiians and is consistent with the profession's commitment to develop empirical knowledge to inform social work practice with culturally diverse and socioeconomically disadvantaged populations. This descriptive study is relevant because this population has high rates of AIDS and historic difficulty in using conventional health care services, often attributed to cultural conflict (Alu Like, 1985; Hawaii State Department of Health, 1998; Office of Hawaiian Affairs, 1995). The Native Hawaiian population is burdened by disproportionate rates of chronic health problems such as diabetes and cerebrovascular disease (Look & Braun, 1995). Mortality rates from chronic conditions are consistenfly higher among Hawaiians than any other ethnic group living in Hawaii, and no group has a lower life expectancy (Tsark, Blaisdell, & Aluli, 1998). Similar patterns of disparity in health status are emerging in the area of HIV. Notably, Native Hawaiians account for an increasing proportion of all AIDS cases in Hawaii (Hawaii State Department of Health, 1998, 2001). Although there is a growing body of literature examining adherence to HAART, no studies to date have focused on either a native population or a Pacific Islander group. Hawaiian health research documents that lifestyle changes recommended by Western health care professionals often raise issues of cultural imposition, which results in difficulty with treatment follow through and early termination of health services (Look & Braun; Tsark et al.). These findings point to the need for understanding the relationship of health-related behaviors and culturally influenced beliefs and practices. Native Hawaiian initiatives emphasize the fundamental differences between the traditional Hawaiian view of health as holistic and that of the biomedical paradigm reflected in conventional health care systems. Many of the issues raised by native researchers and providers are also of concern to the social work profession, including the need to clarify the role of cultural values and practices in human behavior and the need to develop interventions with an ecological view of health and build on cultural strengths (NASW, 2000). Although there is some research on HIV prevention among Hawaiians, to date there is no research related to the treatment of Hawaiians living with HIV and little research that considers how cultural beliefs and practices influence treatment outcomes among diverse ethnic groups affected by HIV (Mokuau & Kau, 1992). This study attempted to address these converging gaps in the literature and was guided by three questions: (1) How adherent are Native Hawaiians to a prescribed HAART regime? (2) What health beliefs and types of support are associated with adherence? (3) Are there cultural themes specific to Native Hawaiians that might be used to inform social services delivery? Adherence, Health Beliefs, and Perceived Social Support Adherence is a common problem across chronic health conditions and declines with regime complexity, duration, and degree of intrusiveness in daily life (Dunbar, 1990; Meichenbaum & Turk, 1987). HAART regimes often have strict scheduling requirements and detailed directives, may be complicated at advanced stages of HIV, and are complex when consumers are also prescribed drugs for medication side effects, prevention of opportunistic infections, and psychological distress (van Roon et al. …