| The HIV infected population in the Netherlands has evolved from being predominantly composed of Dutch homosexual males to a population of which immigrants form a substantial part. Immigrants were shown to have inferior virologic response to HAART compared to native Dutch patients. A qualitative study among immigrants revealed poor quality of life (QoL), and high levels of depression and HIV stigma concerns, especially fear of social exclusion. These are known risk factors for poor adherence. Recent studies have shown that reduced adherence is also driven by concerns about adverse effects of medication and beliefs about the necessity of treatment, which are often influenced by cultural background. We will investigate to what extent adherence to HAART can be explained by a model in which immigrant status influences adherence via HIV stigma, QoL, depression, social support, and beliefs about medication. This model will be investigated using structural equation modeling. Our sample will comprise 90 native Dutch patients and 90 immigrants on HAART. QoL, depression, HIV stigma, social support, and beliefs about medication will be assessed using validated questionnaires during an interview. Adherence will be assessed by comparing records of prescribed medication and pharmacy records of dispensed medication. Identification of key factors influencing adherence is a prerequisite for the improvement of existing and/or the development of new strategies to assist patients in taking their medication as prescribed. |
