Individual Variability in Barriers Affecting People's Decision to Take HAART: A Qualitative Study Identifying Barriers to Being on HAART

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Abstract
The efficacy of highly active antiretroviral therapy (HAART) has been well documented, particularly among HIV-infected individuals with CD4 cell counts below 200/mm3. Despite this, eligible individuals may continue to show some reluctance to use HAART. The present study explored the factors influencing patients' decision not to take HAART even though it was medically indicated according to current treatment guidelines and available at no cost to the individual. Fifteen eligible patients at an urban HIV clinic were interviewed regarding the barriers that affected their decision to decline HAART. Most participants had previous experience with antiretroviral therapy and though most believed that HAART was beneficial and felt confident that they could adhere to treatment, they did not feel HAART was the right choice for them at the present time. The Critical Incident Technique was used to identify and classify incidents participants identified as influencing their decision not to take HAART. A total of four categories emerged from the data: Medication Factors, Mood, Lack of Support, and Outcome Expectancies. The results of this study highlight the ambivalence individuals may feel when faced with the prospect of taking HAART. The extent to which each of these factors influenced their decision differed substantially among participants. Suggestions for possible clinical interventions that can be used to address these concerns are offered.