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Title: "It depends on our deep belief in the treatment and our values" : understanding HIV-positive drug users' experiences of taking highly active antiretroviral treatment in Taiwan
Author: Ho, Szu-Szu
ISNI:       0000 0004 7654 7694
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2019
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Background: HIV-positive drug users' poor adherence to Highly Active Antiretroviral Therapy (HAART) is a serious global health issue. Erratic use of HAART can result in incomplete viral suppression, increased Human Immunodeficiency Virus (HIV) transmission, development of drug resistance, and limitation of treatment options (Lima et al., 2008, Meresse et al., 2014, Sethi et al., 2003). In clinical practice, nurses play a key role in assessing and supporting HIV-positive drug users' health conditions and adherence to medication regimens during their treatment process. In that sense, it is pivotal to understand HIV-positive drug users' experiences of taking HAART in Taiwan. Aim: The aims of this research are to explore HIV-positive drug users' experiences of taking HAART in Taiwan, and further develop a conceptual model synthesised from the study findings and existing theories that can enhance understanding their experiences. Method: A qualitative study drawing from Constructivist grounded theory approach was conducted to achieve the aims. A sample of 22 HIV-positive drug users was recruited in Northern and Southern Taiwan between September 2015 and July 2016. Semi-structured in-depth interviews were conducted to explore participants' experiences of taking HAART. Data were analysed by using Charmaz's (2014) initial and focused coding principles. The integration and formation of a conceptual model began with focused coding and proceeded through the subsequent analytic process. Findings: Three major concepts emerged in the analysis: 1) HIV-positive identity as part of self-identity, 2) Values attached to HAART, and 3) Conscious Actions. The three concepts were integrated into a conceptual model, Identity-Values-Conscious Actions Model. This proposed model suggests that individuals' integration of HIV into self-identity can lay a solid foundation for self-acceptance and emotion stability. Having this integrated identity, the values individuals place on HAART play a central role in driving their HAART-taking. While the values individuals place on HAART can trigger behavioural changes, data revealed that implementation of conscious actions is an important element for behaviour maintenance. Conclusion: The following conclusions can be drawn from this study. Firstly, the model developed from the study findings can extend our knowledge and understanding of the mechanism underlying HIV-positive drug users' HAART-taking behaviour in the Taiwanese context, and can act as a new reference point to contribute to the development of adherence assessments and associated nursing interventions. Secondly, the findings of this study can draw policymakers' attention to HIV-positive drug users' voice, and suggest to influence policies that can lead to a more inclusive society. Finally, building on the findings from this research and previous studies, further work needs to be done to assess whether this model can be applied to help understand HIV-positive drug users' experiences of taking HAART in different social and cultural contexts.
Supervisor: Holloway, Aisha ; Stenhouse, Rosie Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: drug users ; Taiwan ; HIV-positive ; medication-taking behaviour ; Identity-Values-Conscious Actions Model ; HAART