All the words had been spoken, but somehow the feeling still wasn’t right (Jackson Browne)

Sometimes one of the hardest aspects of caring for patients with HIV is getting the patient to take their medication.

We spend a lot of time and effort in our clinic supporting the patients who need to be on medications.  The doctors, nurses, social workers, even the nutritionists all talk to the patients about this.  And why don’t patients take their meds? Why, one might ask, when you have an illness that is almost always fatal, why would you not take the medication to treat it? Medication which, when taken correctly, can lead one to live a normal life span – barring additional illness or trauma.  Well, the answers vary as widely as the patients giving them.  For some the pills are a reminder of HIV, of its stigma and shame.  For some it’s the hassle and intrusion of pills, for some it’s the side effects – real or perceived.  Some patients feel entirely well and taking pills seems unnecessary no matter what the doctors say. Occasionally a patient denies that HIV even exists and the drugs are just another scam by the government and the drug companies. Some patients are just too disorganized, others too caught up in work or family or drug use (or some combination thereof!). The reasons are sometimes unknown. More than a few patients tell me they never miss a dose but when I tell them their blood tests reveal a different story they might say that yes, they were off the meds briefly when the blood was drawn but now they are taking their medications perfectly.  Or they might continue to say that they never miss a dose and cannot understand why the blood tests aren’t better.  We try to talk to them. The nurses will spend time reviewing the disease process and the importance of taking the meds. But when the visit is over the patient walks out the door.  It can be frustrating trying to help and knowing what is potentially in store.