Experiencias de homofobia y adherencia al tratamiento antirretroviral (TAR) en hombres que tienen sexo con hombres (HSH) / Experiences of homophobia and adherence to antiretroviral treatment (ART) in men who have sex with men (MSM)

Resumen El objetivo del estudio fue conocer la relación de las experiencias de homofobia con la adherencia al tratamiento anti-retroviral (TAR) en hombres que tienen sexo con hombres (HSH). Para ello, se realizó una encuesta transversal con una muestra por conveniencia de HSH que vivían con VIH (n=340) atendidos en dos instituciones públicas de salud de la Ciudad de México. La información sobre la adherencia al TAR en el mes previo de los participantes y sus experiencias de violencia, discriminación y homofobia internalizada se recopiló mediante un cuestionario. Entre 14% y 33% de los HSH reportaron alguna experiencia de discriminación y entre 41% y 60% experimentaron violencia. Cuando los HSH habían experimentado ambos tipos de estresores, el riesgo de baja adherencia TAR fue mayor (RP=6.49 para mes previo) que cuando habían experimentado sólo una de ellas (RP=4.36 para violencia y RP=5.67 para discriminación). Los profesionales de la salud deben ser sensibles a cómo el ambiente sociocultural puede afectar las prácticas de autocuidado de HSH, incluyendo la adherencia al TAR.

Abstract The aim of the study was to know the relationship of homophobic experiences with adherence to antiretroviral treatment (ART) in men who have sex with men (MSM) in Mexico City (CDMX). A cross-sectional study was conducted with a convenience sampling of MSM who lived with HIV, treated at two public health institutions at Mexico City (n=340). A questionnaire was applied to record information related to the adherence to ART of the participants and their experiences of violence and discrimination associated with homophobia and internalized homophobia. Between 14% and 33% of MSM reported experiences of discrimination and between 41% and 60% experienced violence. When participants had jointly experienced both types of stressors, the risk of low adherence to ART in the previous month was higher (RP=6.49) than when they had experienced only one of them (RP=4.36 for violence and RP=5.67 for discrimination). Health professionals must be sensitive to how the sociocultural environment can affect self-care among MSM including ART adherence.

Satisfaction with Healthcare Services and Adherence to Antiretroviral Therapy among Patients with HIV Attending Two Public Institutions.

BACKGROUND: Discontinuation of antiretroviral therapy has adverse consequences in HIV patients and is a major public health problem. We analyzed the relationship between satisfaction with healthcare services and adherence to antiretroviral therapy among patients with HIV in Mexico City. MATERIAL AND METHODS: We conducted a cross-sectional study with patients with HIV (n = 557) who were treated in two public institutions. An ad hoc questionnaire was used to assess perceived satisfaction with healthcare services (i.e. physician/patient relationship, performance of services, and administrative aspects with focus on specific areas) and adherence to HIV treatment (i.e. failure to take antiretroviral therapy on previous day, week, and month). RESULTS: The higher prevalence of non-adherence to antiretroviral therapy was during the previous month (23.5%). Dissatisfied patients with the relationship with their physician were more likely to have low adherence during the previous month (OR: 1.90; p < 0.05). Those who were dissatisfied with the care provided in specific clinical areas had low adherence (OR: 1.67; p = 0.051), but the difference disappeared (OR: 1.26; p = 0.443) after adjusting for satisfaction with physician/patient relationship. CONCLUSIONS: The quality of the relationship between physician and patients is an aspect that impacts on adherence to antiretroviral therapy. It is necessary to promote effective communication between health personnel and patients with HIV.