Although treatment advances have transformed HIV/AIDS into a severe but manageable chronic disease, a substantial proportion of persons living with the disease are not consistently receiving medical care and this prevents them from enjoying improved health and extended survival. Studies report that anywhere from a quarter to almost one-half of HIV-positive persons who know their HIV status remain outside ongoing HIV medical care. These patients tend to initiate ART later than clinically indicated and even when on therapy, do not adhere to their regimens, behaviors that result in high viral loads, low CD4-cell counts, preventable hospitalizations and increased morbidity and mortality. The extensive immuno-suppression these patients experience bolsters the virus'infectiousness and enhances its transmissibility thus contributing to the spread of the epidemic. Therefore, this phenomenon of large numbers of infected individuals remaining outside the health care system for long periods of time has significant clinical and public health implications. Although the existing quantitative studies on non-retention in HIV care have successfully identified a constellation of individual- and structural-level factors that hinder patients'ongoing engagement in care, there is a need for qualitative research that bridges these sets of predictors and explains how patients'lay beliefs about HIV and its treatment and attitudes toward health care providers and systems are linked to structural constraints. To achieve this goal we propose a primarily qualitative investigation of 120 HIV-positive hospitalized patients, who were diagnosed and aware of their HIV status for at least two years and have not seen an HIV outpatient provider in at least the past six months. The primary innovative feature of the proposed study is our use of Cockerham's model of health lifestyle as a sensitizing framework. Another is our conducting bedside qualitative interviews with hospitalized HIV-positive patients.
The specific aims are to investigate how: 1) the participants'lay beliefs regarding the nature of HIV disease and its impact on their health, functioning, and everyday life shape their health practices and lifestyles;2). the participants'beliefs about the risk and benefits of taking antiretroviral therapy shape their health practices and lifestyles;3) the participants'perceptions of and experiences with health care providers and health care institutions shape their health-related practices and their health lifestyles;and 4) the variety of structural constraints and opportunities participants encounter in attempting to protect and preserve their health (e.g., poverty, housing instability) shape their health practices and health lifestyles.
Although treatment advances have transformed HIV/AIDS into a severe but manageable chronic disease, a substantial proportion of HIV-positive persons are not consistently receiving medical care, and therefore, are not enjoying the benefits of these advances. This lack of retention in care has significant clinical and public health implications, such as low CD4-cell counts, preventable hospitalizations, increased morbidity and mortality, and high viral loads that enhance the transmissibility of HIV. To explore the underpinnings of this problem, we propose a primarily qualitative investigation of 120 HIV-positive hospitalized patients, who have not seen an HIV outpatient provider in at least the past six months.