| Background: China's free ART program began from a pilot of 100 HIV/AIDS patients in 2002, and expanded rapidly during the past eight years. By the end of 2010, more than 100,000 HIV/AIDS patients had been treated through this program. Under this potent medical intervention, significant reductions in mortality have been observed among treated patients. The current treatment evaluation system heavily relies on medical indicators, and little is known about the dynamic needs of HIV/AIDS patients and their family members, including supporting factors of treatment adherence in the era of HAART. The primary objective of this study is to understand and evaluate the medical and psychological needs of both treated HIV/AIDS patients and their family members, and to explore the supporting factors of treatment adherence.;Methods: This study was conducted in three ART hospitals in Luxi City, Dehong Prefecture, Yunnan Province. Between August 2010 and January 2011, qualitative in-depth interviews were conducted with 20 currently treated HIV/AIDS patients and 21 of their family members. A cross-sectional survey was conducted among 499 HIV/AIDS patients who were currently being treated with HAART and 302 of their family members.;Results: Patients on HAART who were infected with HIV though injection drug use and were current smokers typically had poorer physical health than other participants on HAART. Better financial status and better physician-patient relationship were associated with both physical and psychological well-being. Family awareness of the patient's HIV status was negatively associated with the patient's psychological well-being. Higher levels of perceived HIV-related stigma were associated with poorer psychological health and poorer family functioning. Of the 302 family members surveyed, 117 were HIV-positive and 72 of those were receiving HAART. Infected family members typically had lower scores on both the physical and mental component summaries of quality of life measurement. Factors associated with a better physical component summary included having better financial status, lighter care-giving burden, a stronger feeling of entrapment, being HIV-negative, and better patient quality of life. Factors associated with a better mental component summary included having better financial status, less tangible support, more affection from others, a lighter care-giving burden, and better patient quality of life. A strong desire to stay alive and concern about the family were the two most important motivations for adhering to treatment. For those with strong motivation, environmental factors and reminder methods to take doses on time were important for treatment adherence, and became deeply ingrained habits that ensure long-term adherence.;Conclusions: In addition to providing HAART only, China's treatment program needs to pay more attention to other medical issues that may have high prevalence among HIV/AIDS population. Moreover, support services should be integrated into existing medical treatment and the services should target both the patients and their families. The national physician training program should include more non-medical components in its training curriculum in order to improve the quality of service. Treatment adherence education should be implemented at the time of HIV diagnosis, and stimulating strong motivation should be the core components. Cooperation within the health system and between different government systems should be improved to ensure the continuum of treatment. |
