| Since Hippocrates, health care providers have struggled with helping patients adhere to their prescribed medication regimens. Adherence averages 50 percent across therapeutic categories and across diseases, and is the single most important modifiable factor that compromises treatment outcomes.; Decades of behavioral research have failed to either identify the causes of medication non-adherence or impact low adherence rates. In the current neoliberal atmosphere with its emphasis on an economy driven medical marketplace and patient responsibility, medical protocol adherence takes on additional importance. Patients are held accountable for both exacerbating and alleviating their health conditions and must accept blame for their own illness and responsibility for their own care. Despite ideologies of personal empowerment, individuals' abilities to exert control over their own lives are often profoundly limited by the restrictions placed on them by the outside social and political power structures and the limitations of the biomedical megastructure. Medical cost managers focus on the bottom line, and non-adherence leads to increased costs.; Ethnographic methods were used to study the medical adherence behaviors and motivations of a sample of individuals who were currently taking antiretroviral medications for HIV/AIDS and were patients of an urban health clinic, rather than the quantitative methods typically used to explore adherence behavior. This research found that patient adherence behaviors were not simple, isolated behaviors but rather a group of complex, purposeful, often thoroughly thought-out and, to these patients, logical responses to the their socio-cultural positions and their roles within the biomedical environment. Through manipulating their medication adherence behaviors patients triggered events that allowed them to assert power and influence over people and situations in ways that were normally unavailable to them, permitting them to achieve important personal and social goals. Patients make choices about their medication adherence and in this neoliberal environment manipulating medication is an important patient tool that empowers patients in significant ways. This study suggests that patients will find it hard to relinquish this tool unless they are empowered in their lives in some other significant way. |
