The many advances in HIV treatment in the past twenty years have led to the approval of close to 20 HIV drugs. Using these drugs together in potent combinations has helped many people control their HIV and live longer and healthier lives.

However, the HIV drugs can produce potent side effects. They can also have complicated dosing schedules and food restrictions. This can make adherence (sticking to your pill schedule) seem very difficult to many people.

Adherence to HIV medication is important. HIV drugs need to be in your blood at certain levels to be effective. Dosing schedules are designed to maximize these levels. By not taking medicine on schedule, you risk allowing drug levels to drop. This may allow HIV to make copies of itself and even make changes (mutations). These mutations can help the virus survive, even in the presence of HIV medication. This is called resistance.

When HIV becomes resistant to a drug you are taking, that drug will probably stop working. This may lead to an increase in your viral load and a decrease in your CD4 cell count. At that point, you will probably have to switch to another HIV drug.

Resistance to one drug can sometimes also cause resistance to other drugs you have not taken. (This is called cross-resistance.) Resistance can affect your treatment options in the future by reducing the number of drugs that will work effectively against your virus.

The best way to prevent resistance is to adhere closely to your medication schedule. Some studies suggest that 95 percent adherence may be required to receive the most benefits from HIV treatment.

Many women find it difficult to take their HIV medication as prescribed for the following reasons:

• A busy lifestyle
• Not having disclosed their HIV status to work colleagues, friends, lovers, or family
• Depression, a leading cause of non-adherence, is more common in HIV+ women than HIV+ men
• Other life stresses, such as childcare or parenting issues
• Current or past problems with side effects
• Active substance use or alcoholism
• Cultural beliefs
• In America, women are less likely to have health insurance than men. Without health insurance, women are unlikely to be able to access adequate care and treatment
• Homeless women and women in prison face additional barriers to accessing treatment

Despite the complexity of women’s lives, numerous studies have found that they are just as likely to adhere to HIV regimens as men, especially when the women have a longstanding and trusting doctor-patient relationship.

Even though it may be embarrassing, it's important to tell your doctor about the number of times you have missed a dose or did not take it correctly. He or she may suggest a change in your dosing schedule or drug regimen that makes it easier. In recent years, some HIV drugs have become available that require fewer pills per day and have no food restrictions. There are also new ways to combine older drugs that make them easier to take.

Side effects are an important factor in determining whether women continue on their HIV drugs. While all of the HIV drugs can cause side effects, not everyone will experience them. It is a good idea to find out what side effects to expect before you start your drugs. Then ask your doctor how to manage minor side effects if they arise. You may want to stock up on doctor-recommended treatments for common side effects like nausea or diarrhea.

If you do experience a side effect, don’t just stop taking your pills. Follow the recommendations given by your doctor. If the problem persists, speak to your doctor about other solutions, including switching drugs.

• Believe that the medications will help you fight the virus and stay well. If you don't think so, you won't bother taking your pills right. If you have any doubts, speak to your doctor. Ask your doctor or pharmacist to explain exactly how to take your pills and give you written instructions. 
• Use a daily activity, one that you do every day without fail (like waking up in the morning or going to bed at night), to remind you to take your pills. When it’s time to do that activity, you will know that it’s also time to take your pills.
• If you don’t want others to see you taking your pills, quietly slip away to a secluded area or the bathroom. If that won’t work, say the medications are for another health problem or that they are vitamins.
• If you suspect substance use or mental health issues are preventing you from taking your medications correctly, talk to your physician or case manager so they can get you help. There are good treatments available.
• Take advantage of tools available from your clinic or pharmacy such as pillboxes, calendars, diaries, and beepers to help you remember to take your medications.

Adherence is hard work and takes a lot of commitment. It helps to have other people on your side. One way to do this is to put together a support network. Your doctor is one of the most important people in your network. Talk openly with him or her about how to fit HIV treatments into your lifestyle.

There are many other sources of information and support available to women who are taking or thinking about taking HIV treatments. If you can, include family, friends, case managers, treatment educators, and counselors in your network. You can also get involved with your local AIDS service organization or a support group . These are places where you will be able to ask questions and share experiences. When you are feeling discouraged, turn to your network for support and encouragement.

1		Cheever, L. (2001). Adherence to HIV therapies: A guide to the clinical care of women with HIV/AIDS, first edition. U.S. Department of Health and Human Services, HIV/AIDS Bureau: Retrieved July 2003 from http://hab.hrsa.gov/publications/womencare.htm.
2		Paterson, D. et. al. (1999). How much adherence is enough? A prospective study of adherence to protease inhibitor therapy using MEMS caps. Sixth Conference on Retroviruses and Opportunistic Infections, Chicago. Abstract 92: Retrieved July 2003 from http://www.thebody.com/confs/retro99/session15.html#92.
3		Sorenson, S. J. et. al. (2002). Gender-related factors influencing medication and clinic visit adherence in HIV/AIDS patients. International AIDS Conference, Barcelona. Abstract WePeB5856XIV.
4		Wilson, E, et. al. (2002). Adherence to antiretroviral therapy and its association with sexual behavior in a national sample of women with human immunodeficiency virus. Clinical Infectious Diseases 34(4). 529-534.