Impact of Inconsistent Medication Supply
among Romanian HIV Positive Young Adults
Issues
Cognitive level - thoughts regarding
the situation (n=30)
14%
Adopting a
healthier lifestyle
22%
29%
Ambivalence
Injustice
14%
Bad
consequences
21%
Finding solutions
Description
Emotional reactions (n=30)
14%
27%
Fear
Grief
Confusion
31%
Optimism
28%
Identified Behaviours (n=30)
Asking for
Information
29%
Passivity
39%
Group Protests
18%
Adapting to the
new rules
14%
Subjective meaning asociated
with short term lack of ART:
32%
32%
Worsening of
heatlh state
Diseases
Whithout any
symptoms
36%
At the moment in Constanta there are approximately 960 HIV+ patients registered, of which 791 are active patients and
743 are taking ART. From January to April, the Centre of Excellence (COE) patients have been faced with a very unusual
situation due to Ministry of Health and Ministry of Finance mismanagement and lack of communication. This led to:
the antiretroviral medications have been released for very short periods of time (initially for two weeks, after that pa-
tients received medication for 5 days, 3 days or even only for one day)
the lack of certain types of medication (there have been periods in which most of the patients haven’t received one or
more than one type of ART from their therapeutic scheme)
the total lack of therapy (during 7 days there has been no antiretroviral medications released)
the change of the way in which the therapy was released (telephone programing 24 h before coming to the clinic for
picking it up)
This situation has generated a wave of anxiety and dissatisfaction among the patients – in this context the BBSF psycholo-
gists had to work with the patients in order to mitigate the impact of the situation on the emotional balance of the patients,
their beliefs about the situation/disease, their general health perception, the perceived long term effects and the coping
mechanisms frequently being used.
All the psychologists reported that the distress generated by the situation was perceived in a similar way by an adherent pa-
tient as by a nonadherent patient, or regardless of how long they have been on ART.
The psychologists have used a structured interview (see annex A), to better understand the impact of this period on their
patients. Thirty patients were interviewed, of which twelve (40%) had been nonadherent in the past and eighteen (60%)
had no interruptions in taking their ART, ever. The interview followed the cognitive behavioral theory and took place in
the clinic as well as at the patients’ homes. Their answers have been processed considering the different levels of the per-
sonality: emotional, cognitive and behavioral. The fact that the interviews were conducted after three months from the
critical point (the total lack of ART) is to be mentioned.
At the emotional level, the patients have reported elevated levels of anxiety, fearing that the effects of lack of ART on their
general health can be serious and irreversible. The most common emotional reactions were: fear, grief and confusion, but
some were optimistic, hoping that the situation will resolve itself quickly.
At the cognitive level the patients live with the confusion of the messages that they receive. These messages can be used
an excuse or incentive for nonadherence in the future. Their thoughts were mainly about adopting a healthier lifestyle, the
negative consequences that could follow the interruption, about finding solutions to resolve the problem at hand and deal-
ing with the injustice of the situation.
At the behavioral level the patients have expressed their complaints, have reacted in different ways, some trying to attract
attention on the situation in an attempt to find a solution quickly, while some chose not to react (passivity), in order not to
be discovered as being a HIV positive person.
Lessons learned During this period the COE psychologists have been put in a very delicate situation trying to maintain the emotional bal-
ance of their patients and to encourage them to use positive thoughts. This situation leads to potentially impairing their
trust in the information that counselors provided over time and the trust in the quality of the services of the COE.
Next steps The situation described above is a very unusual situation for the patients and the COE psychologists. It is obvious that in
this period the patients have dealt with serious emotional and physical discomfort regardless of their adherence levels. If
this situation continues, there is a chance that various situations will appear which will be very hard to deal with by pa-
tients, doctors, psychologists or anyone else that has a role in the care and treatment of HIV positive individuals.
Authors: We need to develop a protocol regarding the counseling services of problems occurring in such situations.
Simona Stanciu, Corina Pop, Luiza Vlahopol,
Ana-Maria Schweitzer, Baylor Black Sea Foundation
(BBSF), Romania