‘Poor compliance would mean that widespread drug resistance would inevitably follow…’

  The HIV virus mutates rapidly and it is true that if drugs are not taken at regular intervals, there is a higher risk of drug resistance developing.  Similarly, the advice to practise safe sex practices for those infected with HIV remains very important, if they are to avoid picking up resistant strains from their partners.

  The evidence is that compliance is actually often a lot better in places like Africa (e.g. Senegal >87%), compared to the West (e.g. San Francisco 50%).  If people are not started on HAART until they are quite unwell, they not only tend to tolerate the inconvenience of taking it better; they notice the benefits to their health more, and are better motivated to adhere to their therapy.  Knowing that this is perhaps their one and only chance to survive and watch their kids grow up is a powerful motivator.

  Our experience with tuberculosis (TB) control has shown us that the most effective way of ensuring adherence is to use a ‘directly-observed therapy’-based (DOT) approach, whether this be in New York or New Guinea.  This involves the patient having a nominated treatment supporter, who witnesses and records the swallowing of TB drugs out in the community.  It need not be a health worker; it could be anyone, a neighbour, teacher, local shopkeeper etc., as long as they are reliable and willing to take on this role.  This is also the approach used with HAART drugs in Haiti, to good effect.  DOT may be viewed as an infringement of civil liberties in the West, but in the South, it is taken for what it is, a sign of responsible citizenship.