"I will start treatment when I think the time is right": HIV-positive gay men talk about their decision not to access antiretroviral therapy

In a qualitative study, 20 HIV-infected Australian gay men were interviewed about their non-uptake of antiretroviral drug therapy. The main reasons given for not accessing therapy were fear of side effects; fear of long-term damage to body organs; the inconvenience of the treatment regimens; belief that the regimen’s demands would be a threat to morale; and belief that there was no reason to start therapy in the absence of AIDS-related symptoms. Actions taken by the men to monitor and maintain their health included seeing a doctor regularly; having regular T-cell and viral load tests; and trying to maintain a positive outlook by not letting HIV/AIDS “take over” their lives. Almost half the men considered they had been subjected to unreasonable pressure to access therapy and there was considerable pride at having resisted this pressure. The findings suggest that the men were content to go along with the biomedical model for managing HIV/AIDS on all matters other than the question of if and when to access therapy. They also suggest that underlying the men’s dissent from the biomedical model was a different mode of thinking than is required by the model: contrary to the model’s demands, the men focused strongly on factors close to the “here and now” of immediate experience. The practical implications of the findings are explored