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The success of Highly Active Anti-Retroviral Therapy (HAART) requires a high rate of adherence to a complex regimen. Even small variations in adherence compromise treatment efficacy and can lead to viral resistance. Low levels of adherence to HAART continue to pose a major barrier to the success of these treatments. Studies investigating adherence to HAART have focused on practical barriers, yet studies in other illness groups suggest that patients' perceptions of their illness and treatment have a strong influence. This thesis is concerned with furthering our understanding of non-adherence to HAART. It begins with a review of HIV and its treatment. A critical review of the literature was conducted using systematic techniques. This identifies outstanding questions relating to the antecedents of adherence to HAART. The aim of this investigation was primarily to test the Self-Regulatory Model (SRM) and extensions to it to incorporate treatment perceptions (perceptions of personal necessity for HAART and concerns about adverse effects) in predicting adherence to HAART.

Antiretroviral therapy has given hope and expectations for a better life to HIV positive individuals, however, HIV medication cannot be effective without HIV positive individuals’ compliance to it. This study investigated the ways in which living with HIV and taking medication is located within the psychological, social and cultural context of everyday life and relationships in Greece. It also examined gender and identity issues, which make compliance/non-compliance understandable from the HIV positive peoples’ perspective. In addition, emphasis was given to locating compliance to medical regimes in which the perspectives of HIV positive persons were prioritised and understood in relation to relationships with health care professionals. A mixed methods approach was undertaken to provide understanding of compliance and non-compliance factors to HIV medication in a holistic way. A self-completed questionnaire was used to examine the psychosocial factors underpinning compliance to medication. Face-to-face semi-structured interviews were used to explore issues of identity, gender, relationship between doctors and patients and social understandings of HIV. Finally, self-completed weekly diaries were used to document compliance actions, thoughts and feelings in order to reveal the ways medical regimes fit into everyday life. The study was conducted in three Public Hospitals, one Governmental Hospice and one Non-governmental Organization. Eighty (63 males and 17 females) Greek HIV positive patients completed the questionnaire. Interview sample consisted of 7 and 3 males and females respectively. Finally, 6 Greek HIV positive males and 3 females completed the diaries of the research. The questionnaire data was analysed using descriptive statistics via SPSS 11. In addition, a range of non-parametric tests (Mann Whitney and Kruskal Wallis) were used in order to check if ordinal variables influence compliance with HIV medication. Finally linear regression analysis was used in order to establish the influence of factors on compliance with HIV medication. Interviews and the diaries data were analysed though thematic analysis, focusing on identification of patterns and behaviours which were then interpreted in terms of themes. The findings of the study indicated that, when support was given from life partners compliance with HV medication was increased. However, when support was given from family members, compliance with HIV medication was decreased. According to the findings, family dynamics have changed in several cultures over recent decades, partner roles have changed especially in the west and in Mediterranean societies. In regards to 6 medicalization in everyday life, the study showed that when individuals were experiencing side effects, or had fears of future side effects, religious issues (punishment for homosexuality), loss of one’s freedom due to medication, non-compliant behaviours could occur. Finally, the study indicated that some HIV positive individuals perceived their health levels as good and believed that not taking medication once or twice a week was a compliant behaviour. Hence, false perceptions regarding health levels and compliance issues could lead to non-compliant behaviours. A further examination on the communication patterns of the family system and its impact on HIV positive individuals is recommended as it is clearly not very helpful any more. Further exploration of the general socio-cultural positioning of Greece is recommended as certain HIV positive individuals coped with HIV diagnosis and taking medication, by rejecting it. Finally, the need for psychological support is recommended as it is very rarely provided within the Greek health care system.