AIDS and Behavior

, Volume 23, Issue 12, pp 3396–3410 | Cite as

Yes to Recreational Drugs and Complementary Medicines But No to Life-Saving Medications: Beliefs Underpinning Treatment Decisions Among PLHIV

  • Amary MeyEmail author
  • David Plummer
  • Gary D. Rogers
  • Maree O’Sullivan
  • Amber Domberelli
  • Shailendra Anoopkumar-Dukie
Original Paper


Despite the life-preserving benefits of antiretroviral therapy (ART), some people living with HIV (PLHIV) delay, decline or diverge from recommended treatment while paradoxically being willing to use potentially dangerous substances, such as recreational drugs (RD) and complementary medicines (CM). During 2016 and 2017, interviews were conducted with 40 PLHIV, in Australia to understand drivers underpinning treatment decisions. While many believed ART to be effective, they expressed concerns about long-term effects, frustration over perceived lack of autonomy in treatment decisions and financial, emotional and physical burdens of HIV care. In contrast, they ascribed a sense of self-control over the use of RD and CM, along with multiple professed benefits. The perceived burden of ART emerged as a motivator for deviating from recommended treatment, while positive views towards RD and CM appear to justify use. This study may serve as guidance for the development of future strategies to address barriers to treatment uptake and adherence and subsequently health outcomes for PLHIV in Australia and elsewhere.


HIV Antiretroviral therapy Recreational drugs Complementary medicines Beliefs 



We wish to express our deepest gratitude to the participants who shared their journeys and helped us to understand their perspective of managing life with HIV. We also wish to extend thanks to HIV Foundation Queensland for their financial support in enabling such an important study to be completed.


This research was funded by HIV Foundation Queensland.

Compliance with Ethical standards

Conflicts of interest

All authors declare that they have no conflicts of interest


  1. 1.
    UNSAIDS. How AIDS changed everything. 2015. Accessed March 21 2019.
  2. 2.
    AVERT. Global HIV and AIDS statistics. [Internet]. 2017. Accessed March 21 2019.
  3. 3.
    World Health Organization. HIV/AIDS. [Internet]. Accessed March 21 2019.
  4. 4.
    Williams CKO. Global HIV/AIDS burden and associated diseases. Cancer and AIDS: Part II: cancer pathogenesis and epidemiology. Cham: Springer; 2019. p. 59–96.Google Scholar
  5. 5.
    World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. 2014. Accessed March 21 2019.
  6. 6.
    World Health Organization. Global update on the health sector response to HIV, 2016–2021. Accessed March 21 2019.
  7. 7.
    UNAIDS. 90-90-90—An ambitious treatment target to help end the AIDS epidemic. [Internet]. Accessed March 21 2019.
  8. 8.
    AIDSinfo. Current guidelines. [Internet]. Accessed March 22 2019.
  9. 9.
    Cambiano V, Lampe FC, Rodger AJ, et al. Long-term trends in adherence to antiretroviral therapy from start of HAART. AIDS. 2010;24(8):1153–62.PubMedCrossRefGoogle Scholar
  10. 10.
    Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.PubMedCrossRefGoogle Scholar
  11. 11.
    Langebeek N, Gisolf EH, Reiss P, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med. 2014;12:142–142.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    UNAIDS. The gap report. 2014. Accessed March 21 2019.
  13. 13.
    UNAIDS. On the fast-track to end AIDS. 2016. Accessed March 21 2019.
  14. 14.
    Australian Government Department of Health. Eighth National HIV Strategy 2018–2022.$File/HIV-Eight-Nat-Strategy-2018-22.pdf. Accessed March 21 2019.
  15. 15.
    Kirby Institue. HIV, viral Hepatitis and sexually transmissible infections in Australia. Annual surveillance report 2018. [Internet]. 2018. Accessed March 21 2019.
  16. 16.
    Mey A, Plummer D, Dukie S, Rogers GD, O’Sullivan M, Domberelli A. Motivations and barriers to treatment uptake and adherence among people living with HIV in Australia: a mixed-methods systematic review. AIDS Behav. 2017;21(2):352–85.PubMedCrossRefGoogle Scholar
  17. 17.
    Mey A, Plummer D, Anoopkumar-Dukie S, Domberelli A. What’s the attraction? The role of performance enhancement as a driver of recreational drug use. J Subst Use. 2018;23(3):294–9.CrossRefGoogle Scholar
  18. 18.
    Mey A, Plummer D, Anoopkumar-Dukie S, Domberelli A. What’s the attraction? social connectedness as a driver of recreational drug use. J Subst Use. 2018;23(3):327–34.CrossRefGoogle Scholar
  19. 19.
    United Nations Office on Drugs and Crime. World drug report. 2015. Accessed March 21 2019.
  20. 20.
    Butler S. The prevention of substance use, risk and harm in Australia: a review of the evidence. Drugs. 2005;12(3):247–8.Google Scholar
  21. 21.
    Lee E, Mao L, Lea T, et al. Gay community periodic survey: Melbourne. 2017. Accessed March 21 2019.
  22. 22.
    Broady T, Mao L, Lee E, et al. Gay community periodic survey: Tasmania 2018. Accessed 10 Feb 2019.
  23. 23.
    Freeman P, Walker BC, Harris DR, et al. Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities. Arch Pediatr Adolesc Med. 2011;165(8):736–40.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Hembling J, Bertrand J, Melendez G, Ponchick L. Drug users and HIV risk in Guatemala City, Guatemala. J Drug Issues. 2019;49(2):296–307.CrossRefGoogle Scholar
  25. 25. Substance use and HIV risk. [Internet]. 2018. Accessed Feb 10 2019.
  26. 26.
    Kong TSK, Laidler KJ. The paradox for chem-fun and gay men: a neoliberal analysis of drugs and HIV/AIDS policies in Hong Kong. J Psychoact Drugs. 2019;31:1–9.CrossRefGoogle Scholar
  27. 27.
    Lee MP, Chan ML, Chan YT, et al. Survey on drug use among people living with HIV in Hong Kong. Int J Ment Health Addict. 2018;16(6):1312–21.CrossRefGoogle Scholar
  28. 28.
    Daskalopoulou M, Rodger AJ, Phillips AN, Speakman A, Lampe FC. Prevalence of recreational drug use is indiscriminate across antiretroviral regimens of differing drug–drug interactions among MSM. AIDS. 2016;30(5):810–2.PubMedCrossRefGoogle Scholar
  29. 29.
    Newman CE, Mao L, Persson A, et al. ‘Not until I’m absolutely half-dead and have to:’ accounting for non-use of antiretroviral therapy in semi-structured interviews with people living with HIV in Australia. AIDS Patient Care STDS. 2015;29(5):267–78.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Gold RS, Hinchy J, Batrouney CG. The reasoning behind decisions not to take up antiretroviral therapy in Australians infected with HIV. Int J STD AIDS. 2000;11(6):361–70.PubMedCrossRefGoogle Scholar
  31. 31.
    Gold RS, Ridge DT. “I will start treatment when I think the time is right”: HIV-positive gay men talk about their decision not to access antiretroviral therapy. AIDS Care. 2001;13(6):693–708.PubMedCrossRefGoogle Scholar
  32. 32.
    Bracchi M, Stuart D, Castles R, Khoo S, Back D, Boffito M. Increasing use of ‘party drugs’ in people living with HIV on antiretrovirals: a concern for patient safety. AIDS (London, England). 2015;29(13):1585–92.CrossRefGoogle Scholar
  33. 33.
    Feldman MB, Kepler KL, Irvine MK, Thomas JA. Associations between drug use patterns and viral load suppression among HIV-positive individuals who use support services in New York City. Drug Alcohol Depend. 2019;197:15–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Troiano G, Mercurio I, Bacci M, Nante N. Hidden dangers among circuit parties—a systematic review of HIV prevalence, sexual behaviors and drug abuse during the biggest gay events. J Hum Behav Soc Environ. 2018;28(8):983–91.CrossRefGoogle Scholar
  35. 35.
    Phanuphak P, Phanuphak N. Time for action on methamphetamine use and HIV. Lancet HIV. 2018;5(7):339–40.CrossRefGoogle Scholar
  36. 36.
    Sangiovanni RJ, Jakeman B, Nasiri M, Ruth L, Mahatme S, Patel N. Relationship between contraindicated drug-drug interactions and subsequent hospitalizations among patients living with HIV initiating combination antiretroviral therapy. AIDS Res Hum Retrovir. 2019. Scholar
  37. 37.
    Sewell J, Cambiano V, Miltz A, et al. Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013–2016. Sex Transm Infect. 2018;94(7):494.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Montgomery L, Bagot K, Brown JL, Haeny AM. The association between marijuana use and HIV continuum of care outcomes: a systematic review. Curr HIV/AIDS Rep. 2019;16(1):17–28.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Pepper N, Zúñiga ML, Reed MB. Prevalence and correlates of “popper” (amyl nitrite inhalant) use among HIV-positive Latinos living in the U.S.-Mexico border region. J Ethn Subst Abuse. 2019;07:1533–2659.Google Scholar
  40. 40.
    Pool ERM, Winston A, Bagkeris E, et al. High-risk behaviours, and their associations with mental health, adherence to antiretroviral therapy and HIV parameters, in HIV-positive men who have sex with men. HIV Med. 2019;20(2):131–6.PubMedGoogle Scholar
  41. 41.
    Prasad A, Kulkarni R, Shrivastava A, Jiang S, Lawson K, Groopman JE. Methamphetamine functions as a novel CD4+T-cell activator via the sigma-1 receptor to enhance HIV-1 infection. Sci Rep. 2019;9(1):958.
  42. 42.
    Ogbuagu O, Marshall BDL, Tiberio P, et al. Prevalence and correlates of unhealthy alcohol and drug use among men who have sex with men prescribed HIV pre-exposure prophylaxis in real-world clinical settings. AIDS Behav. 2019;23(1):190–200.PubMedCrossRefGoogle Scholar
  43. 43.
    Gupta RK, Wainberg MA, Brun-Vezinet F, et al. Oral antiretroviral drugs as public health tools for HIV prevention: global implications for adherence, drug resistance, and the success of HIV treatment programs. J Infect Dis. 2013;207(Suppl 2):S101–6.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Cadosch D, Bonhoeffer S, Kouyos R. Assessing the impact of adherence to anti-retroviral therapy on treatment failure and resistance evolution in HIV. J R Soc Interface. 2012;9(74):2309–20.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Fogarty L, Roter D, Larson S, Burke J, Gillespie J, Levy R. Patient adherence to HIV medication regimens: a review of published and abstract reports. Patient Educ Couns. 2002;46(2):93–108.PubMedCrossRefGoogle Scholar
  46. 46.
    Nachega JB, Hislop M, Dowdy DW, Chaisson RE, Regensberg L, Maartens G. Adherence to nonnucleoside reverse transcriptase inhibitor-based HIV therapy and virologic outcomes. Ann Intern Med. 2007;146(8):564–73.PubMedCrossRefGoogle Scholar
  47. 47.
    von Wyl V, Klimkait T, Yerly S, et al. Adherence as a predictor of the development of class-specific resistance mutations: the Swiss HIV cohort study. PLoS ONE. 2013;8(10):e77691.CrossRefGoogle Scholar
  48. 48.
    Wilson KJ, Doxanakis A, Fairley CK. Predictors for non-adherence to antiretroviral therapy. Sex Health. 2004;1(4):251–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Australian Government Department of Health Therapeutic Goods Administration. Complementary medicines. [Internet]. 2019. Accessed Feb 14 2019.
  50. 50.
    Abou-Rizk J, Alameddine M, Naja F. Prevalence and characteristics of CAM use among people living with HIV and AIDS in Lebanon: implications for patient care. J Evid Based Complement Altern Med. 2016;2016:11.Google Scholar
  51. 51.
    Bahall M. Prevalence, patterns, and perceived value of complementary and alternative medicine among HIV patients: a descriptive study. BMC Complement Altern Med. 2017;17(1):422.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Braun LA, Forrester CA, Rawlins MD, et al. Complementary medicine use by people living with HIV in Australia—a national survey. Int J STD AIDS. 2016;27(1):33–8.PubMedCrossRefGoogle Scholar
  53. 53.
    de Visser R, Ezzy D, Bartos M. Alternative or complementary? Nonallopathic therapies for HIV/AIDS. Altern Ther Health Med. 2000;6(5):44–52.PubMedGoogle Scholar
  54. 54.
    Kelso-Chichetto NE, Okafor CN, Harman JS, Canidate SS, Cook CL, Cook RL. Complementary and alternative medicine use for HIV management in the State of Florida: medical monitoring project. J Altern Complement Med. 2016;22(11):880–6.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Littlewood RA, Vanable PA. Complementary and alternative medicine use among HIV-positive people: research synthesis and implications for HIV care. AIDS Care. 2008;20(8):1002–18.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Littlewood RA, Vanable PA. A global perspective on complementary and alternative medicine use among people living with HIV/AIDS in the era of antiretroviral treatment. Curr HIV/AIDS Rep. 2011;8(4):257–68.PubMedCrossRefGoogle Scholar
  57. 57.
    Lorenc A, Robinson N. A review of the use of complementary and alternative medicine and HIV: issues for patient care. AIDS Patient Care STDS. 2013;27(9):503–10.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    McDonald K, Slavin S. My body, my life, my choice: practices and meanings of complementary and alternative medicine among a sample of Australian people living with HIV/AIDS and their practitioners. AIDS Care. 2010;22(10):1229–35.PubMedCrossRefGoogle Scholar
  59. 59.
    Mills E, Wu P, Ernst E. Complementary therapies for the treatment of HIV: in search of the evidence. Int J STD AIDS. 2005;16(6):395–403.PubMedCrossRefGoogle Scholar
  60. 60.
    Owen-Smith A, DePadilla L, DiClemente R. The assessment of complementary and alternative medicine use among individuals with HIV: a systematic review and recommendations for future research. J Altern Complement Med. 2011;17(9):789–96.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Suwassa L, Jutatip S, Ladaval ON. Factors related to the use of complementary and alternative medicine among people living with HIV/AIDS in Bangkok, Thailand. Health Sci J. 2013;7(4):436–46.Google Scholar
  62. 62.
    Syed IA, Sulaiman SAS, Hassali MA, Thiruchelvam K, Syed SH, Lee CKC. Beliefs and practices of complementary and alternative medicine (CAM) among HIV/AIDS patients: a qualitative exploration. Eur J Integr Med. 2016;8(1):41–7.CrossRefGoogle Scholar
  63. 63.
    Thomas S, Lam K, Piterman L, Mijch A, Komesaroff P. Complementary medicine use among people living with HIV/AIDS in Victoria, Australia: practices, attitudes and perceptions. Int J STD AIDS. 2007;18(7):453–7.PubMedCrossRefGoogle Scholar
  64. 64.
    Thorpe RD. ‘Doing’ chronic illness? Complementary medicine use among people living with HIV/AIDS in Australia. Soc Health Illn. 2009;31(3):375–89.CrossRefGoogle Scholar
  65. 65.
    Pan X, Zhang A, Henderson GE, et al. Traditional, complementary, and alternative medical cures for HIV: rationale and implications for HIV cure research. Glob Public Health. 2019;14(1):152–60.PubMedCrossRefGoogle Scholar
  66. 66.
    Brooks KM, George JM, Kumar P. Drug interactions in HIV treatment: complementary and alternative medicines and over-the-counter products. Expert Rev Clin Pharmacol. 2017;10(1):59–79.PubMedCrossRefGoogle Scholar
  67. 67.
    Stolbach A, Paziana K, Heverling H, Pham P. A review of the toxicity of HIV medications II: interactions with drugs and complementary and alternative medicine products. J Med Toxicol. 2015;11(3):326–41.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Lea T, Hammoud M, Bourne A, et al. Attitudes and perceived social norms toward drug use among gay and bisexual men in Australia. Subst Use Misuse. 2019;16:1–11.Google Scholar
  69. 69.
    Lune H. Qualitative research methods for the social sciences. 9th ed. Long Beach: Pearsons; 2017.Google Scholar
  70. 70.
    Marshall MN. Sampling for qualitative research. Fam Pract. 1996;13(6):522–6.PubMedCrossRefGoogle Scholar
  71. 71.
    Teddlie C, Yu F. Mixed methods sampling: a typology with examples. J Mix Methods Res. 2007;1(1):77–100.CrossRefGoogle Scholar
  72. 72.
    Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533–44.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Glaser B, Strauss A. The discovery of Grounded Theory: strategies for qualitative research. Chicago: Aldine Publishing Company; 1967.Google Scholar
  74. 74.
    Kallio H, Pietilä A-M, Johnson M, Kangasniemi M. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. J Adv Nurs. 2016;72(12):2954–65.PubMedCrossRefGoogle Scholar
  75. 75.
    Brinkmann S, Kvale S. Interviews: learning the craft of qualitative research interviewing. 3rd ed. Denmark: Sage; 2015.Google Scholar
  76. 76.
    Pope C, Ziebland S, Mays N. Analysing qualitative data. In: Pope C, Mays N, editors. Qualitative research in health care. Hoboken: Blackwell Publishing Ltd; 2007. p. 63–81.Google Scholar
  77. 77.
    Layder D. Understanding social theory. London: Sage; 2006.CrossRefGoogle Scholar
  78. 78.
    Thorpe RD. Integrating biomedical and CAM approaches: the experiences of people living with HIV/AIDS. Health Sociol Rev. 2008;17(4):410–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Amary Mey
    • 1
    Email author
  • David Plummer
    • 2
  • Gary D. Rogers
    • 3
  • Maree O’Sullivan
    • 4
  • Amber Domberelli
    • 1
  • Shailendra Anoopkumar-Dukie
    • 1
  1. 1.School of Pharmacy and PharmacologyGriffith UniversitySouthportAustralia
  2. 2.Anton Breinl Centre for Public Health and Tropical MedicinesJames Cook UniversityTownsvilleAustralia
  3. 3.School of MedicineGriffith UniversityGold CoastAustralia
  4. 4.Gold Coast Sexual Health ClinicQueensland HealthGold CoastAustralia

Personalised recommendations