Saturday, 19 July 2014

Why do some Chinese patients with HIV refuse lifesaving antiviral treatment?

by Michael Woodhead
[UPDATED] China has a huge number of people with HIV, though fortunately there are now effective antiretroviral drugs that can prevent progression of the infection and allow people to live with HIV rather than die from it. However, for some reason some Chinese people refuse antiretroviral treatment and become victims of AIDS.
According to Dr Lu Hongzhou an infectious diseases specialist at Fudan University, this is because some Chinese still have 'traditional thinking' and believe they can overcome the disease through traditional methods such as Chinese medicine rather than with 'superficial'  western medicine. Writing in Bioscience Trends this week, Dr Lu describes a typical such case involving a man called Zhang Shan who was diagnosed with HIV in 2010. At that time he was already quite unwell with a CD4 cell count of 49/μL and he also had tuberculosis.  His prognosis was poor and he was advised to immediately start antiretroviral therapy. However, Zhang refused, citing his belief that he did not believe in  western medicine and that he could conquer the infection by finding out more about the virus and seeking Chinese remedies. For the next year he did a lot of reading and travelled to visit several famous "monks and Taoist priests" who claimed that they could cure him of his disease. Zhang's HIV infection deteriorated and he eventually decided to seek medical help again when he was extremely sick with a CD4 cell count of just only 8/μL. He was persuaded to start on anti-retroviral medications and made some recovery, but by that time he had left treatment very late and had already experienced some disability. After several months of antiviral treatment Zhang was still alive, but his doctors told him that he had missed his best opportunity because the earlier treatment begins, the better.
Dr Lu said the case highlighted the barriers that Chinese beliefs represented to delivering effective treatment for HIV. He characterised these barriers as including "society, history, morality and ideology, family, education" (- and most of all,the patient’s mindset).
"The daunting task is to transform or change traditional or inculcated beliefs of potential AIDS patients so that they are open to antiretroviral therapy, which is a product of modern science, to help their plight," he concludes.
Update: A newly published study shows that only about half of patients with HIV were still taking their antiviral medication after six months. One significant finding in this study was that many patients had depressison, which may have affected their motivation to continue with treatment.

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