Taking your drugs regularly and on time is known as adherence. The reason you need good adherence is to ensure that the drugs work properly.

When you take a dose of anti-HIV drugs, after a few hours or so they reach sufficiently high levels in your blood to keep HIV suppressed. Over time, however, the levels of the drugs in your blood start to drop away again. It’s important that you take another dose before the levels of the drugs drop too low and allow HIV to start to become more active. As long as you take your doses at the right time every day then they should work properly. If you keep missing doses, or take them at the wrong times, then HIV may start to replicate faster. This is when drug resistance is likely to occur [1].

Missing a dose
Try not to be too hard on yourself for missing a dose. Most men will forget every once in a while. If you have forgotten to take one of your doses of drugs, take them as soon as you remember. Even if you missed a dose at night and remembered in the morning, take the dose you missed as soon as you can. Then continue to take your doses at your normal times, even if this means that you will be taking two doses fairly close together.

Adherence tips
If you’re wondering how best to remember to take your anti-HIV drugs on time, then here are a few tips from some other HIV positive gay men:

"I bought myself a pill box that comes with an alarm, so every morning and every evening at 10 o’clock the beeper sounds - it really has helped make sure I take my drugs at the right time. As well as my alarm pill box, I also put my doses for a whole week into a marked pill box, which I got free from my clinic when I started treatment." (Craig, 34)

"I found a good routine when I started taking my drugs. Morning when I got to work and mid evening after I'd eaten and collapsed in front of the TV, both 9:30. However I found one dose a week particularly difficult to remember, Saturday evening when I was getting ready to go out. So when I found a website that would send me a text at exactly the right time I realised that this was an ideal solution. This message says "pills" and I swallow them and get on with my evening. No more doses of pills looking at me on a Sunday morning and feeling a different sort of regret." (Richard, 38)

"Most of my friends know that I’m HIV positive, and that I’m on HIV treatment. I find that this helps in that they are all so used to me taking my meds at a certain time, they know when it’s time for my meds. There have been a few times, usually when I’ve had a few drinks too many, that friends have reminded me to take my pills, or even woken me up to take them." (Jim, 28)

"I use a watch with a dual alarm – always lets me know when it’s time to take my pills." (Samuel, 22)

"I have a dosset box with little trays marking the days of the week, which I picked up from the pharmacy at my clinic. It means that if I’m ever not sure whether I’ve taken my pills, like if I’ve been partying, I can look at the box and see whether that day’s tray is empty or not. I also have a little pouch with a single dose of my meds that I carry with me the whole time. That way if I find myself going out when I hadn’t planned it, or if I pick up unexpectedly, I have my pills with me so I don’t miss a dose or get anxious about it. I also have a vibrating watch, which gives me a subtle reminder." (Mark, 37)

Carrying your pills
There will be times when you need to carry your anti-HIV drugs with you when you’re not at home. For instance, you’ll need to carry them with you if you need to take a dose when you’re at work, out clubbing or when travelling.

When you are carrying your anti-HIV drugs with you, you may want to think about a number of things. This may include what you are going to carry them in or the reaction you may get from people seeing you taking them. It’s worth remembering, however, that you’ll probably be more self conscious about taking your pills than other people will be about you taking them. If you are concerned about people seeing you then you could always go to the toilet to take them.

First of all it’s a good idea to make sure that you carry your pills safely. You may be able to get pill containers from your clinic or a chemist, and these should close tightly so as not to fall open in your bag or pocket. Make sure that you also have them somewhere you won’t lose them. At best it can be annoying when you discover you’ve lost your pills and have to go home again from wherever you are to get some more. At worst you could be miles away from home meaning that you probably will miss a dose or even doses until you get home again.

"I’m always worried about remembering to have enough pills with me wherever I go. I once missed a dose because I was away at a friend’s house and realised I didn’t have any with me. That mistake made me think, and I decided to leave a couple of doses of my drugs at the homes of people I regularly visit. This has already paid off – I lost my bag on the way to my partner’s mum’s house but since there were some there I didn’t have to miss a dose" (Craig, 34)

If you don’t want people to know that you have HIV, you’ll need to think about taking your anti-HIV drugs somewhere that people won’t see you. This can sometimes be difficult, and if people do see you taking them they could ask some awkward questions.

If you are searched anywhere, for instance by the police or by security at a club or at an airport, you may be asked what the pills you are carrying are for. This can be a problem if you are with people who don’t know you have HIV. There’s also the chance that whoever is searching you does not believe that they are prescribed drugs. You can get round this by carrying a prescription from your clinic with you, although this won’t get round the fact you may feel forced into disclosure.

When it comes to foreign travel, some countries have entry restrictions for people with HIV. We talk more about travelling abroad with HIV in the section on Travel.

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1 Ajay K. Sethi, Ph.D., M.H.S. Adherence and HIV Drug Resistance. The Hopkins HIV Report. January 2004