A generative analogy to help discuss prophylaxis with children and young people

Alex Accoroni
Clinical Psychologist in the HIV Liaison Team, South London and Maudsley NHS Trust, UK

The online Merriam-Webster dictionary defines prophylaxis as ‘measures designed to preserve health (as of an individual or of society) and prevent the spread of disease’ [1]. In the field of HIV medicine, ensuring that patients take their medication on a daily basis in order to suppress the replication of the virus is a crucial part of HIV prophylaxis (www.aidsmap.com/about-hiv/basics/undetectable-viral-load-and-hiv-transmission). The terms adherence and concordance are now often used to refer to the patient’s following of medical advice in taking medication – which, one assumes, has been understood to a level that helps the patient to be consistent in this task. Fisher et al. define adherence as ‘the extent to which a person’s behaviour corresponds with medical advice’ [2]. The concept itself seems to change with shifting social and cultural sensibilities. In fact, we have more recently seen the introduction of the term ‘concordance’. Stevenson suggests that it was adopted to signal a ‘shift from paternalistic practice … [to] the notion of health care practitioners and patients working in partnership’ [3]. In order to acknowledge this, the term ‘concordance’ will be used in this article interchangeably with ‘adherence’, which I am historically more used to. Read more…