Logo image
Back
Examining the interactive effect of perceived stigma, HIV disclosure and social support on long-term HAART adherence among recently-sober HIV-positive women
Dissertation   Open access

Examining the interactive effect of perceived stigma, HIV disclosure and social support on long-term HAART adherence among recently-sober HIV-positive women

Sabine Eustache
Doctor of Public Health (Dr.P.H.), Drexel University
May 2012
DOI:
https://doi.org/10.17918/etd-4333
pdf
Eustache_Sabine_20122.62 MBDownloadView
PDF Open Access Open Access (License Unspecified)

Abstract

HIV-positive persons HIV-positive women Highly active antiretroviral therapy Public Health
The discovery of highly active antiretroviral therapy (HAART) is one of the most remarkable scientific advances in the 30-year history of the HIV epidemic. HAART effectively suppresses viral load and increases CD4 count, delaying the clinical progression of HIV disease, reducing HIV-related morbidity and mortality and minimizing the risk of drug resistance. The benefits of HAART, however, are dependent on strict medication adherence. Unfortunately, many adults living with HIV do not adequately adhere to their medication regimen. Estimates of average rates of nonadherence range from 50% to 70%. This rate is even poorer among drug users. Understanding the relationships between perceived stigma, HIV disclosure, and social support are crucial to facilitating HAART adherence, and ultimately, the clinical stabilization of HIV disease. Researchers have examined the relationships between HAART adherence and stigma, HAART adherence and HIV disclosure and HAART adherence and social support, largely using cross-sectional designs. Little is known about the effects of perceived stigma, HIV disclosure and social support on long-term HAART adherence. Even less is known about the interactive effects of these constructs. The purpose of this dissertation was to learn how perceived stigma, HIV disclosure, and social support operate together to impact long-term HAART adherence and HIV biological markers among women with a history of drug abuse. This dissertation was a secondary analysis of Structural Ecosystemic Therapy for Adherence (SETA), a 4-month randomized controlled intervention study designed to improve HAART adherence and reduce drug abuse relapse and HIV transmission risk behaviors among recently sober HIV-positive women. The study analyzed quantitative data from 171 predominately African American women. The central hypothesis of this study was that HIV disclosure moderates the relationships between perceived stigma and HAART adherence and social support and HAART adherence among HIV-positive women with a history of drug abuse. The study found HIV disclosure was unassociated with HAART adherence, viral load and CD4 count. Consistent with the study's hypotheses, higher HIV stigma concerns were associated with nonadherence to HAART therapy and disease severity as defined by viral load and CD4 count. The study also found social support had both positive and negative effects on HAART adherence, viral load and CD4 count, depending on the domain of support. Tests of interactions revealed significant interactions between the study variables. The relationship between perceived stigma and long-term HAART adherence varied by disclosure. Similarly, the relationship between perceived stigma and HAART adherence varied by social support and the association between disclosure and CD4 count varied by perceived stigma. Adverse effects of perceived stigma highlights the need for continued culturally-sensitive education and training about HIV and AIDS. The research findings also suggest that public health practitioners and medical providers should make concerted efforts to assess and address disclosure and stigma concerns among adults on prescribed HAART regimen. Additionally, practitioners should work with adults living with HIV to understand the dynamics of the family and social support networks.

Metrics

42 File views/ downloads
26 Record Views

Details

Logo image