Disparities in Reported Reasons for Not Initiating or Stopping Antiretroviral Treatment Among a Diverse Sample of Persons Living with HIV
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Disparities in the use of antiretroviral therapy (ART) for HIV disease have been documented across race, gender, and substance use groups.
The current analysis compares self-reported reasons for never taking or stopping ART among a diverse sample of men and women living with HIV.
HIV + (N = 3,818) adults, 968 of whom reported discontinuing or never using ART.
Computerized self-administered and interviewer-administered self-reported demographic and treatment variables, including gender, race, ethnicity, CD4 count, detectable viral load, and reported reasons for not taking antiretroviral therapy.
Despite equivalent use of ART in the current sample, African-American respondents were 1.7 times more likely to report wanting to hide their HIV status and 1.7 times more likely to report a change in doctors/clinics as reasons for stopping ART (p = .049, and p = .042) and had odds 4.5 times those of non-African Americans of reporting waiting for viral marker counts to worsen (p = < .0001). There was a lower tendency (OR = 0.4) for women to endorse concerns of keeping their HIV status hidden as a reason for stopping ART compared to men (p = .003). Although those with an IDU history were less likely to be on ART, no differences in reasons for stopping or never initiating ART were found between those with and without an IDU history.
A desire to conceal HIV status as well as a change in doctors/clinics as reasons for discontinuing ART were considerably more common among African Americans, suggesting that perceived HIV/AIDS stigma is an obstacle to maintenance of treatment. Findings also indicate differences in reasons for stopping ART by gender and a perceived desire to wait for counts to worsen as a reason for not taking ART by African Americans, regardless of detectable viral load, CD4 count, age, education, employment, sexual orientation, and site.
- Eisenman, D, Bogart, LM, Bird, CE (2007) Differential diffusion of HIV technologies by gender: the case of highly active antiretroviral therapy. AIDS Patient Care STDS 21: pp. 390-399 CrossRef
- Gebo, KA, Fleishman, JA, Conviser, R (2005) Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001. J Acquir Immune Defic Syndr 38: pp. 96-103 CrossRef
- Shapiro, MF, Morton, SC, McCaffrey, DF (1999) Variations in the care of HIV-infected adults in the United States: results from the HIV Cost and Services Utilization Study. JAMA 281: pp. 2305-2315 CrossRef
- Celentano, DD, Vlahov, D, Cohn, S, Shadle, VM, Obasanjo, O, Moore, RD (1998) Self-reported antiretroviral therapy in injection drug users. JAMA 280: pp. 544-546 CrossRef
- Cunningham, WE, Markson, LE, Andersen, RM (2000) Prevalence and predictors of highly active antiretroviral therapy use in patients with HIV infection in the united states. HCSUS Consortium. HIV Cost and Services Utilization. J Acquir Immune Defic Syndr 25: pp. 115-123 CrossRef
- Reif, S, Whetten, K, Thielman, N (2007) Association of race and gender with use of antiretroviral therapy among HIV-infected individuals in the Southeastern United States. South Med J 100: pp. 775-781
- Celentano, DD, Galai, N, Sethi, AK, Shah, NG, Strathdee, SA, Vlahov, D, Gallant, JE (2001) Time to initiating highly active antiretroviral therapy among HIV-infected injection drug users. AIDS 15: pp. 1707-1715 CrossRef
- Morin, SF, Sengupta, S, Cozen, M, Richards, TA, Shriver, MD, Palacio, H, Kahn, JG (2002) Responding to racial and ethnic disparities in use of HIV drugs: analysis of state policies. Public Health Rep 117: pp. 263-272
- Gore-Felton, C, Rotheram-Borus, MJ, Weinhardt, LS (2005) The Healthy Living Project: an individually tailored, multidimensional intervention for HIV-infected persons. AIDS Educ Prev 17: pp. 21-39 CrossRef
- Johnson, MO, Catz, SL, Remien, RH (2003) Theory guided, empirically supported avenues for intervention on HIV medication nonadherence: Findings from the Healthy Living Project. AIDS Patient Care STDS 17: pp. 645-656 CrossRef
- Weinhardt, LS, Kelly, JA, Brondino, MJ (2004) HIV transmission risk behavior among men and women living with HIV in four US cities. J AIDS Human Retrovirol 36: pp. 1057-1066
- Clark, HJ, Lindner, G, Armistead, L, Austin, BJ (2003) Stigma, disclosure, and psychological functioning among HIV-infected and non-infected African-American women. Women Health 38: pp. 57-71
- Parker, R, Aggleton, P (2003) HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med 57: pp. 13-24 CrossRef
- Bogart, LM, Thorburn, S (2005) Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans?. J Acquir Immune Defic Syndr 38: pp. 213-218 CrossRef
- Tobias, C, Cunningham, WE, Cunningham, CO, Pounds, MB (2007) Making the connection: the importance of engagement and retention in HIV medical care. AIDS Patient Care STDS 21: pp. S3-S8
- Giordano, TP, Gifford, AL, White, AC (2007) Retention in care: a challenge to survival with HIV infection. Clin Infect Dis 44: pp. 1493-1499 CrossRef
- Kremer, H, Sonnenberg-Schwan, U (2003) Women living with HIV does sex and gender matter? A current literature review. Eur J Med Res 8: pp. 8-16
- Gaskins, S (1999) Issues for women with heterosexually transmitted HIV disease. AIDS Patient Care STDS 13: pp. 89-96 CrossRef
- Disparities in Reported Reasons for Not Initiating or Stopping Antiretroviral Treatment Among a Diverse Sample of Persons Living with HIV
Journal of General Internal Medicine
Volume 24, Issue 2 , pp 247-251
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- treatment disparities
- substance use
- Industry Sectors
- Author Affiliations
- 1. Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
- 2. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- 3. Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- 4. Center for Community Health, University of California, Los Angeles, Los Angeles, CA, USA