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Psychosocial Characteristics Associated with Both Antiretroviral Therapy Adherence and Risk Behaviors in Women Living with HIV

Abstract

The purpose of this study was to identify key psychosocial characteristics of HIV-infected women who exhibit different levels of both ART adherence and risk behaviors. We analyzed baseline data from 193 predominately African American HIV-infected women participating in a behavioral clinical trial. Women were categorized into high/low groups based on levels of adherence and risky behaviors. There was a significant interaction effect for internal motivation for adherence. Women at high risk for poor health and transmitting HIV (low adherence/high risk group) had the lowest levels of internal motivation and also reported more difficult life circumstances. Gender roles, caretaking and reliance on men for economic and other support may promote external versus internal motivation as well as riskier behaviors in this group. The highest levels of internal motivation were found in those with High Adherence/High Risk behaviors. This group was highly knowledgeable about HIV and had the lowest VL. Compared to others, this group seems to tolerate risky behaviors given their high level of adherence. Adherence and risk reduction behaviors are key to individual and public health. Motivation and risk compensation should be addressed when providing interventions to women living with HIV.

Resumen

El propósito de este estudio fue identificar las características psicosociales fundamentales de las mujeres infectadas por el VIH que presentan diferentes niveles de adherencia a antirretrovirales y los comportamientos de riesgo. Se analizaron los datos de referencia de 193 mujeres infectadas por el VIH, predominantemente Africano Americanos, que participaron en un ensayo clínico de comportamiento. Las mujeres se clasificaron en grupos de alta/baja en base a los niveles de adherencia y conductas de riesgo. Hubo un efecto de interacción significativo para la motivación interna para la adhesión. Las mujeres con alto riesgo de mala salud y de transmisión del VIH (baja adherencia/grupo de alto riesgo) tuvieron los niveles más bajos de la motivación interna y también reportaron circunstancias de vida más difíciles. Los roles de género, cuidados y la dependencia en los hombres por el apoyo económico y otros tipos de apoyo pueden promover la motivación externa versus la motivación interna, así como los comportamientos de mayor riesgo en este grupo. Se encontró que los niveles más altos de motivación interna fue en aquellos con comportamientos de alto riesgo y de alta adherencia. Este grupo fue muy bien informados sobre el VIH y tenía la carga viral más bajo. En comparación con otros, este grupo parece que tolera conductas de riesgo, dado su alto nivel de adherencia. Adherencia y conductas de riesgo son la clave para la salud individual y pública. La motivación y la compensación del riesgo deberán dirigir al proporcionar intervenciones a las mujeres que viven con el VIH.

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Acknowledgments

This study was funded by the National Institutes of Nursing Research/National Institutes of Health (R01NR008094) and in part by the Emory Center for AIDS Research (P30 AI050409).

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Correspondence to Marcia McDonnell Holstad.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Holstad, M.M., Spangler, S., Higgins, M. et al. Psychosocial Characteristics Associated with Both Antiretroviral Therapy Adherence and Risk Behaviors in Women Living with HIV. AIDS Behav 20, 1084–1096 (2016). https://doi.org/10.1007/s10461-015-1209-5

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Keywords

  • HIV/AIDS
  • ART
  • Antiretroviral medication adherence
  • Sexual risk behavior
  • Motivation
  • Difficult life circumstances
  • Self-efficacy

Palabras clave

  • VIH/SIDA
  • terapia antiretroviral
  • la adherencia a medicación/medicina antiretroviral
  • el comportamiento de riesgos sexual
  • motivación
  • circunstancias difíciles de la vida
  • la autoeficacia