AIDS and Behavior

, Volume 21, Issue 12, pp 3599–3606 | Cite as

Caregivers’ Support Network Characteristics Associated with Viral Suppression among HIV Care Recipients

  • Julie A. Denison
  • Mary M. Mitchell
  • Allysha C. Maragh-Bass
  • Amy R. Knowlton
Original Paper

Abstract

Informal care receipt is associated with health outcomes among people living with HIV. Less is known about how caregivers’ own social support may affect their care recipient’s health. We examined associations between network characteristics of informal caregivers and HIV viral suppression among former or current drug using care recipients. We analyzed data from 258 caregiver-recipient dyads from the Beacon study, of whom 89% of caregivers were African American and 59% were female. In adjusted logistic regression analysis, care recipients had lower odds of being virally suppressed if their caregiver was female, was caring for youth involved in the criminal justice system, and had network members who used illicit drugs. Caregivers’ greater numbers of non-kin in their support network was positively associated with viral suppression among care recipients. The findings reveal contextual factors affecting ART outcomes and the need for interventions to support caregivers, especially HIV caregiving women with high-risk youth.

Keywords

Informal HIV caregiving Black/African American HIV/AIDS Viral load suppression Social support networks 

Notes

Acknowledgements

The study team gratefully acknowledges the study participants’ time and openness during this research.

Funding

This study was supported by the National Institute on Drug Abuse (R01 DA13142-01A1 and R01 DA019413), and the National Institute of Nursing Research (R01 NR14050-01), and the National Center for Complementary and Integrative Health (5K01AT009049-02). This research was also supported by the Johns Hopkins Center for AIDS Research (1P30AI094189).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Bradley H, Hall HI, Wolitski RJ, Van Handel MM, Stone AE, LaFlam M, et al. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States, 2011. MMWR Morb Mortal Wkly Rep. 2014;63(47):1113–7.PubMedGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention (CDC). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 US dependent areas—2012. HIV surveillance supplemental report 2014;19(3).Google Scholar
  3. 3.
    Hall HI, An Q, Hutchinson AB, Sansom S. Estimating the lifetime risk of a diagnosis of the HIV infection in 33 states, 2004–2005. J Acquir Immune Defic Syndr. 2008;49(3):294–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Maryland Department of Health and Mental Hygiene, Prevention and Health Promotion Administration, Center for HIV Surveillance, Epidemiology and Evaluation Infectious Disease Bureau. Baltimore City HIV/AIDS epidemiological profile fourth quarter 2012. Maryland Department of Health and Mental Hygiene. 2012. http://phpa.dhmh.maryland.gov/OIDEOR/CHSE/Shared%20Documents/Baltimore-City.pdf. Accessed 17 March 2015.
  5. 5.
    U.S. Census Bureau. 2009–2013 American Community Survey 5-Year Profiles 2015; 2015; Available at: http://www.census.gov/search-results.html?q=baltimore+city+poverty&page=1&stateGeo=none&searchtype=web&search.x=0&search.y=0. Accessed 25 Oct 2015.
  6. 6.
    Drug Strategies. Smart Steps: Treating Baltimore’s Drug Problem. 2000. http://www.drugstrategies.com/wp-content/uploads/2014/05/baltimore.pdf. Accessed 27 May 2016.
  7. 7.
    Justice Policy Institute and the Prison Policy Initiative. The right investment? Corrections spending in Baltimore City. 2015. http://www.justicepolicy.org/uploads/justicepolicy/documents/rightinvestment_design_2.23.15_final.pdf. Accessed 17 Mar 2015.
  8. 8.
    Meyer JP, Chen NE, Springer SA. HIV treatment in the criminal justice system: critical knowledge and intervention gaps. AIDS Res Treat. 2011;2011:680617.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Springer SA, Spaulding AC, Meyer JP, Altice FL. Public health implications for adequate transitional care for HIV-infected prisoners: five essential components. Clin Infect Dis. 2011;53(5):469–79.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Pearson FS, Shafer MS, Dembo R, del Mar Vega-Debién G, Pankow J, Duvall JL, et al. Efficacy of a process improvement intervention on delivery of HIV services to offenders: a multisite trial. Am J Public Health. 2014;104(12):2385–91.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Turner HA, Catania JA, Gagnon J. The prevalence of informal caregiving to persons with AIDS in the United States: caregiver characteristics and their implications. Soc Sci Med. 1994;38(11):1543–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Moody AL, Morgello S, Gerits P, Byrd D. Vulnerabilities and caregiving in an ethnically diverse HIV-infected population. AIDS Behav. 2009;13(2):337–47.CrossRefPubMedGoogle Scholar
  13. 13.
    Pearlin LI, Semple S, Turner H. Stress of AIDS caregiving: a preliminary overview of the issues. Death Stud. 1988;12(5–6):501–17.CrossRefPubMedGoogle Scholar
  14. 14.
    Knowlton AR. Informal HIV caregiving in a vulnerable population: toward a network resource framework. Soc Sci Med. 2003;56(6):1307–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Wagner GJ, Ryan GW. Relationship between routinization of daily behaviors and medication adherence in HIV-positive drug users. AIDS Patient Care STDS. 2004;18(7):385–93.CrossRefPubMedGoogle Scholar
  16. 16.
    Fredriksen-Goldsen KI, Shiu C, Starks H, Chen W, Simoni J, Kim H, et al. “You must take the medications for you and for me”: family caregivers promoting HIV medication adherence in China. AIDS Patient Care STDS. 2011;25(12):735–41.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Knowlton AR, Arnsten JH, Gourevitch MN, Eldred L, Wilkinson JD, Rose CD, et al. Microsocial environmental influences on highly active antiretroviral therapy outcomes among active injection drug users: the role of informal caregiving and household factors. J Acquir Immune Defic Syndr. 2007;1(46 Suppl 2):S110–9.CrossRefGoogle Scholar
  18. 18.
    Mitchell MM, Robinson AC, Nguyen TQ, Knowlton AR. Informal caregiver characteristics associated with viral load suppression among current or former injection drug users living with HIV/AIDS. AIDS Behav. 2015;19:1–6.CrossRefGoogle Scholar
  19. 19.
    Stetz KM, Brown M. Physical and psychosocial health in family caregiving: a comparison of AIDS and cancer caregivers. Public Health Nurs. 2004;21(6):533–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Mitchell MM, Knowlton A. Caregiver role overload and network support in a sample of predominantly low-income, African-American caregivers of persons living with HIV/AIDS: a structural equation modeling analysis. AIDS Behav. 2012;16(2):278–87.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Poindexter CC, Linsk NL. HIV-related stigma in a sample of HIV-affected older female African American caregivers. Soc Work. 1999;44(1):46–61.CrossRefPubMedGoogle Scholar
  22. 22.
    Mitchell MM, Knowlton A. Stigma, disclosure, and depressive symptoms among informal caregivers of people living with HIV/AIDS. AIDS Patient Care STDS. 2009;23(8):611–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Bevans M, Sternberg EM. Caregiving burden, stress, and health effects among family caregivers of adult cancer patients. JAMA. 2012;307(4):398–403.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Prachakul W, Grant JS. Informal caregivers of persons with HIV/AIDS: a review and analysis. J Assoc Nurses AIDS Care. 2003;14(3):55–71.CrossRefPubMedGoogle Scholar
  25. 25.
    Trivedi R, Beaver K, Bouldin ED, Eugenio E, Zeliadt SB, Nelson K, et al. Characteristics and well-being of informal caregivers: results from a nationally-representative US survey. Chronic Illn. 2014;10(3):167–79.CrossRefPubMedGoogle Scholar
  26. 26.
    Pirraglia PA, Bishop D, Herman DS, Trisvan E, Lopez RA, Torgersen CS, et al. Caregiver burden and depression among informal caregivers of HIV-infected individuals. J Gen Intern Med. 2005;20(6):510–4.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Pearlin LI, Aneshensel CS, LeBlanc AJ. The forms and mechanisms of stress proliferation: The case of AIDS caregivers. J Health Soc Behav. 1997;38:223–36.CrossRefPubMedGoogle Scholar
  28. 28.
    Aneshensel CS, Pearlin LI, Schuler RH. Stress, role captivity, and the cessation of caregiving. J Health Soc Behav. 1993;34:54–70.CrossRefPubMedGoogle Scholar
  29. 29.
    Navaie-Waliser M, Spriggs A, Feldman PH. Informal caregiving: differential experiences by gender. Med Care. 2002;40(12):1249–59.CrossRefPubMedGoogle Scholar
  30. 30.
    Ruiz DS, Kopak A. The consequences of parental incarceration for African American mothers, children, and grandparent caregivers. J Pan Afr Stud. 2014;7(6):9.Google Scholar
  31. 31.
    Latkin CA, Knowlton AR. Social network assessments and interventions for health behavior change: a critical review. Behav Med. 2015;41(3):90–7.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Mitchell MM, Robinson AC, Wolff JL, Knowlton AR. Perceived mental health status of drug users with HIV: concordance between caregivers and care recipient reports and associations with caregiving burden and reciprocity. AIDS Behav. 2014;18(6):1103–13.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Knowlton AR, Mitchell MM, Robinson AC, Nguyen TQ, Isenberg S, Denison J. Informal HIV caregiver proxy reports of care recipients’ treatment adherence: relationship factors associated with concordance with recipients’ viral suppression. AIDS Behav. 2015;19(11):2123–9.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Knowlton AR. Informal caregiving in a vulnerable population: toward a network resource framework. Soc Sci Med. 2003;56(6):1307–20.CrossRefPubMedGoogle Scholar
  35. 35.
    Arribas JR, Horban A, Gerstoft J, Fatkenheuer G, Nelson M, Clumeck N, et al. The MONET trial: darunavir/ritonavir with or without nucleoside analogues, for patients with HIV RNA below 50 copies/ml. AIDS. 2010;24(2):223–30.CrossRefPubMedGoogle Scholar
  36. 36.
    Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.CrossRefGoogle Scholar
  37. 37.
    Lawton M, Brody E. Physical self-maintenance scale (functional assessment). Gerontologist. 1969;9:179–86.CrossRefPubMedGoogle Scholar
  38. 38.
    Barrera M. A method for the assessment of social support networks in community survey research. Connections. 1980;3(3):8–13.Google Scholar
  39. 39.
    SPSS I. IBM SPSS statistics for Windows, version 20.0. 2011.Google Scholar
  40. 40.
    Pearlin LI, Aneshensel CS, LeBlanc AJ. The forms and mechanisms of stress proliferation: The case of AIDS caregivers. J Health Soc Behav. 1997;38:223–36.CrossRefPubMedGoogle Scholar
  41. 41.
    Squires K, Feinberg J, Bridge DA, Currier J, Ryan R, Seyedkazemi S, et al. Insights on GRACE (Gender, Race, And Clinical Experience) from the patient’s perspective: grace participant survey. AIDS Patient Care STDS. 2013;27(6):352–62.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Knowlton AR, Yang C, Bohnert A, Wissow L, Chander G, Arnsten JA. Main partner factors associated with worse adherence to HAART among women in Baltimore, Maryland: a preliminary study. AIDS care. 2011;23(9):1102–10.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Wight RG. Precursive depression among HIV infected AIDS caregivers over time. Soc Sci Med. 2000;51(5):759–70.CrossRefPubMedGoogle Scholar
  44. 44.
    Turner HA, Pearlin LI, Mullan JT. Sources and determinants of social support for caregivers of persons with AIDS. J Health Soc Behav. 1998;39:137–51.CrossRefPubMedGoogle Scholar
  45. 45.
    Stewart-Williams S. Altruism among kin vs nonkin: effects of cost of help and reciprocal exchange. Evol Human Behav. 2007;28(3):193–8.CrossRefGoogle Scholar
  46. 46.
    Rook KS, Pietromonaco PR, Lewis MA. When are dysphoric individuals distressing to others and vice versa? Effects of friendship, similarity, and interaction task. J Pers Soc Psychol. 1994;67(3):548.CrossRefPubMedGoogle Scholar
  47. 47.
    Knowlton AR, Yang C, Bohnert A, Wissow L, Chander G, Arnsten JA. Informal care and reciprocity of support are associated with HAART adherence among men in Baltimore, MD, USA. AIDS Behav. 2011;15(7):1429–36.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Julie A. Denison
    • 1
  • Mary M. Mitchell
    • 2
  • Allysha C. Maragh-Bass
    • 3
  • Amy R. Knowlton
    • 2
  1. 1.Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of Health Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Formerly part of the Department of Health Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations