Abstract
OBJECTIVE: The study objective was to characterize respondents’ prognostic perceptions of HIV infection and to explore how perceptions might affect medication and safe sex nonadherence.
METHODS: Surveys were mailed to 295 clients of an HIV-specific case management organization. Participants were asked to describe experience with HIV/AIDS right after serostatus knowledge and currently, using provided word lists, after which they were asked to assess current life expectancy. Self-reported information on antiretroviral medication and safe sex nonadherence was obtained.
RESULTS: A total of 220 (75%) clients (66% nonwhite, 73% male, 63% gay/bisexual, 50% educated >12 years, and 53% with incomes <$10,000/year) returned surveys. Negative descriptors from word lists were significantly less common and positive descriptors significantly more common now compared to right after serostatus knowledge. Current perceptions about life expectancy indicated that most respondents thought they would live many years, many believing they would live well into old age. Whites (odds ratio [OR], 0.34; P=.01) were less likely and those with >12 years education (OR, 2.76; P=.02) and with CD4 cell counts >200 (OR, 2.70; P=.01) were more likely to have optimistic prognostic beliefs. The optimistic subgroup, when compared with the pessimistic subgroup, was more likely to report medication (26% vs 13%, P=.04) and safe sex (57% vs 29%, P=.004) nonadherence.
CONCLUSIONS: Seropositive individuals, including persons of color (adjusted) as well as women and drug users (unadjusted), self-reported optimistic beliefs about their prognosis. Those with more optimism about their prognosis were significantly more likely to report medication and safe sex nonadherence. A better understanding of seropositive patients’ prognostic beliefs and the factors determining them is warranted.
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References
Sullivan A. When plagues end. The New York Times Magazine. November 10, 1996. 52–8, 60–2, 76–7, 84.
James JS. New optimism on controlling HIV infection. ATN. 1996;249:1–3.
Marwick C. HIV/AIDS care calls for reallocation of resources. JAMA. 1998;279:491–3.
Gallo RC. AIDS as a clinically curable disease: the growing optimism. Aids Patient Care STDS. 1996;10:7–9.
Altice FL, Friedland GH. The eral of adherence to HIV therapy. Ann Intern Med. 1998;129:503–5.
Siegel K, Krauss BJ. Living with HIV infection: adaptive tasks of seropositive gay men. J Health Soc Behav. 1991;32:17–32.
Lerner BH, Gulick RM, Dubler NN. Rethinking nonadherence: historical perspectives on triple-drug therapy for HIV disease. Ann Intern Med. 1998;129:573–8.
Montaner JSG, Reiss P, Cooper D, et al. A randomized, double-blind trial comparing combinations of nevirapine, didanosine, and zidovudine for HIV-infected patients: the INCAS Trial. JAMA. 1998;279:930–7.
Havlir DV, Marschner IC, Hirsch MS, et al. Maintenance antiretroviral therapies in HIV-infected subjects with undetectable plasma HIV RNA after triple-drug therapy. New Engl J Med. 1998;339:1261–8.
Ventura SJ, Peters KD, Martin JA, Maurer JD. Births and deaths: United States, 1996. Monthly Vital Statistics Report. Hyattsville, MD: National Center for Health Statistics; 1997.
Gulick RM, Mellors JW, Havlir D, et al. Treatment with indinivir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. New Engl J Med. 1997;337:734–9.
Detels R, Muoz A, McFarlane G, et al. Effectiveness of potent antiretroviral therapy on time to AIDS and death in men with known HIV infection duration. JAMA. 1998;280:1497–503.
Stone VE, Mauch MY, Steger K, Janas SF, Craven DE. Race, gender, drug use, and participation in AIDS clinical trials. J Gen Intern Med. 1997;12:150–7.
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Supplemental Report. Atlanta, Ga: U.S. Department of Health and Human Services, Centers for Disease Control; 2001; 1–16.
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report. Atlanta, Ga: U.S. Department of Health and Human Services, Centers for Disease Control; 2000:1–41.
Centers for Disease Control and Prevention. Update: Trends in AIDS incidence-United States, 1996. Morb Mortal Wkly Rep. 1997;46:861–7.
Centers for Disease Control. Summary of notifiable diseases, United States, 1998. Morb Mortal Wkly Rep. 1998;47:1–93.
Centers for Disease Control. Public Health Service guidelines for counseling and antibody testing to prevent HIV infection and AIDS. Morb Mortal Wkly Rep. 1987;36:509–15.
Centers for Disease Control. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Morb Mortal Wkly Rep. 1992;41:1–13.
Cunningham WE, Rana HM, Shapiro MF, Hays RD. Reliability and validity of self-report CD4 counts in persons hospitalized with HIV disease. J Clin Epidemiol. 1997;50:829–35.
Thompson C, Salvato PD. Intravenous Drug Use and the Immune System. Presented at the 12th International Conference on AIDS, Geneva, Switzerland, June 28–July 3, 1998. Faribault, Minn: Marathon Multimedia; 1998.
Deeks SG, Smith M, Holodniy M, Kahn JO. HIV-1 protease inhibitors: a review for clinicians. JAMA. 1997;277:145–53.
Rando TA. Death and the Dying Patient. Grief, Dying, and Death: Clinical Interventions for Caregivers. Champaign, Ill: Research Press Company; 1984:199–225.
Shapiro MF, Morton SC, McCaffrey DF, et al. Variations in the care of HIV-infected adults in the United States: results from the HIV Cost and Services Utilization Study. JAMA. 1999;281:2305–15.
Cunningham WE, Andersen RM, Katz MH, et al. The impact of competing subsistence needs and barriers on access to medical care for persons with HIV receiving care in the United States. Med Care. 1999;37:1270–81.
City of Philadelphia Department of Public Health. AIDS Surveillance Quarterly Update. (Cases Reported Through June 30, 1999). Philadelphia, PA: AIDS Activities Coordinating Office, Epidemiology Unit; 1999;19.
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This study was funded by the Research Foundation of the University of Pennsylvania. Dr. Holmes is supported by a grant from the National Institute of Allergy and Infectious Diseases (A10 1482).
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Holmes, W.C., Pace, J.L. HIV-seropositive individuals’ optimistic beliefs about prognosis and relation to medication and safe sex adherence. J GEN INTERN MED 17, 677–683 (2002). https://doi.org/10.1046/j.1525-1497.2002.00746.x
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DOI: https://doi.org/10.1046/j.1525-1497.2002.00746.x