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The Role of HIV Serostatus Disclosure in Antiretroviral Medication Adherence

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Abstract

This study examined the relationship between HIV serostatus disclosure and adherence to antiretroviral therapy (ART). The study was conducted with 215 HIV-seropositive patients who demonstrated poor adherence (<80%) and who were in serodiscordant relationships. Participants completed self-report measures regarding HIV serostatus disclosure and reasons for missing ART doses, as well as electronic monitoring of ART adherence (MEMS caps). Overall, 19% of the sample reported missing medication doses in the last two months due to concerns regarding serostatus disclosure. Participants who reported greater serostatus disclosure to others demonstrated higher rates of adherence, and this relationship remained after controlling for other explanatory variables. The relationship between disclosure and adherence was not mediated by practical support for adherence from others. Interventions to improve ART adherence should address the role of serostatus disclosure by providing patients with skills to maintain adherence in contexts of non-disclosure and to make informed choices regarding selective disclosure.

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REFERENCES

  • Ammassari, A., Trotta, M. P., Murri, R., Castelli, F., Narciso, P., Noto, P., et al. (2002). Correlates and predictors of adherence to highly active antiretroviral therapy: Overview of published literature. Journal of Acquired Immune Deficiency Syndrome, 31, S123–S127.

    Google Scholar 

  • Bangsberg, D. R., Hecht, F. M., Charlebois, E., Zolopa, A. R., Holodiny, M., Sheiner, L., et al. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS, 14, 357–366.

    Article  PubMed  CAS  Google Scholar 

  • Bangsberg, D. R., Sharon, P., Charlebois, E. D., Clark, R. A., Roberston, M., Zolopa, A. R., et al. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS, 15, 1181–1183.

    Article  PubMed  CAS  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory-II. San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Black, B. P., & Miles, M. S. (2002).Calculating the risks and benefits of disclosure in African American women who have HIV. Journal of Obstetric and Gynecological Neonatal Nursing, 31, 688–697.

    Google Scholar 

  • Blaney, N. T., Fernandez, I., Ethier, K. A., Wilson, T. E., Walter, E., & Koenig, L. J., for the Perinatal Guidelines Evaluation Project Group. (2004). Psychosocial and behavioral correlates of depression among HIV-infected pregnant women. AIDS Patient Care and STDs, 18(7), 405–415.

    Article  PubMed  Google Scholar 

  • Bozzette, S. A., Berry, S. H., Duan, N., Frankel, M. R., Leibowitz, A. A., Lefkowitz, D., et al. (1998). The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium. New England Journal of Medicine, 339(26), 1897–904.

    Article  PubMed  CAS  Google Scholar 

  • Catz, S. L., Kelly, J. A., Bogart, L. M., Benotsch, E. G., & McAiliffe, T. L. (2000). Patterns, correlates and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19, 124–133.

    Article  PubMed  CAS  Google Scholar 

  • Chesney, M. A., Chambers, D. B., Taylor, J. M., & Johnson, L. M. (2003). Social support, distress, and well-being in older men living with HIV infection. Journal of Acquired Immune Deficiency Syndromes, 33, S185 –S193.

    PubMed  Google Scholar 

  • Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. Patient Care Committee and Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care, 12(3), 255–266.

    Article  PubMed  CAS  Google Scholar 

  • Chesney, M. A., Ickovics, J., Hecht, F. M., Sikipa, G., & Rabkin, J. (1999). Adherence: a necessity for successful HIV combination therapy. AIDS, 12(Supp A), S271–S278.

    Google Scholar 

  • Chesney, M. A., & Smith, A. W. (1999). Critical delays in HIV testing and care. American Behavioral Scientist, 42, 1162–1174.

    Article  Google Scholar 

  • Christensen, A., & Shenk, J. L. (1991). Communication, conflict, and psychological distance in nondistressed, clinic, and divorcing couples. Journal of Consulting and Clinical Psychology, 59, 458–463.

    Article  PubMed  CAS  Google Scholar 

  • Clark, H. J., Lindner, G., Armistead, L., & Austin, B. (2003). Stigma, disclosure, and psychological functioning among HIV-infected and non-infected African-American women. Women and Health, 38(4), 57–71.

    Article  Google Scholar 

  • Clingerman, E. (2004). Physical activity, social support, and health-related quality of life among persons with HIV disease. Journal of Community Health Nursing, 21(3), 179–197.

    Article  PubMed  Google Scholar 

  • Cohen, C. I., & Sokolovsky, J. (1978). General Social Survey network items. Connections, 8, 119–122.

    Google Scholar 

  • D’Angelo, L. J., Abdalian, S. E., Sarr, M., Hoffman, N., Belzer, M., & the Adolescent Medicine HIV/AIDS Research Network. (2001). Disclosure of serostatus by HIV infected youth: The experience of the REACH study (Reaching for Excellence in Adolescent Care and Health). Journal of Adolescent Health, 29, 72–79.

    Article  PubMed  CAS  Google Scholar 

  • Demas, P., Schoenbaum, E. E., Wills, T. A., Doll, L. S., & Klein, R. S. (1995). Stress, coping, and attitudes toward HIV treatment in injecting drug users: A qualitative study. AIDS Education and Prevention, 7(5), 429–442.

    PubMed  CAS  Google Scholar 

  • DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis. Health Psychology, 23, 207–218.

    Article  PubMed  Google Scholar 

  • Duran, S., Spire, B., Raffi, F., Walter, V., Bouhour, D., Journot, V., et al. (2001). Self-reported symptoms after initiation of a protease inhibitor in HIV-infected patients and their impact on adherence to HAART. HIV Clinical Trials, 2(1), 38–45.

    Article  PubMed  CAS  Google Scholar 

  • El-Bassel, N., Cooper, D. K., Chen, D. R., & Schilling, R. F. (1998). Personal social networks and HIV status among women on methadone. AIDS Care, 10(6), 735–749.

    Article  PubMed  CAS  Google Scholar 

  • Ewart, C. K. (1991). Social action theory for a public health psychology. American Psychologist, 46, 931–946.

    Article  PubMed  CAS  Google Scholar 

  • Gibb, D. M., Goodall, R. L., Giacomet, V., McGee, L., Compagnucci, A., & Lyall, H,, for the Paediatric European Network for Treatment of AIDS Steering Committee (2003). Adherence to prescribed antiretroviral therapy in human immunodeficiency virus-infected children in the PENTA 5 trial. Pediatric Infectious Disease Journal, 22, 56–62.

    Article  PubMed  Google Scholar 

  • Golin, C., Isasi, F., Bontempi, J. B., & Eng, E. (2002). Secret pills: HIV-positive patients’ experiences taking antiretroviral therapy in North Carolina. AIDS Education and Prevention, 14(4), 318–329.

    Article  PubMed  Google Scholar 

  • Gonzalez, J. S., Penedo, F. J., Antoni, M. H., Duran, R. E., Fernandez, M. I., McPherson-Baker, S., et al. (2004). Social support, positive states of mind, and HIV treatment adherence in men and women living with HIV/AIDS. Health Psychology, 23, 413–418.

    Article  PubMed  Google Scholar 

  • Gordillo, V., del Amo, J., Soriano, V., & Gonzalez-Lahoz, J. (1999). Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS, 13, 1763–1769.

    Article  PubMed  CAS  Google Scholar 

  • Heckman, T. G., Anderson, E. S., Sikkema, K. J., Kochman, A., Kalichman, S. C., & Anderson, T. (2004). Emotional distress in nonmetropolitan persons living with HIV disease enrolled in a telephone-delivered coping improvement group intervention. Health Psychology, 23, 94–100.

    Article  PubMed  Google Scholar 

  • Herek, G. M., Capitanio, J. P., & Widaman, K. F. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92(3), 371–377.

    Article  PubMed  Google Scholar 

  • Hoff, C. C. McKusick, L., Hillard, B., & Coates, T. J. (1992). The impact of HIV antibody status on gay men's partner preferences: A community perspective. AIDS Education and Prevention, 4, 197–204.

    PubMed  CAS  Google Scholar 

  • Horowitz, M., Adler, N., & Kegeles, S. (1988). A scale for measuring the occurrence of positive states of mind: A preliminary report. Psychosomatic Medicine, 50, 477–483.

    PubMed  CAS  Google Scholar 

  • Justice, A. C., Holmes, W., Gifford, A. L., Rabeneck, L., Zackin, R., Sinclair, G., et al. (2001). Development and validation of a self-completed HIV symptom index. Journal of Clinical Epidemiology, 54, S77–S90.

    Article  PubMed  Google Scholar 

  • Kalichman, S. C., DiMarco, M., Austin, J., Luke, W., & DiFonzo, K. (2003). Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women. Journal of Behavioral Medicine, 26(4), 315–332.

    Article  PubMed  Google Scholar 

  • Kelly, J. A., Murphy, D. A., Bahr, G. R., & Kalichman, S. C. (1993). Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. American Journal of Psychiatry, 150, 1679–1686.

    PubMed  CAS  Google Scholar 

  • Klitzman, R. L., Kirschenbaum, S. B., Dodge, B., Remien, R. H., Ehrhardt, A. A., Johnson, M. O., et al. (2004). Intricacies and inter-relationships between HIV disclosure and HAART: A qualitative study. AIDS Care, 16(5), 628–640.

    Article  PubMed  CAS  Google Scholar 

  • Leserman, J., Jackson, E. D., Petitto, J. M., Golden, R. N., Silva, S. G., Perkins, D. O., et al. (1999). Progression to AIDS: The effects of stress, depressive symptoms, and social support. Psychosomatic Medicine, 61, 397–406.

    PubMed  CAS  Google Scholar 

  • Malcolm, S. E., Ng, J. J., Rosen, R. K., & Stone, V. E. (2003). An examination of HIV/AIDS patients who have excellent adherence to HAART. AIDS Care, 15, 251–261.

    Article  PubMed  CAS  Google Scholar 

  • Mellins, C. A., Kang, E., Cheng-Shiun, L., Havens, J. F., & Chesney, M. A. (2003). Longitudinal study of mental health and psychosocial predictors of medical treatment adherence in mothers living with HIV disease. AIDS Patient Care and STDs, 17(8), 407–416.

    Article  PubMed  Google Scholar 

  • Mellins, C. A., Brackis-Cott, E., Dolezal, C., & Abrams, E. J. (2004). The role of psychosocial and family factors in adherence to antiretroviral treatment in human immunodeficiency virus-infected children. Pediatric Infectious Disease Journal, 23, 1035–1041.

    Article  PubMed  Google Scholar 

  • Morse, E. V., Simon, P. M., Coburn, M., Hyslop, N., Greenspan, D., & Balson, P. M. (1991). Determinants of subject compliance within an experimental anti-HIV drug protocol. Social Science & Medicine, 10, 1161–1167.

    Article  Google Scholar 

  • Mostashari, F., Riley, E., Selwyn, P. A., & Altice, F. L. (1998). Acceptance and adherence with antiretroviral therapy among HIV-infected women in a correctional facility. Journal of Acquired Immune Deficiency Syndromes, 18(4), 341–348.

    CAS  Google Scholar 

  • Murphy, D. A., Steers, W. N., & Dello Stritto, M. E. (2001). Maternal disclosure of mother's HIV serostatus to their young children. Journal of Family Psychology, 15, 441–450.

    Article  PubMed  CAS  Google Scholar 

  • Murri, R., Ammassari, A., Gallicano, K., De Luca, A., Cingolani, A., Jacobson, D., et al. (2000). Patient-reported nonadherence to HAART is related to protease inhibitor levels. Journal of Acquired Immune Deficiency Syndromes, 24, 123–128.

    PubMed  CAS  Google Scholar 

  • Ouette, M., Juretzko, P., Kroidl, A., Sagir, A., Wettstein, M., Siegrist, J., et al. (2002). Lipodystrophy syndrome and self-assessment of well-being and physical appearance in HIV-positive patients. AIDS Patient Care and STDs, 16(9), 413–417.

    Article  PubMed  Google Scholar 

  • Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133, 21–30.

    PubMed  CAS  Google Scholar 

  • Prado, G., Feaster, D. J., Schwartz, S. J., Pratt, I. A., Smith, L., & Szapocznik, J. (2004). Religious involvement, coping, social support, and psychological distress in HIV-seropositive African American mothers. AIDS and Behavior, 8, 221–235.

    Article  PubMed  Google Scholar 

  • Pugatch, D., Bennett, L., & Patterson, D. (2002). HIV medication adherence in adolescents: A qualitative study. Journal of HIV/AIDS Prevention and Education for Adolescents and Children, 5(1-2), 9–29.

    Article  Google Scholar 

  • Remien, R. H., Stirratt, M. J., Dolezal, C., Dognin, J. S., Wagner, G. J., Carballo-Dieguez, A., et al. (2005). Couple-focused support to improve HIV medication adherence: A randomized controlled trial. AIDS, 19, 807–814.

    Article  PubMed  Google Scholar 

  • Safren, S. A., Radomsky, A. S., Otto, M. W., & Salomon, E. (2002). Predictors of psychological well-being in a diverse sample of HIV-positive patients receiving highly active antiretroviral therapy. Psychosomatics, 43, 478–485.

    Article  PubMed  Google Scholar 

  • Serovich, J. M. (2001). A test of two HIV disclosure theories. AIDS Education and Prevention, 13, 355–364.

    Article  PubMed  CAS  Google Scholar 

  • Siegel, K., Schrimshaw, E. W., & Raveis, V. H. (2000). Accounts for non-adherence to antiviral combination therapies among older HIV-infected adults. Psychology, Health & Medicine, 5(1), 29–42.

    Article  Google Scholar 

  • Stirratt, M. J. (2005). I have something to tell you: HIV serostatus disclosure strategies and sexual practices. In P. N. Halkitis, C. Gomez, & R. Wolitski (Eds.), HIV+ Sex: The psychological and interpersonal dynamics of HIV-seropositive gay and bisexual men's relationships. Washington, DC: American Psychological Association.

    Google Scholar 

  • Swindells, S., Mohr, J., Justis, J. C., Berman, S., Squier, C., Wagener, M. M., et al. (1999). Quality of life in patients with human immunodeficiency virus infection: impact of social support, coping style and hopelessness. International Journal of STDs and AIDS, 10(6), 383–391.

    Article  CAS  Google Scholar 

  • Wills, T. A., & Fegan, M. F. (2001). Social networks and social support. In A. Baum, T. A. Revenson, & J. E. Singer (Eds.), Handbook of health psychology (pp. 209–234). Mahwah, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Wood, E., Hogg, R. S., Yip, B., Harrigan, P. R., O’Shaughnessy, M. V., & Montaner, J. S. (2003). Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 × 10(9) cells/L. Annals of Internal Medicine, 139, 810–816.

    PubMed  Google Scholar 

  • Wood, E., Hogg, R. S., Yip, B., Harrigan, P. R., O’Shaughnessy, M. V., & Montaner, J. S. (2004). The impact of adherence on CD4 cell count responses among HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes, 35, 261–268.

    Article  PubMed  Google Scholar 

  • Zea, M. C., Reisen, C. A., Poppen, P. J., Bianchi, F. T., & Echeverry, J. J. (2005). Disclosure of HIV status and psychological well-being among Latino gay and bisexual men. AIDS & Behavior, 9, 15–26.

    Article  Google Scholar 

  • Zierler, S., Cunningham, W. E., Andersen, R., Shapiro, M. F., Bozzette, S. A., Nakazono, T., et al. (2000). Violence victimization after HIV infection in a U.S. probability sample of adult patients in primary care. American Journal of Public Health, 90(2), 208–215.

    PubMed  CAS  Google Scholar 

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Acknowledgement

This study was supported by the National Institute of Mental Health (R01 MH61173 Serodiscordant Couples, Medical Adherence, and HIV Risk; Robert H. Remien, Ph.D.). Michael J. Stirratt, Ph.D., is a post-doctoral fellow supported by a training grant from the National Institute of Mental Health (T32 MH19139 Behavioral Sciences Research in HIV Infection; Anke A. Ehrhardt, Ph.D.). The authors acknowledge the contributions of the SMART Couples Study Team: Nabila El Bassel, Ph.D., Robert Kertzner, Ph.D., Alex Carballo-Dieguez, Ph.D., and Joanna Dognin, Psy.D. We also thank Tiffany Jung, N. P., Robert Warford, N.P., Ernie Attah, Ph.D., and Ronit Epstein, B.A., for their assistance with the conduct of this study. We are grateful to Victoria Sharp, M.D., and the clinical staff at St. Luke’s-Roosevelt Hospital Center for their collaboration on this project and to the men and women who participated in this study

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Stirratt, M.J., Remien, R.H., Smith, A. et al. The Role of HIV Serostatus Disclosure in Antiretroviral Medication Adherence. AIDS Behav 10, 483–493 (2006). https://doi.org/10.1007/s10461-006-9106-6

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