Abuse and Resilience in Relation to HAART Medication Adherence and HIV Viral Load Among Women with HIV in the United States

Abstract

Abuse is highly prevalent among HIV + women, leading to behaviors, including lower adherence to highly active antiretroviral therapy (HAART) that result in poor health outcomes. Resilience (functioning competently despite adversity) may buffer the negative effects of abuse. This study investigated how resilience interacted with abuse history in relation to HAART adherence, HIV viral load (VL), and CD4 + cell count among a convenience sample of 138 HIV + women from the Ruth M. Rothstein CORE Center/Cook County Health and Hospital Systems site of the Women's Interagency HIV Study (WIHS). Resilience was measured by the 10-item Connor-Davidson Resilience Scale (CD-RISC). HAART adherence ( ‡ 95% vs. < 95% self reported usage of prescribed medication) and current or prior sexual, physical, or emotional/domestic abuse, were reported during structured interviews. HIV viral load ( ‡ 20 vs. < 20 copies/mL) and CD4 + count (200 vs. < 200 cells/mm) were measured with blood specimens. Multiple logistic regressions, controlling for age, race, income, enrollment wave, substance use, and depressive symptoms, indicated that each unit increase in resilience was significantly associated with an increase in the odds of having ‡ 95% HAART adherence and a decrease in the odds of having a detectable viral load. Resilience-Abuse interactions showed that only among HIV + women with sexual abuse or multiple abuses did resilience significantly relate to an increase in the odds of ‡ 95% HAART adherence. Interventions to improve coping strategies that promote resilience among HIV + women may be beneficial for achieving higher HAART adherence and viral suppression.

Substance Abuse, Violence, and HIV/AIDS (SAVA) Syndemic Effects on Viral Suppression Among HIV Positive Women of Color

“…4,5 These factors may negatively affect health outcomes in myriad ways, including decreased engagement in HIV care, 6 and reduced adherence to medications. 7,8 An estimated 8% of HIV-positive people in the US abuse alcohol, 9,10 while onethird of HIV patients receiving care report active drug use. 10 Both alcohol and drug abuse are associated with poor ART adherence and viral suppression failure.…”

“…[10][11][12] Approximately 55% of women living with HIV/AIDS have experienced intimate partner violence (IPV). 13 A history of trauma, abuse, and violence for HIV-infected women is associated with decreased medication adherence, 9,11,12 and increased viral load. 13,14 Studies consistently document high prevalence of mental health disorders and symptomatology among HIV positive populations.…”

'Experience talks, resilience shapes' revisiting historic trauma: impact on treatment in indigenous males living with HIV/AIDS in British Columbia

“…A limited number of studies have reported that positive and healthy decisions and actions stem from an initial development of a positive attitude towards life, acceptance of one's HIV/AIDS situation, generating meaning out of it, and being optimistic and these are related to better health outcomes (Dale et al, 2014). This stands true of Indigenous men in this study, many of whom also extend this positive attitude to a form of "pride culture" in their day-today lives.…”

“…In two recent studies with women living with HIV/AIDS, resilience in those who had sexual abuse history was shown to potentially promote better adherence to HAART, to decrease the viral load and slow down CD4 + cell count decline rates (Dale et al, 2014;Ickovics et al, 2006). This finding was attributed to positive psychological factors exhibited by the study participants.…”

“…Most researchers now regard resilience as neither a trait nor unique capacity but a dynamic developmental process through which, following the experience of adversity/trauma, one or a group overcome(s), positively cope(s) with or adapt(s) to the adversity/trauma and its negative effects/ trajectories (Dale et al, 2014;Fergus & Zimmerman, 2005;Fox et al, 2015;Herrick, 2011;Rutter, 2012;Truffino, 2010) and is able to utilize sustainable resources for health and well-being (Panter-Brick & Leckman, 2013;Southwick et al, 2014). Mediated by differing protective factors operating around the individual or group, the meaning of resilience and resilience capacity may be specific and unique to the given culture and context at any one time, and those recovering from trauma may show resilience acquisition and maintenance periods, as well as times of fragility (Aburn et al, 2016;Gartland et al, 2011;Herrick, Stall, Goldhammer, Egan, & Mayer, 2014;Herrman et al, 2011;Isaak et al, 2015;Ungar, 2008).…”