Disclosure of Complementary and Alternative Medicine Use to Health Care Providers among HIV-Infected Women

Abstract

To determine prevalence and predictors of complementary and alternative medicine (CAM) use disclosure to health care providers and whether CAM use disclosure is associated with highly active antiretroviral therapy (HAART) adherence among HIV-infected women, we analyzed longitudinal data collected between October 1994 and March 2002 from HIV-infected CAM-using women enrolled in the Women’s Interagency HIV Study. Repeated measures Poisson regression models were constructed to evaluate associations of selected predictors with CAM use disclosure and association between CAM use disclosure and HAART adherence. A total of 1377 HIV-infected women reported CAM use during study follow-up and contributed a total of 4689 CAM-using person visits. The overall prevalence of CAM use disclosure to health care providers was 36% across study visits. Women over 45 years old, with a college education, or with health insurance coverage were more likely to disclose their CAM use to health care providers, whereas women identified as non-Hispanic Black or other ethnicities were less likely to communicate their CAM usage. More health care provider visits, more CAM domains used, and higher health care satisfaction scores had significant relationships with increased levels of CAM use disclosure. Restricting analysis to use of herbal or nonherbal medications only, similar results were obtained. Compared to other CAM domains, mind–body practice had the lowest prevalence of CAM use disclosure. Additionally, CAM use disclosure was significantly associated with higher HAART adherence. From this study, we showed that a high percentage of HIV-infected women did not discuss their CAM use with health care providers. Interventions targeted towards both physicians and patients may enhance communication of CAM use, avoid potential adverse events and drug interactions, and enhance HAART adherence.

Beliefs and practices of complementary and alternative medicine (CAM) among HIV/AIDS patients: A qualitative exploration

“…In addition, interventions involving both physicians and patients may enhance communication of CAM use, avoid potential adverse events and drug interactions as well as could enhance ARTs adherence. [50] Study limitations:…”

Looking beyond the barriers: Practical and symbolic factors associated with disclosure of complementary and alternative medicine (CAM) use

“…, Tthe fFew studies have examined factors associated with disclosure as most have focused instead on other than those that can be considered the conceptual opposite of those linked to non-disclosure. For example, several studies have noted that the quality of the relationship with one's conventional care provider and satisfaction with this care promotes disclosure of CAM [7,9,18]. However, no studies to date have investigated if and how the quality of CAM care may be associated with CAM disclosure.…”

“…Thus, disclosing CAM use may similarly reflect feeling empowered to act on behalf of one's own health. With respect to taking control over one's health, there is also evidence that disclosure is associated with engaging in disease self-management behaviours [7].…”

“…The sociodemographic factors associated with non-disclosure include lower education [12], younger age [7], and gender [5,11], although the findings for the latter factor are inconsistent. Among the reasons for not disclosing CAM use noted in current research, perceiving that physicians will disapprove or react negatively to CAM use [12][13][14][15], and that disclosing CAM use wasn't important for their care [13][14][15][16][17], figure prominently.…”

“…Indeed disclosure of CAM use is critical for coordination of care and minimizing treatment conflicts [4]. However, estimates of CAM use disclosure to physicians vary widely depending on the population, but in general can be low ranging from 12 to 53 percent in oncology patients [5,6], 36 percent in HIV patients [7], and 21 to 71 percent in general medical populations [8,9]. Successful co-ordination of care depends in part upon consumers playing an active role in facilitating communication between their different care providers [10].…”