Perspectives of middle-aged African-American women in the Deep South on antiretroviral therapy adherence

Abstract

Despite evidence of stabilization in some areas of the US, HIV infection in Black women is not declining in the Deep South. Using a phenomenological approach to qualitative inquiry, we investigated women's experiences influencing their adherence to HAART in an urban setting. Inclusion criteria specified Black women who had been aware of their HIV status for at least two years and were engaged in HIV outpatient care. Twelve single face-to-face confidential in-depth semi-structured interviews were conducted from a sample of pre-dominantly middle-aged women retained in care at an HIV clinic in Atlanta, Georgia. Data was analyzed by two independent reviewers and three themes emerged from the group of women's accounts of their experiences. First, sentinel events led to changes in perspective and motivated women to adhere to HAART. Second, recognition that one had the personal strength necessary to cope with HIV fostered adherence. Finally, relationships with healthcare providers especially trust issues surrounding this relationship, impacted adherence both positively and negatively. These findings suggest that HAART adherence is a complex issue among middle-aged urban Black women with HIV in the Deep South. Providers caring for this patient population should recognize that sentinel events, personal strength, and positive healthcare relationships are opportunities to improve adherence.

Rebooting resilience: shifts toward dynamic, multi-level, and technology-based approaches for people living with HIV

“…This paper highlights the role of diverse "villages", including those of kinship, choice, and circumstance, that BWLWH identify as critical to their ability to overcome adversities across the lifespan. Dale and Safren's (2019) findings, informed by 45 in-depth qualitative interviews with BWLWH and community stakeholders, extend previous research (e.g., Dale, Pierre-Louis, Bogart, O'Cleirigh, & Safren, 2018;DeMoss, Bonney, Grant, Klein, del Rio, & Barker, 2014) in suggesting that social networks can help BWLWH better cope with HIV-related challenges. In particular, women reported about their positive experiences with communities that supported them in being their authentic selves, healthcare providers who prioritized empathy and compassion, and family members who provided "safe havens" from HIV-related stigma and adversity.…”

The State of Adherence to HIV Care in Black Women

“…Social networks and relationships can be enabling or motivating factors influencing health care outcomes such as retention in care and ART adherence in WLWH. The patient-provider relationship is often a salient factor positively associated with retention in care and ART adherence (DeMoss et al, 2014; Kempf et al, 2010; Messer et al, 2013; Tufts, Wessell, & Kearney, 2010; Webel & Higgins, 2012). In-depth interviews with 14 Black WLWH revealed that relationships with their providers positively influenced ART adherence (DeMoss et al, 2014).…”

“…The patient-provider relationship is often a salient factor positively associated with retention in care and ART adherence (DeMoss et al, 2014; Kempf et al, 2010; Messer et al, 2013; Tufts, Wessell, & Kearney, 2010; Webel & Higgins, 2012). In-depth interviews with 14 Black WLWH revealed that relationships with their providers positively influenced ART adherence (DeMoss et al, 2014). In addition to a positive patient-provider relationship in facilitating rapport, women in the rural Deep South reported wanting their providers to be caring and to inquire about their overall well-being (Boehme et al, 2012).…”

“…Inadequate social support and poor patient-provider relationships were consistently cited as interpersonal factors associated with or predictors of retention in care and/or ART adherence (DeMoss et al, 2014; Kempf et al, 2010; Messer et al, 2013; Toth, Messer, & Quinlivan, 2013; Tufts, Wessell, & Kearney, 2010; Webel & Higgins, 2012). Social support in the form of family, friends, or peers were seen as valuable resources that improved ART adherence and retention in care.…”

“I Created Something New with Something that Had Died”: Photo-Narratives of Positive Transformation Among Women with HIV

“…It is necessary, though, to better understand the association between the photo-story process, how it helps women express transformation and change, and how the expression and/or transformation process may be related to health outcomes including both prevention and treatment outcomes [54]. The tentative explanations that we generated about how positive health, spirituality, self-acceptance and confidence transformations are related to women's health need to be tested more extensively to determine the association between photo-stories, transformation, and health behavior.…”