Social Support, Disclosure, and Use of Antiretroviral Therapy

Waddell, Elizabeth Needham; Messeri, Peter

doi:10.1007/s10461-005-9042-x

Cited by 84 publications

(84 citation statements)

References 16 publications

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“…This was because it is more difficult to hide one's status when taking ARV treatment, due to regular clinical visits to the clinic, having one's blood drawn frequently, and having to take medication at specific times, twice daily for the rest of one's life. Thus, to avoid disclosure and keep their social support within the household, and social ties with friends and acquaintances, PLHIV will either delay or stop taking their ARVs (Makoae et al 2009;Waddell & Messeri 2006). To the contrary, Stirratt, Remien, Smith, Copeland, Dolezal, Krieger, et al (2006) found that individuals who disclosed had higher rates of adherence than those who had not.…”

Section: Résumémentioning

confidence: 99%

To tell or not to tell: Negotiating disclosure for people living with HIV on antiretroviral treatment in a South African setting

Linda¹

2013

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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Disclosure of HIV status occurs for a variety of reasons and in various contexts, such as to sexual partners to enable safer sexual choices, to health-care workers to access treatment and care services and to family and community members to gain various forms of support. The reasons for disclosure or non-disclosure are shaped by the relationships, needs and circumstances of people living with HIV (PLHIV) at the time of disclosure. The purpose of this study was to investigate and describe the act and experience of disclosure in order to understand how these experiences of disclosure impact on the lives of PLHIV on antiretroviral (ARV) treatment and influence adherence to treatment. Using a qualitative research design, I conducted an ethnographic study at and through the referral clinic at the Tygerberg Hospital in Cape Town, South Africa. Ninety-three adult patients (75 women) participated in the study, 32 of whom were visited at home to conduct semi-structured in-depth interviews, and 61 of them participated in a cross-sectional study at the referral clinic using researcher-administered questionnaires. A general inductive approach was used to analyse the data. Participants in both arms of the study disclosed mainly to family members, then partners and then to friends and other persons; only five had not disclosed to anyone at all. In deciding to disclose or not, the author began to see how patients negotiated their disclosure. From weighing up other people's reactions, to being concerned about the effect of their disclosure on their disclosure targets, to concealing one's status to evade untoward negative reactions towards themselves. Further, negotiating one's disclosure is not only about to whom or how to disclose, it also means finding good opportunities to disclose or conceiving ways of hiding one's status and/or medication from others in order to enhance access and adherence to their ARV treatment. Perceived rather than actual stigma played an important role in decisions not to disclose. Nonetheless, HIV remains a highly stigmatising disease. The author suggests that both the gains in support and the evasion of negative reactions from the disclosure will continue to drive negotiation of disclosure of one's status in order for patients to access and remain adherent to their treatment. Thus, areas of disclosure and concealment as they influence one's adherence to treatment need to be investigated further to facilitate adherence to treatment.Keywords: stigma, discrimination, social, household, family, partners RésuméLe partage du statut VIH a lieu pour diverses raisons et dans des contextes divers: avec les partenaires sexuels pour permettre des choix à moindre risque, avec les agents de santé pour accéder aux traitements et aux services de soins, et avec des membres de la famille et de la communauté pour obtenir diverses formes de soutien. Les motifs du partage ou du non-partage sont façonnés par les relations, les besoins et les circonstances des personnes vivant avec le VIH (PVVIH) au moment où elle...

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Section: Résumémentioning

confidence: 99%

To tell or not to tell: Negotiating disclosure for people living with HIV on antiretroviral treatment in a South African setting

Linda¹

2013

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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“…Social support has been linked to disease incidence and mortality (House et al, 1988). Maintenance of supportive relationships benefits the health of HIV+ patients, specifically in terms of self-disclosure of HIV status and use of HAART (Waddell & Messeri, 2006). Second, smoking is an independent risk factor for non-AIDS-related mortality in HIV patients (Patel et al, 2006), and to the extent that a synergistic effect exists, deficits in social support could be especially problematic.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Cigarette Smoking among HIV+ Men and Women: Examining Health, Substance Use, and Psychosocial Correlates across the Smoking Spectrum

et al. 2007

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The prevalence of cigarette smoking among HIV+ individuals is greater than that found in the general population. However, factors related to smoking within this population are not well understood. This study examined the associations between smoking and demographic, medical, substance use, and psychosocial factors in a clinic-based sample of HIV+ men and women. Two hundred twelve participants completed self-report measures of tobacco use, HIV-related symptoms, viral load, CD4, alcohol and illicit drug use, depression, and social support. Multinomial logistic regression analyses modeled the independent associations of the cross-sectional set of predictors with smoking status. Results indicated that 74% of the sample smoked at least one cigarette per day; using standard definitions, 23% of the sample were light smokers, 22% were moderate smokers, and 29% smoked heavily. Smoking was associated with more HIV-related symptoms, greater alcohol and marijuana use, and less social support. Light smoking was related to minority race/ethnicity and less income; moderate smoking was associated with less education; and heavy smoking was related to less education and younger age. Viral load, CD4 count, and depression were not associated with smoking status. Psychosocial interventions targeting this population should consider the relationships between biopsychosocial factors and smoking behavior. High Smoking Prevalence among HIV+ Men and Women: Examining Health, Substance Use, and Psychosocial Correlates across the Smoking SpectrumSmoking is highly prevalent among persons living with HIV and may contribute to premature morbidity and mortality. Among HIV+ individuals, prevalence rates of smoking range from 50% to 70% (Burkhalter et al., 2005;Miguez-Burbano et al., 2005;Niaura et al., 2000) compared to 21% for the general population (CDC, 2005). Smoking is strongly associated with two of the primary causes of illness and death in HIV+ patients: community-acquired pneumonia (CAP) and Pneumocystis jiroveci pneumonia (formerly known as Pneumocystis ciroveci; Arcavi & Benowitz, 2004;Miguez-Burbano et al., 2005). HIV+ smokers are also at increased risk for oral lesions (Palacio et al., 1997) Beck & Slade, 1996), and AIDS-related spontaneous pneumothorax (Metersky et al., 1995).Young smokers infected with HIV may be particularly vulnerable to malignant tumors, such as lung cancer (Patel et al., 2006;Spano et al., 2004). Moreover, smoking by HIV+ patients may facilitate the progression to Acquired Immune Deficiency Syndrome (AIDS) (Neiman et al., 1993).Evidence also suggests that smoking has adverse effects on the health-related quality of life (HRQL) of HIV+ men and women. Vidrine et al. (2006) tested a framework for HRQL of life among HIV+ individuals. They found that HRQL is influenced by relationships among physical symptoms, and cognitive, psychological, and social functioning (Brenner et al., 1995;Wilson & Cleary, 1995). They also found that smoking, alcohol use, and SES impair overall HRQL. Other work has also found rel...

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“…HIV status disclosure serves as an important prevention strategy in PMTCT, it enables PMTCT attendees to benefit by being able to use ART prophylaxis, practice safe infant feeding and family planning practices [3,4]. Disclosure is also important for psychosocial support, treatment adherence [6][7][8], stigma reduction and risk reduction behaviour [9] In developed countries HIV status disclosure rate among antenatal care (ANC) women ranges from 42-100% compared to 16.7-32% for developing countries [10]. The Policy in Zimbabwe advocates that all patients and clients, negative and positive, should be empowered to disclose their results to their sexual partners through counselling.…”

Section: Introductionmentioning

confidence: 99%

Determinants of nondisclosure of HIV status among women attending the prevention of mother to child transmission programme, Makonde district, Zimbabwe, 2009

Mucheto¹,

Chadambuka²,

Shambira³

et al. 2011

Pan Afr Med Jrnl

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Introduction The 2007 United Nations General Assembly Report on HIV/AIDS in Zimbabwe reported nondisclosure of HIV status as a challenge in the PMTCT programme. Preliminary investigations on nondisclosure among 21 women tested for HIV at Chinhoyi Hospital showed that only six had disclosed their HIV status. We investigated the determinants of nondisclosure of HIV status. Methods A cross sectional analytic study was conducted at six health facilities in Makonde district. The Theory of Planned Behaviour was adapted to guide socio-cultural variables assessed. Antenatal and postnatal women tested for HIV in the PMTCT program who consented to participate were interviewed. Results We enrolled 334 women. Thirty four percent (114) did not disclose their HIV status. Among HIV positive respondents, 43% (25) did not disclose their status. Women who believed disclosure caused physical abuse (OR=1.81, 95% CI: 1.17-2.90), caused divorce (OR=2.01, 95% CI: 1.25-3.22) and was unimportant (OR= 2.26, 95% CI: 1.33-3.87) were two times less likely to disclose their status. Respondents who received group HIV pre-test counselling were 2.4 times more likely not to disclose. Receiving ANC HIV education at least twice and referral for psychosocial support were significantly protective [OR 0.54 (95% CI 0.24-0.63) and 0.16 (95% CI: 0.06-0.41) respectively. Independent determinants of nondisclosure among HIV positive women were perception that disclosure would cause divorce (AOR=7.82, p=0.03), living with an extended family (AOR=10.3, p=0.01) and needing spousal approval of HIV testing (AOR= 0.11, p<0.001). Conclusion Lack of psychosocial support and counselling for women and belief that disclosure causes divorce, abuse or is unimportant contributes to nondisclosure. Identifying women with social challenges and strengthening their referral for psychosocial support can improve disclosure of HIV status and reduce mother to child transmission of HIV.

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Social Support, Disclosure, and Use of Antiretroviral Therapy

Cited by 84 publications

References 16 publications

To tell or not to tell: Negotiating disclosure for people living with HIV on antiretroviral treatment in a South African setting

To tell or not to tell: Negotiating disclosure for people living with HIV on antiretroviral treatment in a South African setting

Cigarette Smoking among HIV+ Men and Women: Examining Health, Substance Use, and Psychosocial Correlates across the Smoking Spectrum

Determinants of nondisclosure of HIV status among women attending the prevention of mother to child transmission programme, Makonde district, Zimbabwe, 2009

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