The impact of social context on self-management in women living with HIV

Abstract

HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicated all domains of HIV self-management including daily health practices (F=5.40, adjusted R2=0.27, p<0.01), HIV social support (F=4.50, adjusted R2=0.22, p<0.01), and accepting the chronic nature of HIV (F=5.57, adjusted R2=0.27, p<0.01). We found evidence to support the influence of the traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women’s social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population.

A Cross-Sectional Relationship Between Social Capital, Self-Compassion, and Perceived HIV Symptoms

“…Being in paid employment significantly predicted HIV symptom intensity and this evidence adds to the growing body of literature documenting the positive role of paid employment among PLWH (30, 62–65). However, the relationship between symptoms and employment status is difficult to disentangle in a cross-sectional study.…”

“…Social capital represents the degree to which a person has access to high-quality social resources, including social support through social networks. Among PLWH, social capital has been shown to impact a number of health-related outcomes including decreases in HIV transmission (25–28), self-reported physical and psychological health (29), behaviors including HIV self-management (30), and HIV medication adherence (31–33). Available high-quality social resources have been shown to influence one’s regulation of emotions surrounding symptoms (22).…”

Taking It One Day at a Time: African American Women Aging with HIV and Co-Morbidities

“…15 Several recent studies have been conducted that examine the self-management behaviors of women living with HIV. [15][16][17] Overall, these studies indicate that it is important to examine the barriers and facilitators to illness self-management of women due to the unique experience that various intersecting factors including gender, social roles, poverty, race, and HIV stigma have on women's abilities to effectively manage their health. For example, Tufts, Wessell, and Kearney discern that race and gender are important social factors to consider when examining the HIV self-management behaviors of HIV positive women.…”

Unmet core needs for self-determination in HIV-infected women of color in medical care

“…HIV-infected women experience a range of barriers to care (Cunningham et al, 1999; Toth et al, 2013; Webel et al, 2013); and related work suggests unique trajectories for the process of engaging and remaining in HIV care among women of color (WOC) (Messer et al, 2013; Quinlivan et al, 2013). Despite the need to facilitate adoption of HIV health behaviors for women, limited use has been made of motivation theory for understanding HIV medication adherence or engagement in care (Houston et al, 2012; Igreja, 2000; Kennedy et al, 2004 ; Lynam et al, 2009; Toth et al, 2013).…”