The State of Adherence to HIV Care in Black Women

Abstract

The purpose of this systematic review was to assess the state of adherence to HIV care such as HIV medication and appointment adherence among Black women in the United States. After a systematic search of CINAHL, PubMed, EMBASE, and clinicialtrials.gov, 26 studies and two ongoing trials met inclusion criteria. Psychosocial factors such as intersectional stigmas and depression were among the salient factors associated with adherence-to-care behaviors in women living with HIV (WLWH). In addition, interpersonal factors such as social support and the patient-provider relationship were frequently associated with adherence-to-care behaviors. No culturally relevant interventions for Black WLWH were found in the literature, but one ongoing trial that was developed specifically for Black WLWH seemed promising. Considering the dearth of tailored interventions, more gender-specific and culturally relevant interventions are urgently needed to improve adherence-to-care behaviors and optimize health outcomes for Black WLWH.

Microaggressions and Discrimination Relate to Barriers to Care Among Black Women Living with HIV

“…4 These disparities continue across the treatment cascade for women with HIV in the United States with black women having lower treatment engagement, retention, and adherence. [5][6][7] Ongoing disparities in these areas for black women may be due to adversities such race-and HIV-related discrimination and microaggressions that contribute to barriers to receiving HIV-related care. However, no existing literature has explored how these factors relate to barriers to HIV-related care among black women living with HIV (BWLWH).…”

Comment on Project THANKS: Examining HIV/AIDS-Related Barriers and Facilitators to Care in African American Women: A Community Perspective

“…In another study, African American WLWH in the South said it was also important that their health care provider takes a genuine interest in their care. 10 Project THANKS focus groups reinforced these findings.…”

“…A systematic review by Lambert et al found that social support was a valuable resource that improved ART adherence and retention in care. 10 Similarly, Project THANKS participants indicated that it was comforting to connect with other WLWH. Social support was a major theme that arose from the qualitative study.…”

“…Studies show that managing HIV in addition to other chronic conditions can affect treatment adherence (taking multiple medications for multiple conditions), retention in care, exacerbate stress and depression, increase side effects, and lead to worse health outcomes. 10,12,13 In a series of focus groups conducted in Washington, DC, with HIV-positive African American women aged 52 to 65, comorbidities were perceived to be more difficult to self-manage than HIV. 12 Warren-Jeanpiere et al concluded that optimal HIV self-management (adhering to daily medication, eating well, exercising, doing something good for others and self, and engaging in spiritual activities) must be viewed within a larger context that addresses HIV and comorbidities concurrently.…”

Applying a Nursing Perspective to Address the Challenges Experienced by Cisgender Women in the HIV Status Neutral Care Continuum: A Review of the Literature

“…Optimal ART regimens to achieve durable viral load suppression are essential for the survival of PLWH. Yet, most clinical trials have enrolled majority male samples (Lambert et al, 2018), despite ample evidence that women have unique needs requiring tailored intervention. Because clinical trials are the gold standard for determining the safety, efficacy, and effectiveness of medical and behavioral interventions, greater inclusion of women participants is needed to determine their effects on women's health outcomes.…”