Medically Eligible Women Who Do Not Use HAART: The Importance of Abuse, Drug Use, and Race

Cohen, Mardge H.; Cook, Judith Α.; Grey, Dennis D.; Young, Mary; Hanau, Lawrence H.; Tien, Phyllis C.; Levine, Alexandra M.; Wilson, Tracey E.

doi:10.2105/ajph.94.7.1147

Cited by 146 publications

(127 citation statements)

References 31 publications

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“…10 Both alcohol and drug abuse are associated with poor ART adherence and viral suppression failure. [10][11][12] Approximately 55% of women living with HIV/AIDS have experienced intimate partner violence (IPV). 13 A history of trauma, abuse, and violence for HIV-infected women is associated with decreased medication adherence, 9,11,12 and increased viral load.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] Approximately 55% of women living with HIV/AIDS have experienced intimate partner violence (IPV). 13 A history of trauma, abuse, and violence for HIV-infected women is associated with decreased medication adherence, 9,11,12 and increased viral load. 13,14 Studies consistently document high prevalence of mental health disorders and symptomatology among HIV positive populations.…”

Section: Introductionmentioning

confidence: 99%

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Substance Abuse, Violence, and HIV/AIDS (SAVA) Syndemic Effects on Viral Suppression Among HIV Positive Women of Color

Sullivan

Messer

Quinlivan

2015

AIDS Patient Care and STDs

142

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The combined epidemics of substance abuse, violence, and HIV/AIDS, known as the SAVA syndemic, contribute to the disproportionate burden of disease among people of color in the US. To examine the association between HIV viral load suppression and SAVA syndemic variables, we used baseline data from 563 HIV + women of color treated at nine HIV medical and ancillary care sites participating in HRSA's Special Project of National Significance Women of Color (WOC) Initiative. Just under half the women (n = 260) were virally suppressed. Five psychosocial factors contributing to the SAVA syndemic were examined in this study: substance abuse, binge drinking, intimate partner violence, poor mental health, and sexual risk taking. Associations among the psychosocial factors were assessed and clustering confirmed. A SAVA score was created by summing the dichotomous (present/absent) psychosocial measures. Using generalized estimating equation (GEE) models to account for site-level clustering and individual-covariates, a higher SAVA score (0 to 5) was associated with reduced viral suppression; OR (adjusted) = 0.81, 95% CI: 0.66, 0.99. The syndemic approach represents a viable framework for understanding viral suppression among HIV positive WOC, and suggests the need for comprehensive interventions that address the social/environmental contexts of patients' lives.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Substance Abuse, Violence, and HIV/AIDS (SAVA) Syndemic Effects on Viral Suppression Among HIV Positive Women of Color

Sullivan

Messer

Quinlivan

2015

AIDS Patient Care and STDs

142

View full text Add to dashboard Cite

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“…6 In women with HIV, histories of abuse are quite prevalent, 8,9 and have been linked to risky sexual behaviors, HIV medication nonadherence, antiretroviral failure, and increased mortality. 2,3,8,[10][11][12][13] With highly active antiretroviral therapy (HAART), the HIV infection course has changed to that of a chronic illness. Moderate to high levels of adherence are necessary to achieve viral suppression (i.e., undetectable HIV viral load), reverse immune decline (e.g., improved CD4 + cell count), and decrease risk of morbidity and mortality.…”

mentioning

confidence: 99%

“…[22][23][24] Numerous barriers to HIV medication adherence and overall HIV access to care have been reported, including depression, stigma, disclosure, and drug/alcohol use. [25][26][27][28] A history of trauma or abuse among women with HIV has also been linked significantly to medication nonadherence, 3,11,29 as well as to antiretroviral failure and increased mortality. 2,3,8,11,13 Machtinger and colleagues 3 found that among HIV + biological and transgender women, those who reported recent trauma had over four-times the odds of antiretroviral failure in comparison to HIV + women who did not report recent trauma.…”

mentioning

confidence: 99%

“…8,11 In a meta-analysis of psychological trauma and post-traumatic stress disorder (PTSD) in HIV + women, Machtinger and colleagues 9 reported a 55% prevalence of intimate partner violence, a rate more than double the US national average of 25%. 30 Women with HIV also face multiple stressors, including poverty, gender discrimination, stigma, violence, single parenting, and homelessness.…”

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confidence: 99%

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Abuse and Resilience in Relation to HAART Medication Adherence and HIV Viral Load Among Women with HIV in the United States

Dale

Cohen

Weber

et al. 2014

AIDS Patient Care and STDs

117

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Abuse is highly prevalent among HIV + women, leading to behaviors, including lower adherence to highly active antiretroviral therapy (HAART) that result in poor health outcomes. Resilience (functioning competently despite adversity) may buffer the negative effects of abuse. This study investigated how resilience interacted with abuse history in relation to HAART adherence, HIV viral load (VL), and CD4 + cell count among a convenience sample of 138 HIV + women from the Ruth M. Rothstein CORE Center/Cook County Health and Hospital Systems site of the Women's Interagency HIV Study (WIHS). Resilience was measured by the 10-item Connor-Davidson Resilience Scale (CD-RISC). HAART adherence ( ‡ 95% vs. < 95% self reported usage of prescribed medication) and current or prior sexual, physical, or emotional/domestic abuse, were reported during structured interviews. HIV viral load ( ‡ 20 vs. < 20 copies/mL) and CD4 + count (200 vs. < 200 cells/mm) were measured with blood specimens. Multiple logistic regressions, controlling for age, race, income, enrollment wave, substance use, and depressive symptoms, indicated that each unit increase in resilience was significantly associated with an increase in the odds of having ‡ 95% HAART adherence and a decrease in the odds of having a detectable viral load. Resilience-Abuse interactions showed that only among HIV + women with sexual abuse or multiple abuses did resilience significantly relate to an increase in the odds of ‡ 95% HAART adherence. Interventions to improve coping strategies that promote resilience among HIV + women may be beneficial for achieving higher HAART adherence and viral suppression.

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Childhood Trauma and the Inability to Access Hospital Care Among People who Inject Drugs

Randhawa

Azarbar

Dong

et al. 2018

Journal of Traumatic Stress

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Childhood traumatic experiences can disrupt attachment, influence personality development, and precipitate chronic disease. Although the repercussions of these experiences may also pose a barrier to healthcare, few studies have examined the association between childhood trauma and access to healthcare. Therefore, we sought to investigate whether a history of childhood trauma is associated with self-reported inability to access hospital care among persons who inject drugs (PWID). Data were derived from two prospective cohorts of PWID in Vancouver, Canada. We used multivariable generalized estimating equations to examine associations between five types of childhood trauma and self-reported inability to access hospital care, both overall and specifically due to perceived mistreatment by hospital staff. In total, 300 participants (18.3%) reported having tried but being unable to access hospital care in the previous 6 months at some point during the study period; the primary reason was perceived mistreatment by hospital staff (32.1%). In multivariable analyses, childhood emotional abuse was independently associated with self-reported inability to access hospital care, adjusted odds ratio (AOR) = 1.51, 95% CI [1.03, 2.20]. Childhood physical neglect was also independently associated with inability to access care due to perceived mistreatment by hospital staff, AOR = 1.80, 95% CI [1.11, 2.93]. This suggests potentially damaging consequences of early trauma in adult PWID populations. Further, this study emphasizes the need for trauma-informed models of care as well as the need to improve therapeutic alliances with survivors of childhood trauma in the PWID population.

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Medically Eligible Women Who Do Not Use HAART: The Importance of Abuse, Drug Use, and Race

Abstract: One of 4 women for whom HAART was indicated reported not using HAART. Childhood sexual abuse prevention, more intensive abuse treatment, and continuing drug treatment may enhance HIV disease treatment of women.

Cited by 146 publications

References 31 publications

Substance Abuse, Violence, and HIV/AIDS (SAVA) Syndemic Effects on Viral Suppression Among HIV Positive Women of Color

Substance Abuse, Violence, and HIV/AIDS (SAVA) Syndemic Effects on Viral Suppression Among HIV Positive Women of Color

Abuse and Resilience in Relation to HAART Medication Adherence and HIV Viral Load Among Women with HIV in the United States

Childhood Trauma and the Inability to Access Hospital Care Among People who Inject Drugs

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