The impact of HIV treatment-related stigma on uptake of antiretroviral therapy

HIV treatment and management is constantly evolving. This is as a result of more treatment options coming on stream, tolerance changes and progress in treatment management. HIV infection today, in resource-rich countries and in the presence of combination therapies, is experienced as lifelong treatment punctuated by adjustments to antiretroviral therapy (ART) regimens. People who are diagnosed as HIV positive face a number of challenges and changes around the decision to commence treatment, responses to treatment and changes in treatment regimens. This study was set up to examine the experience of switching treatments and the impact of such switches on psychological parameters. The method used was a cross-sectional questionnaire study. A group of 779 HIV-positive clinic attendees at four clinics in London and South East England participated in the study (86% response rate). They provided detail of their treatment switching experiences as well as demographic details, risk and optimism evaluations, quality of life, symptom burden, adherence and disclosure information. The sample ( n=779) comprised 183 (24%) females, 76 (10%) heterosexual males and 497 gay males (66%). Self-reported ethnicity was 67% white, 25% black, 3% Asian and 5% mixed/other ethnicity. One hundred and fifty-five (21%) were ART-naïve and 624 (79%) were ART experienced; 161 (22%) were receiving their first regimen, 135 (18%) had experienced one regimen switch, 196 (26%) had multiple switches and 99 (13.3%) had stopped treatment. Treatment naïve, non-switchers and single switchers generally reported lower symptom burden and higher quality of life. Multiple switchers reported higher physical symptom burden and higher global symptom distress scores. Those who had stopped treatment had significantly lower quality-of-life scores than all other groups. Suicidal ideation was high across the groups and nearly a fifth of all respondents had not disclosed their HIV status to anyone. Reported adherence was suboptimal – 79% of subjects were at least 95% adherent on self-report measures of doses taken over the preceding week. In conclusion, nearly half this clinic sample will have switched treatments. A holistic approach is needed to understand the psychological effects of such switches if lifelong treatment is to be maintained and those on antiretroviral treatment are to attain good quality of life and minimize symptom burden.

Download Full-text

“Moving Forward with Life”: Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165706 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5706

Author(s):

Bronwyn Myers ◽

Charles D. H. Parry ◽

Neo K. Morojele ◽

Sebenzile Nkosi ◽

Paul A. Shuper ◽

...

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Problem Solving ◽

Alcohol Consumption ◽

Controlled Trial ◽

Hiv Treatment ◽

People Living With Hiv ◽

Problem Solving Therapy ◽

The Impact ◽

Alcohol Reduction

Background: In South Africa, interventions are needed to address the impact of hazardous drinking on antiretroviral therapy among people living with HIV (PLWH). Participant feedback about these interventions can identify ways to enhance their acceptability. We interviewed participants in a randomized controlled trial of a brief motivational interviewing and problem-solving therapy (MI-PST) intervention about their perceptions of this alcohol-reduction intervention. Methods: The trial was conducted in HIV treatment clinics operating from six hospitals in the Tshwane region of South Africa. We conducted qualitative in-depth interviews with a random selection of participants. Twenty-four participants were interviewed after the final intervention session and 25 at the six-month follow up. Results: Participants believed that it was acceptable to offer PLWH, an alcohol reduction intervention during HIV treatment. They described how the MI-PST intervention had helped them reduce their alcohol consumption. Intervention components providing information on the health benefits of reduced consumption and building problem-solving and coping skills were perceived as most beneficial. Despite these perceived benefits, participants suggested minor modifications to the dosage, content, and delivery of the intervention for greater acceptability and impact. Conclusions: Findings highlight the acceptability and usefulness of this MI-PST intervention for facilitating reductions in alcohol consumption among PLWH.

Download Full-text

The impact of specific HIV treatment-related adverse events on adherence to antiretroviral therapy: A systematic review and meta-analysis

AIDS Care ◽

10.1080/09540121.2012.712667 ◽

2012 ◽

Vol 25 (4) ◽

pp. 400-414 ◽

Cited By ~ 76

Author(s):

Imad Al-Dakkak ◽

Seema Patel ◽

Eilish McCann ◽

Abhijit Gadkari ◽

Girish Prajapati ◽

...

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Adverse Events ◽

Meta Analysis ◽

Hiv Treatment ◽

The Impact

Download Full-text

Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review

Viruses ◽

10.3390/v14010122 ◽

2022 ◽

Vol 14 (1) ◽

pp. 122

Author(s):

Mariusz Sapuła ◽

Magdalena Suchacz ◽

Andrzej Załęski ◽

Alicja Wiercińska-Drapało

Keyword(s):

Metabolic Syndrome ◽

Antiretroviral Therapy ◽

Plasma Lipid ◽

Hiv Treatment ◽

New Drugs ◽

People Living With Hiv ◽

The Metabolic Syndrome ◽

Major Interest ◽

Living With Hiv ◽

The Impact

The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980’s. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.

Download Full-text

Antiretroviral therapy among patients with HIV in Almaty, Kazakhstan: the implication for HIV-associated tuberculosis control

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11924 ◽

2020 ◽

Vol 14 (11.1) ◽

pp. 128S-132S

Author(s):

Alfiya Denebayeva ◽

Arpine Abrahamyan ◽

Aelita Sargsyan ◽

Karine Kentenyants ◽

Ainur Zhandybayeva ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Treatment Guideline ◽

Hiv Treatment ◽

People Living With Hiv ◽

Preventive Strategy ◽

Hiv Diagnosis ◽

Art Initiation ◽

Living With Hiv ◽

And Control ◽

The Impact

Introduction: Antiretroviral therapy (ART) is an effective preventive strategy against tuberculosis (TB) in people living with HIV (PLWH). In Kazakhstan, according to the revised HIV treatment guideline (2017), ART should be initiated immediately after HIV diagnosis established, regardless of CD4+ count. Aim: To evaluate the impact of early initiation of ART on TB infection in PLWH registered in the Center of Prevention and Control of AIDS, Almaty, Kazakhstan, between 2008 and 2018. Methodology: A retrospective cohort study was conducted using the data of 4,053 patients from electronic HIV case management system (2008-2018) (EHCMS). Results: The study revealed low rates (12.6%) of rapid ART (≤ 1 month after HIV diagnosis). Patients in the rapid ART initiation group were less likely to develop TB compared with those who started treatment >1 month after the HIV detection (odds ratio 1.6; 95% confidence interval [1.1, 2.2]; p = 0.00799). Interestingly, the risk for developing TB among patients receiving ART ≥ 1 month after HIV diagnosis was significantly higher compared with those not taking any treatment. The latter was explained by several confounding not addressed during the analysis, since ART was prescribed to patients with primarily deeper immunodeficiency, while the patients not receiving ART were less immunocompromised. Conclusion: Despite the recently changed HIV treatment guideline in Kazakhstan, ART is still initiated based on the disease severity. In 2018, the initiation of ART during the first month after HIV diagnosis increased by 50%. However, it is necessary to reduce the time to initiation of ART for all patients.

Download Full-text

Faculty Opinions recommendation of A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.5233964.5174065 ◽

2010 ◽

Author(s):

Gerald Friedland ◽

R Douglas Bruce

Keyword(s):

Systematic Review ◽

Health Care ◽

Antiretroviral Therapy ◽

Alcohol Use ◽

Treatment Outcomes ◽

Alcohol Use Disorders ◽

Hiv Treatment ◽

Care Utilization ◽

Hiv Treatment Outcomes ◽

The Impact

Download Full-text

Experiences and Impact of Stigma and Discrimination among People on Antiretroviral Therapy in Dar es Salaam: A Qualitative Perspective

AIDS Research and Treatment ◽

10.1155/2016/7925052 ◽

2016 ◽

Vol 2016 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

Maisara Mhode ◽

Tumaini Nyamhanga

Keyword(s):

Antiretroviral Therapy ◽

Negative Impact ◽

Phenomenological Approach ◽

People Living With Hiv ◽

Stigma And Discrimination ◽

Care Workers ◽

Related Stigma ◽

Positive Treatment ◽

Living With Hiv ◽

The Impact

Background. The impact of stigma on adherence to antiretroviral therapy (ART) has been less studied in Tanzania. Recent studies indicate that people on ART still experience stigma. Qualitative information on the subject matter is especially insufficient.Objective. This paper reports on the dimensions of stigma and discrimination and their impact on adherence to ART as experienced by people living with HIV (PLHIV).Design. A phenomenological approach was used to gather information on the lived experiences of stigma and discrimination. The sample size was determined according to the saturation principle.Results. Respondents experienced different forms of HIV-related stigma such as verbal, social, and perceived stigma. Various forms of discrimination were experienced, including relational discrimination, mistreatment by health care workers, blame and rejection by spouses, and workplace discrimination. HIV-related stigma and discrimination compromised ART adherence by reinforcing concealment of HIV status and undermining social suppport.Conclusion. After nearly a decade of increasing the provision of ART in Tanzania, PLHIV still experience stigma and discrimination; these experiences still appear to have a negative impact on treatment adherence. Efforts to reduce stigma and discrimination remain relevant in the ART period and should be given more impetus in order to maximize positive treatment outcomes.

Download Full-text

The impact of living with HIV: differences in experiences of stigma for heterosexual and homosexual people living with HIV in Australia

Sexual Health ◽

10.1071/sh12170 ◽

2013 ◽

Vol 10 (4) ◽

pp. 316 ◽

Cited By ~ 12

Author(s):

Loren Brener ◽

Hannah Wilson ◽

Sean Slavin ◽

John de Wit

Keyword(s):

Hiv Treatment ◽

Hiv Stigma ◽

Heterosexual Transmission ◽

People Living With Hiv ◽

Hiv Status ◽

Health And Wellbeing ◽

Gay Community ◽

Related Stigma ◽

Living With Hiv ◽

The Impact

Background HIV in Australia has been closely aligned with the gay community and continues to disproportionately affect members of this community. Although heterosexual transmission remains low, recently there has been an increase in new HIV diagnoses attributable to heterosexual sex. This highlights the need to address the health and social consequences for heterosexual people living with HIV (PLHIV). This subanalysis of a larger study compared the experiences of stigma, health and wellbeing of a sample of gay and heterosexual PLHIV. Methods: Data were drawn from a study of experiences of stigma among PLHIV in Australia. All 49 participants who reported being heterosexual were included, as were 49 participants randomly selected from the 611 gay participants. The samples were compared on perceived HIV stigma, HIV treatment-related stigma, perceived negative reactions of others, HIV status disclosure, and health and wellbeing measures. Results: The findings illustrate that heterosexual PLHIV have more negative experiences in terms of both general HIV stigma and treatment-related stigma than gay PLHIV. The heterosexual PLHIV also perceived greater negative reactions in relation to their HIV status by different people in their social environment and were less likely to access treatment than the gay PLHIV. There were no differences between the two groups in any of the health and wellbeing measures. Conclusions: This study shows that in the Australian context, heterosexual PLHIV may feel more stigmatised than gay PLHIV. In view of lower HIV treatment uptake in heterosexual PLHIV, addressing HIV-related stigma could contribute to increasing access to HIV treatment.

Download Full-text