Where Does Fear Lead Us: Antiretroviral Treatment Adherence in Maputo

Abstract

This research aims to deepen knowledge on the role of fear on ART adherence of patients who live in Maputo district in Mozambique, including differences on age, gender and schooling level, on their previous knowledge about HIV and ART and on the impact of the discrimination experiences on the ART adherence. The participants are 602 ART patients living in Maputo district between 21 and 56 years old. The findings reveal that more men than women have interrupted the treatment. Those who did it at least once have more than 39 years old. There are more reports of non-interruption of the treatment on patients who have never been to school or who have been in the high school or more advanced studies. Those who reported that have never interrupted the treatment have more previous knowledge about HIV and the treatment; have never been discriminated and have less fear of being marginalized by being HIV+. Most of those who have interrupted the treatment have already been discriminated by nurses or friends. As fear is automatically processed in our brain, specific contexts of fear related to ART where studied as well as the impact of the fear of those contexts on the behaviors of adherence or of treatment interruption. The results reflect the need to develop national educational policies regarding emotional awareness, adequate emotional support and coping strategies in the context of Fear and of ART adherence. New policies need to address gender and age differences as well as health education access to ART patients, attempting to the stigma and the fear of discrimination as a present element of influence on ART adherence. The study also validates the role of health professionals as high responsible elements on the health of the ART individuals.

Share and Cite:

Moreno, M. , de Matos, M. and Cabral, A. (2014) Where Does Fear Lead Us: Antiretroviral Treatment Adherence in Maputo. Health, 6, 641-648. doi: 10.4236/health.2014.67083.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] WHO, UNICEF, UNAIDS (2013) Global Update on HIV Treatment 2013: Results Impact and Opportunities.
http://www.who.int/iris/bitstream/10665/85326/1/9789241505734_eng.pdf
[2] Wood, E., Hogg, R.S., Yip, B., Harrigan, P.R., O’Shaughnessy, M.V. and Montaner, J.S. (2003) Effect of Medication Adherence on Survival of HIV-Infected Adults Who Start Highly Active Antiretroviral Therapy When the CD4 + Cell Count Is 0.200 to 0.350 × 10(9) Cells/L. Annals of Internal Medicine, 139, 810-816.
http://dx.doi.org/10.7326/0003-4819-139-10-200311180-00008
[3] Wood, E., Hogg, R.S., Yip, B., Harrigan, P.R., O’Shaughnessy, M.V. and Montaner, J.S. (2004) The Impact of Adherence on CD4 Cell Count Responses among HIV-Infected Patients. Journal of Acquired Immune Deficiency Syndromes, 35, 261-268.
http://dx.doi.org/10.1097/00126334-200403010-00006
[4] Patterson, D., Swindells, S., Mohr, J., Brester, M., Vergis, E., Squier, C., Wagener, M. and Singh, N. (2000) Adherence to Protease Innibitor Therapy and Outcomes in Patients with HIV Infection. Annals of Internal Medicine, 133, 21-30.
http://dx.doi.org/10.7326/0003-4819-133-1-200007040-00004
[5] Deeks, S. (2003) Treatment of Antiretroviral Drug-Resistant HIV-1 Infection. Lancet, 362, 2002-2011.
http://dx.doi.org/10.1016/S0140-6736(03)15022-2
[6] Boyer, S., Marcellin, F., Ongolo-Zogo, P., et al. (2009) Financial Barriers to HIV Treatment in Yaounde, Cameroon: First Results of a National Cross-Sectional Survey. Bulletin of the World Health Organization, 87, 279-287.
http://dx.doi.org/10.2471/BLT.07.049643
[7] Byakika-Tusiime, J., Crane, J., Oyugi, J.H., et al. (2009) Longitudinal Antiretroviral Adherence in HIV? Ugandan Parents and Their Children Initiating HAART in the MTCT-Plus Family Treatment Model: Role of Depression in Declining Adherence over Time. AIDS and Behavior, 13, 82-91.
http://dx.doi.org/10.1007/s10461-009-9546-x
[8] Tuller, D.M., Bangsberg, D.R., Senkungu, J., Ware, N.C., Emenyonu, N. and Weiser, S.D. (2009) Transportation Costs Impede Sustained Adherence and Access to HAART in a Clinic Population in Southwestern Uganda: A Qualitative Study. AIDS and Behavior, 14, 778-784.
http://dx.doi.org/10.1007/s10461-009-9533-2
[9] Johnston, R. and Mann, T. (2000) Barriers to Antiretroviral Medication Adherence in HIV Infected Women. AIDS Care, 12, 377-386.
http://dx.doi.org/10.1080/09540120050123774
[10] Applebaum, A., Richardson, M., Brady, S., Brief, D. and Keane, T. (2009) Gender and Other Psychosocial Factors as Predictors of Adherence to Highly Active Antiretroviral Therapy (HAART) in Adults with Comorbid HIV/AIDS, Psychiatric and Substance-Related Disorder. AIDS and Behavior, 13, 60-65.
http://dx.doi.org/10.1007/s10461-008-9441-x
[11] Tapp, C., Milloy, M., Kerr, T., Zhang, R., Guilemi, S., Hogg, R., Montaner, J. and Wood, E. (2011) Female Gender Predicts Lower Access and Adherence to Antiretroviral Therapy in a Setting of Free Healthcare. BMC Infectious Diseases, 11, 86.
http://dx.doi.org/10.1186/1471-2334-11-86
[12] Meacham, C.L. (1997) Women Living with HIV and AIDS: Relationships among Stress, Hopelessness, Coping and Perceptions of Social Support. University of Cincinnati, Cincinnati.
[13] Swindells, S., Mohr, J., Justis, J.C., Berman, S., Squier, C., Wagener, M.M., et al. (2009) Quality of Life in Patients with Human Immunodeficiency Virus Infection: Impact of Social Support, Coping Style and Hopelessness. International Journal of STD & AIDS, 10, 383-391.
http://dx.doi.org/10.1258/0956462991914302
[14] Kelly, J.A., Murphy, D.A., Bahr, G.R. and Kalichman, S.C. (1993) Outcome of Cognitive-Behavioral and Support Group Brief Therapies for Depressed, HIV-Infected Persons. American Journal of Psychiatry, 150, 1679-1686.
[15] Safren, S.A., Radomsky, A.S., Otto, M.W. and Salomon, E. (2012) Predictors of Psychological Well-Being in a Diverse Sample of HIV-Positive Patients Receiving Highly Active Antiretroviral Therapy. Psycho-Somatics, 43, 478-485.
http://dx.doi.org/10.1176/appi.psy.43.6.478
[16] Leserman, J., Jackson, E.D., Petitto, J.M., Golden, R.N., Silva, S.G., Perkins, D.O., et al. (1999) Progression to AIDS: The Effects of Stress, Depressive Symptoms, and Social Support. Psychosomatic Medicine, 61, 397-406.
[17] Chesney, M.A., Chambers, D.B., Taylor, J.M. and Johnson, L.M. (2003) Social Support, Distress, and Well-Being in Older Men Living with HIV Infection. Journal of Acquired Immune Deficiency Syndromes, 33, S185-S193.
http://dx.doi.org/10.1097/00126334-200306012-00016
[18] Wrubel, J., Stumbo, S. and Johnson, M.O. (2010) Male Same Sex Couple Dynamics and Support for HIV Medication Adherence: The Question of Received Social Support. Journal of Social and Personal Relationships, 27, 553-572.
http://dx.doi.org/10.1177/0265407510364870
[19] Fogarty, L., Roter, D., Larson, S., Burke, J., Gillespie, J. and Levy, R. (2002) Patient Adherence to HIV Medication Regimens: A Review of Published and Abstract Reports. Patient Education and Counseling, 46, 93-108.
http://dx.doi.org/10.1016/S0738-3991(01)00219-1
[20] Leserman, J., Jackson, E.D., Petitto, J.M., Golden, R.N., Silva, S.G., Perkins, D.O., et al. (1999) Progression to AIDS: The Effects of Stress, Depressive Symptoms, and Social Support. Psychosomatic Medicine, 61, 397-406.
[21] Johnson, M.O., Catz, S.L., Remien, R.H., Rotheram-Borus, M.J., Morin, S.F., Charlebois, E.D., et al. (2003) Theory Guided, Empirically Supported Avenues for Intervention on HIV Medication Nonadherence: Findings from the Healthy Living Project. AIDS Patient Care STDS, 17, 645-656.
http://dx.doi.org/10.1089/108729103771928708
[22] Lehman, D.R., Ellard, J.H. and Wortman, C.B. (1986) Social Support for the Bereaved: Recipients’ and Providers’ Perspectives on What Is Helpful. Journal of Consulting and Clinical Psychology, 54, 438-446.
http://dx.doi.org/10.1037/0022-006X.54.4.438
[23] Coyne, J.C., Wortman, C.B. and Lehman, D.R. (1988) The Other Side of Support: Emotional over Involvement and Miscarried Helping. In: Gottlieb, B.H., Ed., Marshalling Social Support, Sage, Newbury Park, 305-330.
[24] Shinn, M., Lehman, S. and Wong, N.W. (1984) Social Interaction and Social Support. Journal of Social Issues, 40, 55-76.
http://dx.doi.org/10.1111/j.1540-4560.1984.tb01107.x
[25] Ekman, P. and Friesen, W. (1971) Constants across Cultures in the Face and Emotion. Journal of Personality and Social Psychology, 17, 124-129.
http://dx.doi.org/10.1037/h0030377
[26] Ledoux, J. (2003) The Emotional Brain, Fear and the Amygdala. Cellular and Molecular Neurobiology, 23, 727-738.
http://dx.doi.org/10.1023/A:1025048802629
[27] Olsson, A. and Phelps, E. (2007) Social Learning of Fear. Nature Neuroscience, 10, 1095-1102.
[28] Goffman, E. (1963) Stigma: Notes on the Management of Spoiled Identity. Simon and Schuster Inc., New York.
[29] Corrigan, P. and Watson, A. (2002) The Paradox of Self-Stigma and Mental Illness. Clinical Psychology: Science and Practice, 9, 35-53.
http://dx.doi.org/10.1093/clipsy.9.1.35
[30] Rao, D., Kekwaletswe, T.C., Hosek, S., Martinez, J. and Rodriguez, F. (2007) Stigma and Social Barriers to Medication Adherence with Urban Youth Living with HIV. AIDS Care, 19, 28-33.
http://dx.doi.org/10.1080/09540120600652303
[31] Nyblade, L.C. (2006) Measuring HIV Stigma: Existing Knowledge and Gaps. Psychology Health and Medicine, 11, 335-345.
http://dx.doi.org/10.1080/13548500600595178
[32] Sayles, J., Wong, M., Kinsler, J., Martins, D. and Cunningham, W. (2009) The Association of Stigma with Self-Reported Access to Medical Care and Antiretroviral Therapy Adherence in Persons Living with HIV/AIDS. Journal of General Internal Medicine, 24, 1101-1108.
http://dx.doi.org/10.1007/s11606-009-1068-8
[33] Lee, R.S., Kochman, A. and Sikkema, K.J. (2002) Internalized Stigma among People Living with HIV-AIDS. AIDS and Behavior, 6, 309-319.
http://dx.doi.org/10.1023/A:1021144511957
[34] Haug, N., Sorensen, J., Lllo, N., Gruber, V., Deluchhi, K. and Hall, S. (2005) Gender Differences among HIV-Methadone Maintenance Patients Enrolled in a Medication Adherence Trial. AIDS Care, 17, 1022-1029.
http://dx.doi.org/10.1080/09540120500100882
[35] Tapp, C., Milloy, M., Kerr, T., Zhang, R., Guillemi, S., Hogg, R., Montaner, J. and Wood, E. (2011) Female Gender Predicts Lower Access and Adherence to Antiretroviral in a Setting of Free Healthcare. BMC Infectious Diseases, 11, 86.
http://dx.doi.org/10.1186/1471-2334-11-86
[36] Jones, D.L., McPherson-Baker, S., Lydston, D., Camille, J., Brondolo, E., Tobin, J.N. and Weiss, S.M. (2007) Efficacy of a Group Medication Adherence Intervention among HIV Positive Women: The SMART/EST Women’s Project. AIDS and Behavior, 11, 79-86.
http://dx.doi.org/10.1007/s10461-006-9165-8
[37] Stone, V.E., Hogan, J.W., Schuman, P., Rompalo, A.M., Howard, A.A., Korkontzelou, C. and Smith, D.K. (2001) Antiretroviral Regimen Complexity, Self-Reported Adherence, and HIV Patient’s Understanding of Their Regimens: Survey of Women in the HER Study. Journal of Acquired Immune Deficiency Syndrome, 28, 124-131.
http://dx.doi.org/10.1097/00042560-200110010-00003
[38] Kalichman, S.C., Ramachandran, B. and Catz, S. (1999) Adherence to Combination Antiretroviral Therapies in HIV Patients of Low Literacy. Journal of General Internal Medicine, 14, 267-273.
http://dx.doi.org/10.1046/j.1525-1497.1999.00334.x
[39] Paasche-Orlow, M.K., Cheng, D.M., Palepu, A., Meli, S., Faber, V. and Samet, J.H. (2006) Health Literacy, Antiretroviral Adherence, and HIV-RNA Suppression: A Longitudinal Perspective. Journal of General Internal Medicine, 21, 835-840.
http://dx.doi.org/10.1111/j.1525-1497.2006.00527.x
[40] Gordillo, V., Smo, J., Soriano, V. and González-Lahoz, J. (1999) Sociodemographic and Psychological Variables Influencing Adherence to Antiretroviral Therapy. AIDS, 13, 1763-1769.
http://dx.doi.org/10.1097/00002030-199909100-00021
[41] Levine, P. (2010) In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North Atlantic Books, Berkeley.
[42] Rao, D., Feldman, B., Fredericksen, R., Crane, P., Simoni, J., Kitshata, M. and Crane, H. (2012) A Structural Equation Model of HIV-Related Stigma, Depressive Symptoms, and Medication Adherence. AIDS and Behavior, 16, 711-716.
http://dx.doi.org/10.1007/s10461-011-9915-0

Journals Menu
Follow SCIRP
Contact us
customer@scirp.org
WhatsApp +86 18163351462(WhatsApp)
Click here to send a message to me 1655362766
Paper Publishing WeChat

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.