Perception of Punishment Undermines HIV Treatment Adherence

Although advances in drug therapies have made HIV a manageable illness, patients’ negative attitudes about the disease may undermine treatment, according to new research. Perhaps the most disturbing attitude among many people with HIV is that their infection is “punishment.”

The research, published in the November-December issue of the journal Psychosomatics, takes a rare look at attitude’s effect on an HIV-positive person’s health in the context of the virus now being considered a chronic condition, rather than a terminal illness.

Patients treated with highly active antiretroviral therapy, or HAART, face strict dosing times and food restrictions. Also, HIV infection can carry a stigma that negatively affects patients’ psychological well being.

Steven A. Safren, Ph.D., of the Massachusetts General Hospital Department of Psychiatry, and colleagues examined how social support structures, coping ability and a patient’s beliefs about HIV can combat these stressors.

“[HAART] causes longer life expectancy, reduction of HIV disease progression, and fewer complications related to compromised immunofunctioning,” said Safren. “These advancements, combined with the increasing number of new HIV infections, have resulted in a large and growing cohort of persons with HIV who are living and coping with the multiple stressors that accompany the disease and its treatment.”

Safren and his colleagues surveyed 84 HIV-positive patients as part of a 12-week study of HIV medication adherence. The researchers first assessed patients’ level of depression, quality of life and self-esteem. The researchers also asked participants to complete surveys regarding various life events, perceived social support and coping styles.

Finally, based on clinical experience with HIV-positive patients, the researchers asked participants if they thought their illness was a “punishment.”

“Attributing one’s HIV status as a ‘punishment’ is a common clinical response from patients,” Safren said, adding that such attribution can lead to a number of negative consequences. He found that patients’ beliefs regarding HIV as punishment was one of several variables associated with lowered self-esteem and increased depression.

“The findings from the present study highlight the need for research addressing the effects of treatment for psychosocial issues such as depression, coping, and punishment beliefs about HIV on self care and, in turn, medical outcome,” Safren concluded.

This research was funded by a grant issued through the Community Research Institute of Boston by the Massachusetts Department of Public Health to Fenway Community Health.

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