The Impact of Stigma on Medication Adherence Among HIV-Positive Adolescent and Young Adult Females and the Moderating Effects of Coping and Satisfaction with Health Care
Jaime Martinez, Gary Harper, Russell A. Carleton, Sybil Hosek, Kelly Bojan, Gretchen Clum, and Jonathan Ellen
Abstract
To explore whether HIV stigma negatively impacts adherence to antiviral medications in HIV-infected adolescent women, mode rational analysis was conducted and factors identified that could alter said relationship. Study participants were 178 adolescent females age 15–24, enrolled between 2003–2005, from 5 different cities and 60 provided adherence information. Findings reported by this cohort of 60 adolescent women included: medication adherence, 64.3% reporting adherence at baseline and 45.0% at 12 months; HIV stigma score of 57.60 (standard deviation [SD], 11.83; range, 25–86). HIV stigma was not found to be a significant predictor when binary log it regression was run with medication adherence at 1 year. Using mode rational analysis, factors that could moderate stigma's effect on medication adherence was still pursued and identified the following to be significant at 12 months: health care satisfaction (B=−0.020, standard error [SE]=0.010, p<.05); and Coping (proactive coping strategies [B=0.012, SE=0.005, p<.05]; turning to family [B=0.012, SE=0.016, p<0.05]; spiritual coping [B=0.021, SE=0.010, p<0.05]; professional help [B=0.021, SE=0.010, p<0.05]; physical diversions [B=0.016, SE=0.007, p<0.05]). Factors that had no significant moderating effects included: social support measures (mean=74.9; median=74.0) and depression score greater than 16=43%. We conclude that HIV-infected adolescent women experience HIV stigma and poor adherence over time. Factors like health care satisfaction and coping may minimize stigma's effect on medication adherence. Our findings are tempered by a small sample size and lack of a direct relationship between stigma and adherence on binary log it regression analysis.