title: Utilization of medical treatments and adherence to antiretroviral therapy among HIV-positive adults with histories of childhood sexual abuse.
abstract: HIV is a chronic, life-threatening illness that necessitates regular and consistent medical care. Childhood sexual abuse (CSA) is a common experience among HIV-positive adults and may interfere with treatment utilization. This study examined rates and correlates of treatment utilization among HIV-positive adults with CSA enrolled in a coping intervention trial in New York City. The baseline assessment included measures of treatment utilization, mental health, substance abuse, and other psychosocial factors. In 2002-2004, participants (50% female, 69% African-American, M = 42.3 +/- 6.8 years old) were recruited. Nearly all (99%) received HIV medical care. However, 20% had no outpatient visits and 24% sought emergency services in the past 4 months. Among 184 participants receiving antiretroviral therapy (ART), 22% were less than 90% adherent in the past week. In a multivariable logistic regression model, no outpatient treatment was associated with African American race (AOR = 3.46 [1.42-8.40]), poor social support (AOR = 1.59 [1.03-2.45]), and abstinence from illicit drug use (AOR = 0.37 [0.16-0.85]). Emergency service utilization was associated with HIV symptoms (AOR = 2.30 [1.22-4.35]), binge drinking (AOR=2.92 (1.18-7.24)), and illicit drug use (AOR = 1.98 [1.02-3.85]). Poor medication adherence was associated with trauma symptoms (AOR = 2.64 [1.07-6.75]) and poor social support (AOR = 1.82 [1.09-2.97]). In sum, while participants had access to HIV medical care, a sizable minority did not adhere to recommended guidelines and thus may not be benefiting optimally from treatment. Interventions targeting HIV-positive adults with CSA histories may need to address trauma symptoms, substance abuse, and poor social support that interfere with medical treatment utilization and adherence.
authors.affiliation: McLean Hospital/Harvard Medical School, Belmont, Massachusetts, USA. christina.meade@duke.edu
authors.forename: Christina S
authors.initials: CS
authors.lastname: Meade
authors.forename: Nathan B
authors.initials: NB
authors.lastname: Hansen
authors.forename: Arlene
authors.initials: A
authors.lastname: Kochman
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012944:Social Support
chemical_list: D019380:Anti-HIV Agents