title: 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.
abstract: To explore whether HIV stigma negatively impacts adherence to antiviral medications in HIV-infected adolescent women, moderational 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 logit regression was run with medication adherence at 1 year. Using moderational 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 logit regression analysis.
authors.affiliation: Division of Adolescent and Young Adult Medicine, Stroger Hospital of Cook County, Chicago, Illinois 60612, USA. jmart312@aol.com
authors.forename: Jaime
authors.initials: J
authors.lastname: Martinez
authors.forename: Gary
authors.initials: G
authors.lastname: Harper
authors.forename: Russell A
authors.initials: RA
authors.lastname: Carleton
authors.forename: Sybil
authors.initials: S
authors.lastname: Hosek
authors.forename: Kelly
authors.initials: K
authors.lastname: Bojan
authors.forename: Gretchen
authors.initials: G
authors.lastname: Clum
authors.forename: Gretchen
authors.initials: G
authors.lastname: Glum
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ellen
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D006297:Health Services Accessibility; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D017060:Patient Satisfaction; D011788:Quality of Life; D020377:Self Efficacy; D057545:Social Stigma; D012944:Social Support; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents