Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America.
BACKGROUND
Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one's life chances and overcome life's challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH.


METHODS
We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations.


RESULTS
Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence.


CONCLUSIONS
Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society's most vulnerable populations.
Faculty of Health Sciences, University of Ottawa School of Nursing, 451 chemin Smyth Road, Ottawa, ON K1H 8M5, Canada. craig.phillips@uottawa.ca
J Craig
JC
Phillips
Allison
A
Webel
Carol Dawson
CD
Rose
Inge B
IB
Corless
Kathleen M
KM
Sullivan
Joachim
J
Voss
Dean
D
Wantland
Kathleen
K
Nokes
John
J
Brion
Wei-Ti
WT
Chen
Scholastika
S
Iipinge
Lucille Sanzero
LS
Eller
Lynda
L
Tyer-Viola
Marta
M
Rivero-Méndez
Patrice K
PK
Nicholas
Mallory O
MO
Johnson
Mary
M
Maryland
Jeanne
J
Kemppainen
Carmen J
CJ
Portillo
Puangtip
P
Chaiphibalsarisdi
Kenn M
KM
Kirksey
Elizabeth
E
Sefcik
Paula
P
Reid
Yvette
Y
Cuca
Emily
E
Huang
William L
WL
Holzemer
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003415:Crime; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009656:North America; D012919:Social Behavior
D044966:Anti-Retroviral Agents