Families as catalysts for peer adherence support in enhancing hope for people living with HIV/AIDS in South Africa.
BACKGROUND
Hope is an essential dimension of successful coping in the context of illnesses such as HIV/AIDS, because positive expectations for the future alleviate emotional distress, enhance quality of life and have been linked to the capacity for behavioural change. The social environment (e.g. family, peers) is a regulator of hope for people living with HIV/AIDS (PLWHA). In this regard, the dual aim of this article is (1) to analyze the influence of a peer adherence support (PAS) intervention and the family environment on the state of hope in PLWHA and (2) to investigate the interrelationship between the two determinants.


METHODS
The Effective AIDS Treatment and Support in the Free State study is a prospective randomized controlled trial. Participants were recruited from 12 public antiretroviral treatment (ART) clinics across five districts in the Free State Province of South Africa. Each of these patients was assigned to one of the following groups: a control group receiving standard care, a group receiving additional biweekly PAS or a group receiving PAS and nutritional support. Latent cross-lagged modelling (Mplus) was used to analyse the impact of PAS and the family environment on the level of hope in PLWHA.


RESULTS
The results of the study indicate that neither PAS nor the family environment has a direct effect on the level of hope in PLWHA. Subsequent analysis reveals a positive significant interaction between family functioning and PAS at the second follow-up, indicating that better family functioning increases the positive effect of PAS on the state of hope in PLWHA.


CONCLUSIONS
The interplay between well-functioning families and external PAS generates higher levels of hope, which is an essential dimension in the success of lifelong treatment. This study provides additional insight into the important role played by family dynamics in HIV/AIDS care, and it underscores the need for PAS interventions that are sensitive to the contexts in which they are implemented.
Department of Sociology, Research Centre for Longitudinal and Life Course Studies (CELLO), University of Antwerp, Antwerp, Belgium; caroline.masquillier@ua.ac.be.
Caroline
C
Masquillier
Department of Sociology, Research Centre for Longitudinal and Life Course Studies (CELLO), University of Antwerp, Antwerp, Belgium; Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa.
Edwin
E
Wouters
Department of Sociology, Research Centre for Longitudinal and Life Course Studies (CELLO), University of Antwerp, Antwerp, Belgium.
Dimitri
D
Mortelmans
Department of Economics, University of the Free State, Bloemfontein, South Africa.
Frederik le Roux
Fle R
Booysen
D019380:Anti-HIV Agents / Q000627:therapeutic use; D005190:Family / Q000523:psychology; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D065026:Hope; D006801:Humans; D010379:Peer Group; D012657:Self-Help Groups; D012931:Social Environment; D013019:South Africa
D019380:Anti-HIV Agents
South Africa; family functioning; hope; latent cross-lagged modelling; peer adherence support; randomized controlled trial