title: Life Lessons from Women with HIV: Mutuality, Self-Awareness, and Self-Efficacy.
abstract: Women with HIV in the United States cope with multiple traumas that influence adherence to antiretroviral therapy (ART) and well-being. Narrative themes from three life turning points and a projective story task were compared for two groups of women with HIV (HIV well-managed vs. HIV not well-managed, matched on demographics and narrative word count) to understand predictors of successful outcomes. The well-managed group (n = 10) was virally suppressed and reported ≥95% ART adherence; the not well-managed group (n = 10) had detectable viral load and reported <95% ART adherence. Women were predominantly African American with low socioeconomic status and averaged 46.51 years. A three-stage coding process (with coders blind to group status in stages 1 and 2) involved (1) line by line thematic analyses that generated 155 subthemes reflecting six content areas (interpersonal relationships; culture and community; sense of self; relationship to past, present, and future experiences; self-care; and motivators for change); (2) absence/presence of the 155 subthemes was compared for the two groups; the frequency of 37 subthemes was found to significantly differ; and (3) the 37 differentiating subthemes were conceptually integrated, revealing that the well-managed group's narratives more frequently reflected (a) mutuality (growth-fostering relationships involving reciprocal care and empathy); (b) self-awareness (recognition of personal strengths and weaknesses and multiple factors contributing to life choices and trajectories); and (c) self-efficacy (active coping, self-advocacy, and utilizing resources). Implications for treatment and interconnections among themes are discussed, emphasizing the factors that enable women to care for themselves and others.
authors.affiliation: 1 Department of Psychological and Brain Sciences, Boston University , Boston, Massachusetts.
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Brody
authors.affiliation: 2 Fairhaven College of Interdisciplinary Studies, Western Washington University , Bellingham, Washington.
authors.forename: Dana C
authors.initials: DC
authors.lastname: Jack
authors.affiliation: 1 Department of Psychological and Brain Sciences, Boston University , Boston, Massachusetts.
authors.forename: Dana L
authors.initials: DL
authors.lastname: Bruck-Segal
authors.affiliation: 1 Department of Psychological and Brain Sciences, Boston University , Boston, Massachusetts.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Ruffing
authors.affiliation: 1 Department of Psychological and Brain Sciences, Boston University , Boston, Massachusetts.
authors.forename: Yudelki M
authors.initials: YM
authors.lastname: Firpo-Perretti
authors.affiliation: 3 Behavioral Medicine Service, Massachusetts General Hospital , Boston, Massachusetts.
authors.forename: Sannisha K
authors.initials: SK
authors.lastname: Dale
authors.affiliation: 4 Cook County Health and Hospitals System, Hektoen Institute of Medicine , Chicago, Illinois.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Weber
authors.affiliation: 5 Department of Medicine, Stroger Hospital , Cook County Health & Hospitals System, and Rush University, Chicago, Illinois.
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002641:Chicago; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology / Q000821:virology; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010465:Perception; D012648:Self Care; D020377:Self Efficacy; D012959:Socioeconomic Factors; D014481:United States; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents