AUTHOR=Duthely Lunthita M. , Sanchez-Covarrubias Alex P. , Brown Megan R. , Thomas Tanya E. , Montgomerie Emily K. , Dale Sannisha , Safren Steven A. , Potter JoNell E. 

TITLE=Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter

JOURNAL=Frontiers in Public Health

VOLUME=Volume 9 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.667331

DOI=10.3389/fpubh.2021.667331

ISSN=2296-2565

ABSTRACT=Background: Ending HIV/AIDS in the United States requires tailored interventions. This study is part of a larger investigation to design mCARES, a mobile technology-based, adherence intervention for ethnic minority women with HIV (MWH).

Objective: To understand barriers and facilitators of care adherence (treatment and appointment) for ethnic MWH; examine the relationship between these factors across ethnic groups; and, explore the role of mobile technologies in care adherence.

Methods: Cross-sectional, mixed-methods data were collected from African-American, Hispanic-American and Haitian- American participants. A focus group (n=8) assessed barriers and facilitators to care adherence. We  surveyed women  (n=48) on depression (PHQ-9), HIV-related stigma (HSS) and resiliency (CD-RISC25), and examined the relationships between these factors and adherence to treatment and to care and across groups.

Findings: Qualitatively, barriers to treatment and appointment adherence were caregiver-related stressors (25%) and structural issues (25%); routinization (30%) and religion/spirituality (30%) promoted adherence to treatment and care. Caregiver role was both a hindrance (25%) and promoter (20%) of adherence to treatment and appointments. Quantitatively, HIV-related stigma differed by ethnic group; Haitian-Americans endorsed the highest levels while African-Americans endorsed the lowest. Depression correlated to stigma (R=.534; p<0.001) and resiliency (R=-0.486; p<0.001). Overall, higher depression and stigma were related to viral non-suppression (p<0.05); higher resiliency was related to viral suppression. Among Hispanic-Americans, viral non-suppression was related to depression (p<0.05), and among African-Americans, viral suppression was related to increased resiliency (p<0.04). 

Conclusion: Multiple interrelated barriers to adherence were identified. These findings on ethnic group-specific differences underscore the importance of implementing culturally-competent interventions.