Disparities in Reported Reasons for Not Initiating or Stopping Antiretroviral Treatment Among a Diverse Sample of Persons Living with HIV

• Published in: Journal of general internal medicine : JGIM 2009-02, Vol.24 (2), p.247-251
• Main Authors: Johnson, Mallory O., Chesney, Margaret A., Neilands, Torsten B., Dilworth, Samantha E., Remien, Robert H., Weinhardt, Lance S., Wong, F. Lennie, Morin, Stephen F.
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Addictive behaviors; Adult; Adult and adolescent clinical studies; AIDS; Anti-Retroviral Agents - administration & dosage; Antiretroviral drugs; Biological and medical sciences; Brief Report; Cross-Sectional Studies; Drug addiction; Drug therapy; Female; General aspects; Health behavior; Healthcare Disparities - methods; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - psychology; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Internal Medicine; Interviews as Topic - methods; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Patient Acceptance of Health Care - psychology; Patient Compliance - psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Sex Factors; Socioeconomic Factors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load - methods
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-008-0854-z

BACKGROUND Disparities in the use of antiretroviral therapy (ART) for HIV disease have been documented across race, gender, and substance use groups. OBJECTIVE The current analysis compares self-reported reasons for never taking or stopping ART among a diverse sample of men and women living with HIV. DESIGN Cross-sectional interview. PARTICIPANTS HIV + (N = 3,818) adults, 968 of whom reported discontinuing or never using ART. MEASUREMANTS Computerized self-administered and interviewer-administered self-reported demographic and treatment variables, including gender, race, ethnicity, CD4 count, detectable viral load, and reported reasons for not taking antiretroviral therapy. RESULTS Despite equivalent use of ART in the current sample, African-American respondents were 1.7 times more likely to report wanting to hide their HIV status and 1.7 times more likely to report a change in doctors/clinics as reasons for stopping ART (p = .049, and p = .042) and had odds 4.5 times those of non-African Americans of reporting waiting for viral marker counts to worsen (p = < .0001). There was a lower tendency (OR = 0.4) for women to endorse concerns of keeping their HIV status hidden as a reason for stopping ART compared to men (p = .003). Although those with an IDU history were less likely to be on ART, no differences in reasons for stopping or never initiating ART were found between those with and without an IDU history. CONCLUSIONS A desire to conceal HIV status as well as a change in doctors/clinics as reasons for discontinuing ART were considerably more common among African Americans, suggesting that perceived HIV/AIDS stigma is an obstacle to maintenance of treatment. Findings also indicate differences in reasons for stopping ART by gender and a perceived desire to wait for counts to worsen as a reason for not taking ART by African Americans, regardless of detectable viral load, CD4 count, age, education, employment, sexual orientation, and site.