[First published in EILE Magazine Monthly Issue for September 2014, pages 84,85]
A Look at Psychosocial Problems As Factors in Non-adherence to ART Medication by HIV-Positive MSM – by M. Butler
Problems which some patients have in adhering to ART (antiretroviral therapy) medication may have a basis in psychosocial factors, such as mental health issues and/or substance use, a recent clinical review has revealed, and so interventions which address these co-morbid factors could improve ART adherence in the HIV-positive individual.
“Mental health and substance abuse problems are highly prevalent among HIV-infected men who have sex with men (MSM) and frequently interfere with antiretroviral therapy (ART) adherence”.
Feelings of worthlessness or hopelessness in an individual make it less likely that self-care behaviour patterns will prevail. According to the above-quoted clinical review by Jaclyn White et al., which summarises findings of intervention trials, the belief that you can manage your own condition (sefl-efficacy) is an important factor in whether or not you come up to the 80% plus ART adherence rate necessary to thrive living with HIV.
White et al. report that HIV-positive gay men are twice as likely to suffer from depression as their HIV-negative counterparts. Many have also suffered childhood abuse or other past trauma, and so gay men are also twice as likely to suffer from post-traumatic stress disorder as heterosexual men. General anxiety disorder also affects gay men and can interfere with their adherence to ART medication.
“Novel interventions that address underlying psychosocial health problems are necessary for improving ART adherence to enhance HIV-related health outcomes and suppress HIV viral load in an effort to prevent transmission to uninfected partners” (ref. as above).
Another co-morbid factor which can affect ART adherence among gay and MSM HIV-positive men is substance use. This can include heavy alcohol use, or use of drugs, such as crystal methamphetamine, cocaine or heroin. Crystal meth use in LA among gay men was found by the LA County Department of Health to be twenty times the rate in the general population.
However, withdrawal from both drug and alcohol use can lead to depression and apathy, which would again lead back to non-adherence to medications like ART.
Another mental health issue which could lead to non-adherence is Body Image Dysmorphia (BID) which is often linked with fat redistribution (lipodystrophy) a side effect of ART.
31% said they were concerned with this aspect, and the depression accompanying negative perception of body image could again be a link to non-adherence to ART medication. Although newer medications are said to be less likely to lead to lipodystrophy, the concern still remains among HIV-positive gay and MSM men.
White et al. report that there has been some preliminary success with pairing treatment for these other issues, such as mental health and substance use, with the Life Steps programme, which is aimed specifically at correcting non-adherence to ART.
It is interesting to note that an earlier paper by Berg et al. (2007) into non-adherence and the possible link to mental health and social problems, also suggests that interventions, which address the psycho-social issues affecting patients, should be offered in tandem with advice on adherence to ART medication.The following is the abstract of the Berg et al. review:
A variety of psychosocial stressors are involved in living with HIV, maintaining a regimen of highly active antiretroviral therapy, and negotiating necessary self-care behaviors. Because health care providers are in regular contact with HIV-infected individuals in care, these contacts allow for the opportunity to assess and intervene on important variables related to quality of life and HIV outcomes. This article reviews information about four important behavioral aspects of HIV care: treatment adherence, depression, high-risk sex, and substance abuse. Efforts by health care providers to address these factors may result in better treatment outcomes, enhanced quality of life among HIV patients, and decreased HIV transmission.
Berg, Carla J., Michelson, Susan E., Safren, Steven A. (2007)
The full text of the Berg et al. review can be viewed here.