Spiritual, Religious and Psychosocial Correlates of Adherence Among African-American HIV-Positive Outpatients

Monday, July 11, 2011

Safiya George Dalmida, PhD, MSN, APRN
Family and Community Nursing, Emory University, Atlanta, GA
Harold Koenig, MD
Psychiatry, Duke University, Durham, NC

Learning Objective 1: Identify correlates of HIV medication adherence among HIV-positive outpatients.

Learning Objective 2: Discuss clinical implications of study findings relevant to promoting and enhancing HIV medication adherence.

Purpose: The aims of this study are to examine: (1) religious coping (RCOPE), depression, perceived stress, social support, and health-related quality of life (HRQOL); (2) differences in these mean scores between Blacks and non-Blacks; and (3) identify predictors of HIV medication adherence among HIV+ Blacks in a sample of 292 HIV+ outpatients from infectious disease clinics and AIDS Service Organizations in the southeastern US.

Methods:  A cross-sectional study with 292 HIV+ outpatients was conducted. SPSS 18.0 and one-way ANOVA, correlations and hierarchical regression statistics were used.

Results: : Majority of the sample were African-American/Black (90.1%, n=262) and 6.2% were Caucasian. Majority were unemployed/on disability (90.8%) and impoverished (75.7% income<$11,000/year). Sample means: age=45 years; depression=19.3±12.8; HIV medication adherence=24±.25.9 (higher scores= better adherence on 0-30 scale); and CD4 count=452.5±335.58 cells/µL. Mean negative RCOPE was 4.86±5.34 and positive was 16.6±5.06 (higher scores=more coping on 0-21 scale). HIV+ Blacks had significantly higher mean total RCOPE (p=.035), positive RCOPE (p=.033), and social support satisfaction (p=.004) scores than HIV+ non-Blacks. There were no significant mean differences in number of years in HIV care, HIV medication adherence, depression, perceived stress, or HRQOL. Among HIV+ Blacks, HIV medication adherence was significantly inversely associated with depression (r= –.29; p=.000), perceived stress (r= –.33; p=.000) and significantly positively associated with positive RCOPE (r=.13; p=.04), social support satisfaction (r=.31; p=.000), mental HRQOL (r=.30; p=.000), physical HRQOL (r=.18; p=.009). Among HIV+ Blacks, Negative RCOPE, social support satisfaction, and years in HIV care were the only significant predictors of HIV medication adherence, controlling for socio-demographics.

Conclusion: HIV+ Blacks reported greater religious coping and satisfaction with social support than HIV+ non-Blacks. However, among HIV+ Blacks, negative forms of religious coping may negatively impact HIV medication adherence and greater satisfaction with social support and prolonged/consistent engagement in HIV care may positively impact HIV medication adherence.