Perception of Punishment Undermines Adherence

New research shows that although advances in drug therapies have made HIV a manageable illness, patients' negative attitudes about the disease may undermine treatment. Many people with HIV feel that their infection is "punishment." The report, "Predictors of Psychological Well-Being in a Diverse Sample of HIV-Positive Patients Receiving Highly Active Antiretroviral Therapy," is published in the journal Psychosomatics (2002;43(6):478-485).

The research examines attitude's effect on an HIV-positive person's health in the context of the virus now being considered a chronic condition instead of a terminal illness. HAART patients face strict dosing times and food restrictions. Furthermore, HIV infection can carry a stigma that adversely affects patients' psychological well-being.

Steven A. Safren, Ph.D., of the Massachusetts General Hospital department of psychiatry, and colleagues, looked at the way social support structures, coping ability and a patient's beliefs about HIV can help combat such stressors.

"HAART causes longer life expectancy, reduction of HIV disease progression, and fewer complications related to compromised immunofunctioning," said Safren. "These advancements, combined with the increasing number of new HIV infections, have resulted in a large and growing cohort of persons with HIV who are living and coping with the multiple stressors that accompany the disease and its treatment."

As part of a 12-week study of HIV medication adherence, the researchers surveyed 84 HIV-positive patients. They assessed their level of depression, quality of life and self-esteem. The participants also completed surveys regarding various life events, perceived social support, and coping styles. Finally, they asked patients if they thought their illness was a "punishment."

"Attributing one's HIV status as a 'punishment' is a common clinical response from patients," Safren said, adding that such a belief can lead to numerous negative consequences. The study found a patients' belief that HIV was a punishment was one of several variables related to depression and low self-esteem.

"The findings from the present study highlight the need for research addressing the effects of treatment for psychosocial issues such as depression, coping, and punishment beliefs about HIV on self care and, in turn, eventual medical outcome," Safren concluded.

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