HAART Is No Panacea for Psychosocial Problems: Study Disputes Assumptions and Expectations
September 10, 2004
A study of New York HIV-positive women on highly active antiretroviral therapy (HAART) found the women's psychosocial health was not statistically different from the psychosocial health of infected women before the widespread introduction of HAART.Adapted from:
"When we first conceptualized this study about five or six years ago, there were a lot of assumptions that were going unexamined -- such as that now that there's HAART and people are living longer and AIDS is redefined as a chronic illness, then it's not as distressing an experience," said Karolynn Siegel, Ph.D.
There are many possible explanations for the findings in the study of the 2000-2002 HAART-era women and the 1994-1996 pre-HAART-era women, Siegel said. "One is that most of these women are living in situations where they have significant life stressors: violence, poverty, history of drug abuse, and other problems associated with their socioeconomic status," she said. "Many don't even consider HIV infection the most salient or pressing problem they have to deal with." The pre- and post-HAART groups had equal proportions of African-American, white and Puerto Rican women.
In addition, the women's expectations of HAART were not met. HAART's side effects had compromised some women's lives, and some may be experiencing treatment failure, treatment fatigue or treatment-related uncertainties, said Siegel.
Most of the women said HIV/AIDS is still very stigmatizing and contributes to their shame and depression, said Siegel. "They are living a double life and are afraid of rejection," she said. "Some have been rejected by family and other people and have a loss of self-esteem, depression, and many become isolated." In addition, many women were unwilling, out of fear of rejection, to disclose their HIV status, she said.
"If it is the larger sociocultural context in which these women live, that is the big problem, then we have to chip away at issue of poverty, homelessness, and drug abuse," Siegel suggested. Resources are still needed to help patients improve their housing and lifestyle situations, she said. "The money needs to be there for the psychosocial support for women."
The full report, "Psychosocial Characteristics of New York City HIV-Infected Women Before and After the Advent of HAART," was published in the American Journal of Public Health (2004;94(7):1127-1132).
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.