1 Kilimanjaro Clinical Research Institute/Kilimanjaro Christian Medical Center ; Moshi, Tanzania .
AIDS Patient Care STDS. 2014 Feb;28(2):98-105. doi: 10.1089/apc.2013.0306.
This study examines a proposed theoretical model examining the interrelationships between stigma, disclosure, coping, and medication adherence among 158 HIV-infected patients on antiretroviral therapy (ART) in northern Tanzania. Perceived and self-stigma, voluntary and involuntary disclosure, positive and negative coping, and demographics were assessed by trained interviewers, and self-reported adherence was collected during 5 months follow-up. Data were examined using correlation and regression analyses. The analyses showed that perceived stigma is primarily related to involuntary disclosure, whereas self-stigma is related to voluntary disclosure. Religious coping positively relates to acceptance, whereas perceived stigma explains higher levels of denial of HIV status. Lastly, adherence was negatively affected by alcohol use, self-stigma, and denial. We conclude that adherence is predominantly predicted by negative rather than positive coping mechanisms. Therefore, substituting maladaptive coping mechanisms like denial and alcohol use with a more adaptive coping style may be an important strategy to improve long-term ART adherence and well-being of patients. Moreover, this study showed that it is useful to examine both involuntary and voluntary disclosure when studying its relation with stigma.
本研究考察了一个理论模型，该模型探讨了坦桑尼亚北部 158 名接受抗逆转录病毒疗法 (ART) 的艾滋病毒感染者中污名、披露、应对和药物依从性之间的相互关系。通过培训过的访谈者评估了感知和自我污名、自愿和非自愿披露、积极和消极应对以及人口统计学特征，并且在 5 个月的随访期间收集了自我报告的药物依从性数据。使用相关和回归分析检查了数据。分析表明，感知污名主要与非自愿披露有关，而自我污名与自愿披露有关。宗教应对与接受呈正相关，而感知污名则解释了对 HIV 状况的更高否认水平。最后，酒精使用、自我污名和否认与药物依从性呈负相关。我们得出的结论是，药物依从性主要由消极而非积极的应对机制来预测。因此，用更具适应性的应对方式替代否认和酒精使用等适应不良的应对机制可能是改善长期 ART 依从性和患者福祉的重要策略。此外，本研究表明，在研究其与污名的关系时，同时检查非自愿和自愿披露是有用的。
