Center for Health, Identity, Behavior and Prevention Studies, Rutgers University.
Rory Meyers College of Nursing, New York University.
Behav Med. 2020 Jan-Mar;46(1):75-85. doi: 10.1080/08964289.2019.1570070. Epub 2019 Mar 25.
Consistent antiretroviral adherence is key to viral suppression, but many low-income people of color living with HIV are not optimally adherent due to a wide variety of interrelated social and structural factors. Previous studies have found that HIV medication beliefs are an important facet of adherence. In contrast to the AZT era , currently available antiretroviral therapies are significantly safer and more effective, but research suggests that negative beliefs may persist among racial and ethnic minority people. Twenty-seven semi-structured interviews were conducted with low-income Black and Latinx people living with HIV in New York City that were currently, or had been recently, disengaged from outpatient HIV medical care. This research suggests that socially and economically marginalized people living with HIV, many long-term survivors who lived through the AZT era, recognized that current treatments are very effective in making HIV a chronic, manageable illness and a significant improvement compared to the therapies early in the epidemic. Most importantly, the data suggests that people demonstrate great resilience despite their experiences of social and economic exclusion. Both clinical practice and public health interventions can benefit from these findings. HIV care providers should speak with patients about their beliefs related to HIV medication, and public health interventions should specifically address HIV medication-related beliefs in order to enhance adherence. In order to avoid reifying people's marginalization, public health should endeavor to recognize and support people's resilience.
抗病毒治疗的持续依从性是病毒抑制的关键，但由于各种相互关联的社会和结构性因素，许多患有 HIV 的低收入有色人种人群并不能达到最佳的依从性。先前的研究发现，HIV 药物信念是依从性的一个重要方面。与 AZT 时代不同，目前可用的抗逆转录病毒疗法安全性和有效性显著提高，但研究表明，负面信念可能仍然存在于少数族裔人群中。在纽约市，对 27 名目前或最近已退出门诊 HIV 医疗护理的低收入黑人及拉丁裔 HIV 感染者进行了半结构化访谈。这项研究表明，社会和经济处于边缘地位的 HIV 感染者，其中许多是经历过 AZT 时代的长期幸存者，认识到目前的治疗方法非常有效，可以将 HIV 转变为慢性、可控的疾病，与疾病早期的治疗方法相比有了显著改善。最重要的是，数据表明，尽管人们经历了社会和经济排斥，但他们表现出了巨大的韧性。临床实践和公共卫生干预都可以从这些发现中受益。HIV 护理提供者应该与患者讨论他们对 HIV 药物的信念，而公共卫生干预措施应该专门针对 HIV 药物相关信念，以提高依从性。为了避免将人们的边缘化具体化，公共卫生部门应该努力认识和支持人们的韧性。
