Less than strict adherence to antiretroviral (ARV) medication is the catalyst to the development of drug resistant strains of HIV, sub-therapeutic benefits from ARVs and consequently, opportunistic infections and death. Adherence research has provided numerous reasons for non-adherent behavior in largely homogenous samples but has failed to identify salient reasons for non-adherent behavior in gender and ethnic specific populations. The literature has established African American women are less likely to be adherent to ARVs and have poorer health outcomes compared to their white counterparts. The long-term objectives are two fold: establish potential feasible intervention strategies by exploring the cognitive representations of HIV/AIDS illness of African American women and ultimately reduce the adherence and negative health outcome disparities associated with HIV/AIDS in African American women. The purpose of this descriptive, exploratory study is to describe the cognitive representations of HIV/AIDS illness in African American women living with HIV/AIDS and determine whether the cognitive representations of HIV/AIDS illness held by African American women predict adherence to antiretroviral medication. In this study, 18-45 year old African American women (N= 110), who have been diagnosed with HIV/AIDS for greater than 6 months and are currently on an ARV regimen from a HIV/AIDS care facility in Southeastern Michigan, will be recruited to participate. Cognitive representations of HIV/AIDS illness will be described utilizing the HIV Illness Perception Questionnaire-Revised (Moss-Morris et al., 2002) and adherence will be measured utilizing the CASE Adherence Index (Mannheimer et al., 2006). The Self Regulatory Model of Illness will serve as the theoretical framework for this study.
Four specific aims will be addressed: 1) Describe the cognitive representations of HIV/AIDS illness in African American women living with HIV/AIDS, 2) Determine whether the cognitive representations of HIV/AIDS illness held by African American women predict adherence to antiretroviral medication, 3) Determine whether cognitive representations of HIV/AIDS illness differ between various demographic (income and education) and illness related variables (time since diagnosis, cause of infection and history of regimen change) among African American women, and 4) Explore recent viral HIV RNA and CD4 cell counts in relation to self reported adherence. This study is foundational to the development of interventions aimed at promoting adherence and ultimately reducing the disparities of AIDS health outcomes in African American women as outlined in Healthy People 2010. ? ? ?
