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Bryant J, Smith AKJ, Persson A, Valentine K, Drysdale K, Wallace J, Hamilton M, Newman CE. Logics of control and self-management in narratives of people living with HIV, hepatitis C and hepatitis B. CULTURE, HEALTH & SEXUALITY 2023; 25:1214-1229. [PMID: 36476229 DOI: 10.1080/13691058.2022.2149858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
In Australia, the response to HIV, hepatitis C and hepatitis B has largely been through the constructed category of 'blood borne viruses' which treats these viruses as an interconnected set of conditions with respect to their mode of transmission. In this paper, we explore how people understand their viral infection, and compare the logics underpinning these different understandings. In-depth interviews were conducted with 61 participants who were either living with a blood borne virus or were the family members of people living with them. Our analysis reveals that the viral infection was often described as 'just a condition that needs to be managed', albeit in potentially exhausting ways. This understanding hinged upon a biomedical logic in which viral invasion was seen as causing illness and in turn necessitating biomedical intervention. In contrast, some participants with hepatitis B presented their infection as a condition unintelligible through Western biomedical logics, defined instead by symptomology - in terms of 'liver disease', and/or 'liver inflammation'. This focus on symptomology calls into question the soundness of prevention and management responses to hepatitis B based in biomedical logics and reveals the extent to which living with a virus involves multiple, sometimes incompatible, cultural logics. The different logics underpinning HIV, hepatitis C and hepatitis B reveal shortcomings of framing these viruses together as a coherent single construct.
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Affiliation(s)
- Joanne Bryant
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Asha Persson
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Myra Hamilton
- University of Sydney Business School, Sydney, NSW, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
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2
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Treloar C, Cama E, Lancaster K, Brener L, Broady TR, Cogle A, O'Donnell D. A universal precautions approach to reducing stigma in health care: getting beyond HIV-specific stigma. Harm Reduct J 2022; 19:74. [PMID: 35799296 PMCID: PMC9264680 DOI: 10.1186/s12954-022-00658-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Delivery of effective health care is hampered by stigma, the social processes that attach negative judgement and response to some attributes, conditions, practices and identities. Experiencing or anticipating stigma can lead to a range of practical impacts, including avoidance of health care. While we are concerned about the stigma that is attached to HIV, this commentary makes the argument that the health system is burdened by stigma of many origins. Main body Reducing stigma is a key issue in improving quality of health care. Our focus on HIV is about providing better care in a non-judgemental, respectful and dignified manner which enhances the health and well-being of individuals as well as delivering benefit to society at large through better population health outcomes. However, the same could be said for the numerous possible attributes, conditions, practices and identities that attract stigma. It is unrealistic to expect health systems to respond to siloed appeals for change and action. A unifying logic is needed to propel concerns about stigma to the front of the queue for action by health systems. Conclusion This commentary suggests the need for a universal precautions approach to stigma in health care, that focuses on recognising that all people may experience stigma and discrimination targeted at one or more aspects of their identities, attributes, practices and health conditions. Drawing on health system precepts of equity, access and quality of care, we argue that a universal precautions approach to reducing stigma of all origins can effect everyday aspects of policy, procedure and practice to improve outcomes for individuals and for population health.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Loren Brener
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Aaron Cogle
- National Association of People With HIV Australia (NAPWHA), Sydney, Australia
| | - Darryl O'Donnell
- Australian Federation of AIDS Organisations (AFAO), Sydney, Australia
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Impact of the removal of patient co-payments for antiretroviral therapy (ART) on out-of-pocket expenditure, adherence and virological failure among Australian adults living with HIV. Health Policy 2021; 125:1131-1139. [PMID: 34340883 DOI: 10.1016/j.healthpol.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 06/19/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND In 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket (OOP) healthcare expenditure, improve ART adherence, and better maintain HIV suppression. METHODS Using data from a national, 2-year prospective study of adults with HIV on ART (n=364) (2013-2017), we compared OOP healthcare expenditure, ART adherence, and virological failure (VF) in participants subject to the co-payment policy change with participants from other jurisdictions who never paid, and who always paid, co-payments. We used fixed effects regression models to compare outcomes, and incidence rates for VF. RESULTS Although ART co-payments declined, there was no significant change in total OOP healthcare expenditure in participants ceasing co-payments compared to those who continued (adjusted coefficient 0.09, 95% CI -0.31 to 0.48). Co-payment removal did not significantly reduce suboptimal ART adherence (from 17.5% to 16.3%) or VF (from 5.0 to 3.7 episodes per-100-person-years). Participants in the lowest income group but not receiving concessional government benefits incurred a non-significant increase in total OOP healthcare expenses; while concessional participants experienced a significant increase in non-ART HIV healthcare costs after the policy changed. CONCLUSION In this population, ART co-payments represented a small proportion of OOP healthcare expenditure. Its removal did not materially impact ART adherence or VF, although the study was not powered to detect these.
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Lazuardi E, Newman CE, Anintya I, Rowe E, Wirawan DN, Wisaksana R, Subronto YW, Kusmayanti NA, Iskandar S, Kaldor J, Bell S. Increasing HIV treatment access, uptake and use among men who have sex with men in urban Indonesia: evidence from a qualitative study in three cities. Health Policy Plan 2020; 35:16-25. [PMID: 31625559 DOI: 10.1093/heapol/czz128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 11/12/2022] Open
Abstract
Men who have sex with men make up one of four key populations identified as critical to a successful HIV response in Indonesia. Despite international policies supporting HIV treatment in low- and middle-income countries, Indonesia is one of the few countries experiencing low coverage of HIV treatment and little decrease in HIV incidence. There is poor retention in care and low viral suppression rates among key populations such as men who have sex with men. The national government has committed to increasing treatment access and uptake for people with HIV but little is known about how these men themselves view, use and experience these medications. Drawing on qualitative data collected in 2015-16 from 24 HIV-positive men who have sex with men living in three Indonesian cities, we observed multiple intersecting social and contextual factors that can influence effective HIV treatment use. Although shared stories of strong side effects and fear of unwanted disclosure inhibited treatment uptake, social support from 'buddies' helped to navigate healthcare systems and sharing medication among peers enabled adherence. In order to improve treatment uptake and adherence among Indonesian men who have sex with men living with HIV, these divergent effects of the social meanings and practices associated with HIV treatments in Indonesia must be better acknowledged. A more comprehensive understanding of social and community practices within key populations can strengthen national efforts to improve treatment access and increase adherence. Ongoing decentralization of healthcare in Indonesia, and differentiated care models that enable initiation of treatment in community settings and involve non-medical, community-based organizations in the provision of treatment services have the potential to address the needs of individuals who fall into a key population category such as men who have sex with men.
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Affiliation(s)
- Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.,Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Medika, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Irma Anintya
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Jl. Eijkman No. 38, Kota Bandung, West Java 40161, Indonesia
| | - Emily Rowe
- Kerti Praja Foundation, Jl. Raya Sesetan No. 270, Kota Denpasar, Bali 80223, Indonesia
| | - Dewa N Wirawan
- Kerti Praja Foundation, Jl. Raya Sesetan No. 270, Kota Denpasar, Bali 80223, Indonesia.,Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Jl. P.B. Sudirman, Kota Denpasar, Bali 80232, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Jl. Eijkman No. 38, Kota Bandung, West Java 40161, Indonesia.,Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Jl. Pasteur No. 38, Kota Bandung, West Java 40161, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Medika, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Farmako, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Nur Aini Kusmayanti
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Medika, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Shelly Iskandar
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Jl. Eijkman No. 38, Kota Bandung, West Java 40161, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.,Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
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5
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Mey A, Plummer D, Rogers GD, O’Sullivan M, Domberelli A, Anoopkumar-Dukie S. Yes to Recreational Drugs and Complementary Medicines But No to Life-Saving Medications: Beliefs Underpinning Treatment Decisions Among PLHIV. AIDS Behav 2019; 23:3396-3410. [PMID: 31388852 DOI: 10.1007/s10461-019-02623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the life-preserving benefits of antiretroviral therapy (ART), some people living with HIV (PLHIV) delay, decline or diverge from recommended treatment while paradoxically being willing to use potentially dangerous substances, such as recreational drugs (RD) and complementary medicines (CM). During 2016 and 2017, interviews were conducted with 40 PLHIV, in Australia to understand drivers underpinning treatment decisions. While many believed ART to be effective, they expressed concerns about long-term effects, frustration over perceived lack of autonomy in treatment decisions and financial, emotional and physical burdens of HIV care. In contrast, they ascribed a sense of self-control over the use of RD and CM, along with multiple professed benefits. The perceived burden of ART emerged as a motivator for deviating from recommended treatment, while positive views towards RD and CM appear to justify use. This study may serve as guidance for the development of future strategies to address barriers to treatment uptake and adherence and subsequently health outcomes for PLHIV in Australia and elsewhere.
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Promoting 'Equitable Access' to PrEP in Australia: Taking Account of Stakeholder Perspectives. AIDS Behav 2019; 23:1846-1857. [PMID: 30306435 DOI: 10.1007/s10461-018-2311-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As evidence of the safety and effectiveness of HIV pre-exposure prophylaxis (PrEP) has grown, so has attention to the views of prospective users and providers. However, far less attention has been paid to understanding the perspectives of other stakeholders in the rollout of PrEP access programs. We conducted 21 semi-structured qualitative interviews in 2017 with key stakeholders working across the policy, advocacy, research and/or clinical dimensions of the Australian HIV response, before federal support for a subsidised access scheme was achieved. Our analysis explored three areas of shared concern: who is a suitable candidate for PrEP; why are disparities in PrEP access important; and how can disparities be addressed? In examining how this diverse group of professionals grappled with the challenges of promoting 'equitable access' to PrEP in an increasingly resource rationed health system, we can see how the principles believed to underpin the Australian response to HIV were both reaffirmed and challenged through this period of significant change.
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Young I, Davis M, Flowers P, McDaid LM. Navigating HIV citizenship: identities, risks and biological citizenship in the treatment as prevention era. HEALTH, RISK & SOCIETY 2019; 21:1-16. [PMID: 31105468 PMCID: PMC6494283 DOI: 10.1080/13698575.2019.1572869] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs - and bodies - were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP.
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Affiliation(s)
- Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne
| | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lisa M. McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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8
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Kesselring S, Osborne C, Bever A, Salters K, Cui Z, Chia J, Moore DM, Parashar S, Kaida A, Samji H, Duddy J, Gabler K, Howard T, Nash D, McCandless LC, Patterson TL, Corneil T, Montaner JSG, Hogg RS. Factors associated with delayed and late ART initiation among people living with HIV in BC: results from the engage study. AIDS Care 2018; 31:885-892. [PMID: 30466303 DOI: 10.1080/09540121.2018.1549722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We examined correlates of late and delayed initiation of antiretroviral therapy (ART) in British Columbia, Canada. From December 2013 to December 2015 we recruited treatment-naïve people living with HIV who initiated ART within the previous year. 'Late initiation' was defined as CD4 cell count ≤500 cells/µL at ART initiation and 'delayed initiation' as ≥1 year between HIV diagnosis and initiation. Multivariable logistic regression assessed independent correlates of late and delayed initiation. Of 87 participants, 44 (51%) initiated late and 22 (26%) delayed initiation. Delayed initiation was positively associated with older age (adjusted odds ratio [AOR]: 1.06 per year, 95% confidence interval [95% CI]: 1.01-1.12) and inversely associated with wanting to start ART at diagnosis (AOR: 0.06, 95% CI: 0.02-0.21). Variables associated with late initiation were older age (AOR: 1.09 per year, 95% CI: 1.03-1.15) and medical reason(s) for initiation (AOR: 5.00, 95% CI: 1.41-17.86). Late initiation was less likely among those with greater perceived ART efficacy (AOR 0.94, 95% CI: 0.90-0.98) and history of incarceration (AOR: 0.12, 95% CI: 0.03-0.56). Disparities in timing of initiation were observed for age, perceived ART efficacy, and history of incarceration. Enhanced health services that address these factors may facilitate earlier treatment initiation.
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Affiliation(s)
- Sarah Kesselring
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Charles Osborne
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Andrea Bever
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Kate Salters
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Zishan Cui
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Jason Chia
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - David M Moore
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,b University of British Columbia , Vancouver , British Columbia , Canada
| | - Surita Parashar
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,c Simon Fraser University , Burnaby , British Columbia , Canada
| | - Angela Kaida
- c Simon Fraser University , Burnaby , British Columbia , Canada
| | - Hasina Samji
- c Simon Fraser University , Burnaby , British Columbia , Canada.,d British Columbia Centre for Disease Control , Vancouver , British Columbia , Canada
| | - Janice Duddy
- e Pacific AIDS Network , Vancouver , British Columbia , Canada
| | - Karyn Gabler
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Terry Howard
- f Engage Study Knowledge User , Vancouver , British Columbia , Canada
| | - Denis Nash
- g City University of New York School of Public Health , New York , NY , USA.,h City University of New York Institute for Implementation Science in Population Health , New York , NY , USA
| | | | | | - Trevor Corneil
- j Interior Health Authority , Kelowna , British Columbia , Canada
| | - Julio S G Montaner
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,b University of British Columbia , Vancouver , British Columbia , Canada
| | - Robert S Hogg
- a Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS , St. Paul's Hospital , Vancouver , British Columbia , Canada.,c Simon Fraser University , Burnaby , British Columbia , Canada
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9
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Hollingdrake O, Lui CW, Mutch A, Dean J, Howard C, Fitzgerald L. Factors affecting the decision to initiate antiretroviral therapy in the era of treatment-as-prevention: synthesis of evidence from qualitative research in high-income settings. AIDS Care 2018; 31:397-402. [PMID: 30311499 DOI: 10.1080/09540121.2018.1533235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The emergence of treatment-as-prevention has made early initiation of antiretroviral treatment (ART) a "universal" policy. This review synthesizes qualitative research findings on barriers and facilitators of ART initiation in Organization for Economic Co-operation and Development (OECD) countries published since 2010. Ten articles describing seven research studies were included in the review. Findings confirmed ART initiation as a complicated process involving careful deliberation of the personal risks and benefits of treatment within the broader contexts of everyday life for people living with HIV (PLHIV). They also highlight interpersonal dynamics and concern for the public as increasingly important factors in shaping the decision to initiate treatment. The review provides valuable information for understanding treatment behaviour and maximizing treatment options brought forth by new biomedical advances.
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Affiliation(s)
| | - Chi-Wai Lui
- a School of Public Health , University of Queensland , Brisbane , Australia
| | - Allyson Mutch
- a School of Public Health , University of Queensland , Brisbane , Australia
| | - Judith Dean
- a School of Public Health , University of Queensland , Brisbane , Australia
| | - Chris Howard
- b Department of Life and Program , Queensland Positive People , Brisbane , Australia
| | - Lisa Fitzgerald
- a School of Public Health , University of Queensland , Brisbane , Australia
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10
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Mao L, de Wit J, Adam P, Post JJ, Slavin S, Cogle A, Wright E, Kidd M. Beliefs in Antiretroviral Treatment and Self-Efficacy in HIV Management are Associated with Distinctive HIV Treatment Trajectories. AIDS Behav 2018; 22:887-895. [PMID: 27995435 DOI: 10.1007/s10461-016-1649-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
An online survey was conducted among people living with HIV (PLHIV) in Australia to discern key factors associated with distinctive ART use patterns. The sample (N = 358), was further divided into three groups: those on ART continuously since initiation (n = 208, 58.1%); those on ART intermittently (n = 117, 32.7%); and those not on ART at the time of survey (n = 33, 9.2%). ART non-users were the most likely to hold serious concerns about ART that outweighed perceived necessities (benefits) from ART (AOR = 0.13; 95% CI 0.06-0.29; p < 0.001). They were also the least self-efficacious in HIV disease management (AOR = 0.29; 95% CI 0.09-0.87; p = 0.028). Intermittent ART users were more likely to receive their HIV diagnosis prior to 2003 (AOR = 0.38; 95% CI 0.28-0.53; p < 0.001) and perceive lower HIV management self-efficacy (AOR = 0.50, 95% CI 0.28-0.87; p = 0.015) than continuous users. ART-related beliefs and perceived self-efficacy in HIV self-management play an important role in achieving universal treatment uptake and sustained high levels of adherence.
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Affiliation(s)
- Limin Mao
- Centre for Social Research in Health, UNSW Australia, Room 307, Level 3 John Goodsell Building, Sydney, NSW, 2052, Australia.
| | - John de Wit
- Centre for Social Research in Health, UNSW Australia, Room 307, Level 3 John Goodsell Building, Sydney, NSW, 2052, Australia
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Philippe Adam
- Centre for Social Research in Health, UNSW Australia, Room 307, Level 3 John Goodsell Building, Sydney, NSW, 2052, Australia
| | - Jeffrey J Post
- Prince of Wales Clinical School, UNSW Australia, Sydney, Australia
| | - Sean Slavin
- Centre for Social Research in Health, UNSW Australia, Room 307, Level 3 John Goodsell Building, Sydney, NSW, 2052, Australia
| | - Aaron Cogle
- National Association of People With HIV Australia, Sydney, Australia
| | - Edwina Wright
- Department of Infectious Disease, The Alfred Hospital and Monash University, Melbourne, Australia
- The Burnet Institute, Melbourne, Australia
| | - Michael Kidd
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
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11
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Mey A, Plummer D, Dukie S, Rogers GD, O'Sullivan M, Domberelli A. Motivations and Barriers to Treatment Uptake and Adherence Among People Living with HIV in Australia: A Mixed-Methods Systematic Review. AIDS Behav 2017; 21:352-385. [PMID: 27826734 DOI: 10.1007/s10461-016-1598-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Australia, approximately 30% of people diagnosed with HIV are not accessing treatment and 8% of those receiving treatment fail to achieve viral suppression. Barriers limiting effective care warrant further examination. This mixed-methods systematic review accessed health and social sector research databases between November and December 2015 to identify studies that explored the perspective of people living with HIV in Australia. Articles were included for analysis if they described the experiences, knowledge, attitudes and beliefs, in relation to treatment uptake and adherence, published between January 2000 and December 2015. Quality appraisal utilised the Mixed Methods Appraisal Tool Version 2011. Seventy-two studies that met the inclusion criteria were reviewed. The interplay of lack of knowledge, fear, stigma, physical, emotional and social issues were found to negatively impact treatment uptake and adherence. Strategies targeting both the individual and the wider community are needed to address these barriers.
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Affiliation(s)
- Amary Mey
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - David Plummer
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Shailendra Dukie
- School of Pharmacy, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Gary D Rogers
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Maree O'Sullivan
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Amber Domberelli
- School of Medicine, Griffith University, Gold Coast Campus, Southport, QLD, Australia
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12
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Power J, Lyons A, Brown G, Dowsett GW, Lucke J. Use of antiretroviral treatment among people living with HIV in Australia between 1997 and 2012. AIDS Care 2016; 29:61-66. [PMID: 27327874 DOI: 10.1080/09540121.2016.1198751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Current international targets aim for 90% of people diagnosed with HIV to be on antiretroviral treatment (ART). This paper aims to identify sociodemographic and attitudinal factors associated with ART non-use over time in three samples of Australian people living with HIV (PLHIV). Data for this paper were derived from an Australian cross-sectional survey of PLHIV that was repeated at three different time points: 1997, 2003, and 2012. There were approximately 1000 respondents to each survey (n = 3042 in total). The survey included approximately 250 items related broadly to health and well-being, ART use, and attitudes towards ART use. Univariate and multivariate logistic regression analyses were used. While the proportion of participants using ART increased between 1997 and 2012 (78.8-87.6%, p < .001), there was a decrease between 1997 and 2003 to 70.6% (p < .001). Factors linked to ART non-use remained steady over those 15 years. In all cohorts, people less likely to be using ART were younger and had a more recent diagnosis of HIV. In 2003 and 2012, people in full-time employment were less likely to be using ART, while those whose main source of income was a pension or social security were more likely to be using ART. Multivariate models showed that, at each time point, a belief in the health benefits of delayed ART uptake was associated with non-use. These findings suggest that there may be barriers to ART uptake that have persisted over time despite changes to clinical guidelines that now encourage early uptake.
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Affiliation(s)
- J Power
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - A Lyons
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - G Brown
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - G W Dowsett
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - J Lucke
- a The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
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Persson A, Newman CE, Mao L, de Wit J. On the Margins of Pharmaceutical Citizenship: Not Taking HIV Medication in the "Treatment Revolution" Era. Med Anthropol Q 2016; 30:359-77. [PMID: 26756317 DOI: 10.1111/maq.12274] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Abstract
With the expanding pharmaceuticalization of public health, anthropologists have begun to examine how biomedicine's promissory discourses of normalization and demarginalization give rise to new practices of and criteria for citizenship. Much of this work focuses on the biomedicine-citizenship nexus in less-developed, resource-poor contexts. But how do we understand this relationship in resource-rich settings where medicines are readily available, often affordable, and a highly commonplace response to illness? In particular, what does it mean to not use pharmaceuticals for a treatable infectious disease in this context? We are interested in these questions in relation to the recent push for early and universal treatment for HIV infection in Australia for the twin purposes of individual and community health. Drawing on Ecks's concept of pharmaceutical citizenship, we examine the implications for citizenship among people with HIV who refuse or delay recommended medication. We find that moral and normative expectations emerging in the new HIV "treatment revolution" have the capacity to both demarginalize and marginalize people with HIV.
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Affiliation(s)
- Asha Persson
- Centre for Social Research in Health, UNSW Australia.
| | | | - Limin Mao
- Centre for Social Research in Health, UNSW Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Australia
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Appreciating doubts about HIV medicine. J Int AIDS Soc 2015; 18:20717. [PMID: 26653859 PMCID: PMC4676422 DOI: 10.7448/ias.18.1.20717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/06/2015] [Indexed: 11/12/2022] Open
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