People who adhere less-well to their HIV treatment regimens are more likely to be depressed, use cannabis and have unprotected sex, according to an American study published in the March 2003 edition of the journal Sexually Transmitted Infections.
Investigators in Atlanta, Georgia recruited 391 HIV-positive patients (275 men and 116 women) to see if they could find a link between adherence to HIV treatments and unprotected sex. The overwhelming majority, 71%, of the study sample were African-Americans, 24% were white and 5% were of other ethnicities. The sample tended to be poorly educated, with over 54% completing less than 12 years in full-time education, and poor, with nearly two-thirds having an income of less than $10,000 a year. Fifty-three percent of the sample said they were gay, 11% bisexual and 36% heterosexual.
Average age of the patients was 41 years and the mean timeliving with diagnosed HIV was a little over eight and a half years. AIDS had been diagnosed in 36% of patients.
Patients were asked to report their background characteristics and those on anti-HIV therapy were asked to name the drugs they were currently taking and to recall how many doses (if any) they had missed in the last seven days. If a patient reported missing a dose, then they were asked how many.
Mood was assessed using the Beck depression inventory and by a social support questionnaire. Patients were also asked if they had used alcohol, cannabis, cocaine, crack or any other drugs in the past three months.
In interviews, patients were asked about their sexual behaviour over the past three months, including condom use, number of sexual partners, and the HIV status of partners.
Of the 391 people in the study, 65% (255) were taking anti-HIV therapy. Of these 44% reported missing one dose in the previous week, a further 11% two doses, an additional 11% three doses and a further 10% missed four or more doses in the past seven days.
Controlling their results for number of years living with HIV, sex, and sexual orientation, the investigators found that patients missing doses were more likely to report depression, a lack of social support and hopelessness. Drug use was also more frequently reported by people missing doses, with 31% saying they had used cannabis (against 14% of patients who reported taking all their medication), and 18% cocaine (10% of adherent patients).
Again controlling for number of years living with HIV, sex, and sexual orientation, the investigators found that people who reported missing doses were more likely to have had unprotected anal or vaginal sex in the previous three months than patients reporting 100% adherence (32% versus 19%) and to have had unprotected sex with a partner of different or unknown HIV status (15% versus 8%) .
The study finding suggested to the investigators that, “[non]adherence to antiretroviral medication among people living with HIV-AIDS is associated with sexual behaviours that confer risks of HIV transmission.” In addition depression and drug use “serve as markers for clusters of health compromising behaviours that include both treatment [non] adherence and continued sexual risk behaviour.” They call for “comprehensive” health behavior interventions to be targeted at people reporting poor adherence and unprotected sex.
Further information on this website
Adherence - Factsheet
Kalichman SC et al. HIV treatment adherence and unprotected sex practices in people receiving antiretroviral therapy Sexually Transmitted Infections, 79: 59-61, 2003.