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01.12.2013 | Research article | Ausgabe 1/2013 Open Access

BMC Public Health 1/2013

Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America

Zeitschrift:
BMC Public Health > Ausgabe 1/2013
Autoren:
J Craig Phillips, Allison Webel, Carol Dawson Rose, Inge B Corless, Kathleen M Sullivan, Joachim Voss, Dean Wantland, Kathleen Nokes, John Brion, Wei-Ti Chen, Scholastika Iipinge, Lucille Sanzero Eller, Lynda Tyer-Viola, Marta Rivero-Méndez, Patrice K Nicholas, Mallory O Johnson, Mary Maryland, Jeanne Kemppainen, Carmen J Portillo, Puangtip Chaiphibalsarisdi, Kenn M Kirksey, Elizabeth Sefcik, Paula Reid, Yvette Cuca, Emily Huang, William L Holzemer
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2458-13-736) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

This work was completed as part of an international research collaborative, and was only possible because of each site investigator’s hard work and commitment to the project. Each author substantially contributed to designing the research protocol, collected data, assisted in the analysis, and in the writing of this manuscript. Therefore, each author made significant contributions to this work as outlined below and we want to acknowledge these contributions. Each author has approved the final version of this manuscript. JCP conceived the research question and design, collected data, completed the analysis, and interpreted of data, and wrote the first draft of the manuscript. ARW contributed to developing the research question, study design, collected data assisted with the theoretical model development, assisted with the analysis and interpretation of the data and assisted Dr. Phillips in writing the manuscript. CDR, contributed to developing the research study design, collected data, assisted with the analysis and assisted Dr. Phillips in writing the manuscript. IBC contributed to developing the research study design, collected data and assisted with the interpretation of the data and assisted Dr. Phillips in writing the manuscript. KMS contributed to developing the research study design, collected data, assisted with the theoretical model development, analysis and interpretation of the data and assisted Dr. Phillips in writing the manuscript. JV contributed to developing the research study design, collected data, assisted with the theoretical model development, and assisted with the interpretation of the data and assisted Dr. Phillips in writing the manuscript. DW contributed to developing the research study design, collected data and assisted with the analysis and interpretation of the data and assisted Dr. Phillips in writing the manuscript. KN contributed to developing the research study design, translated the instruments and protocol, collected data and assisted with the interpretation of the data and assisted with the analysis and interpretation of the data and she assisted Dr. Phillips in writing the manuscript. JB contributed to developing the research study design, collected data and assisted with the analysis and interpretation of the data and he assisted Dr. Phillips in writing the manuscript. WTC contributed to developing the research study design, translated the instruments and protocol, collected data and assisted with the analysis and interpretation of the data and she assisted Dr. Phillips in writing the manuscript. SI contributed to developing the research study design, translated the instruments and protocol, collected data and assisted with the analysis and interpretation of the data and assisted Dr. Phillips in writing the manuscript. LSE contributed to developing the research study design, collected data and assisted with the interpretation of the data and assisted Dr. Phillips in writing the manuscript. LTV contributed to developing the research study design, collected data and assisted with the interpretation of the data and assisted Dr. Phillips in writing the manuscript. MRM contributed to developing the research study design, collected data and assisted with the interpretation of the data and assisted Dr. Phillips in writing the manuscript. PN contributed to developing the research study design, collected data and assisted with the interpretation of the data and assisted Dr. Phillips in writing the manuscript. MOJ contributed to developing the research study design, collected data and assisted with the analysis and interpretation of the data and he assisted Dr. Phillips in writing the manuscript. MM contributed to developing the research study design, translated the instruments and protocol, collected data and assisted with the analysis and interpretation of the data and she assisted Dr. Phillips in writing the manuscript. JK, contributed to developing the research study design, collected data and assisted with the interpretation of the data and assisted Dr. Phillips in writing the manuscript. CJP, contributed to developing the research study design, translated the instruments and protocol, collected data and assisted Dr. Phillips in writing the manuscript. PC contributed to developing the research study design, translated the instruments and protocol, collected data and assisted with the analysis and interpretation of the data and assisted Dr. Phillips in writing the manuscript. KMK contributed to developing the research study design, collected data and assisted with the interpretation of the data and assisted Dr. Phillips in writing the manuscript. ES contributed to developing the research study design, collected data and assisted with the interpretation of the data and assisted Dr. Phillips in writing the manuscript. PR contributed to developing the research study design, collected data and assisted with the analysis and interpretation of the data and she assisted Dr. Phillips in writing the manuscript. YC managed the study database and coordinated communication between all study sites and assisted Dr. Phillips in writing the manuscript. EH managed the study database. WLH contributed to developing the research study design, collected data and assisted with the analysis and interpretation of the data, and he assisted Dr. Phillips in writing the manuscript. Each author has read and agrees with the final version of the manuscript submitted to BMC Public Health.

Abstract

Background

Human rights approaches to manage HIV and efforts to decriminalize HIV exposure/transmission globally offer hope to persons living with HIV (PLWH). However, among vulnerable populations of PLWH, substantial human rights and structural challenges (disadvantage and injustice that results from everyday practices of a well-intentioned liberal society) must be addressed. These challenges span all ecosocial context levels and in North America (Canada and the United States) can include prosecution for HIV nondisclosure and HIV exposure/transmission. Our aims were to: 1) Determine if there were associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital (resources to support one’s life chances and overcome life’s challenges), and HIV antiretroviral therapy (ART) adherence among PLWH and 2) describe the nature of associations between the social structural factor of criminalization of HIV exposure/transmission, the individual factor of perceived social capital, and HIV ART adherence among PLWH.

Methods

We used ecosocial theory and social epidemiology to guide our study. HIV related criminal law data were obtained from published literature. Perceived social capital and HIV ART adherence data were collected from adult PLWH. Correlation and logistic regression were used to identify and characterize observed associations.

Results

Among a sample of adult PLWH (n = 1873), significant positive associations were observed between perceived social capital, HIV disclosure required by law, and self-reported HIV ART adherence. We observed that PLWH who have higher levels of perceived social capital and who live in areas where HIV disclosure is required by law reported better average adherence. In contrast, PLWH who live in areas where HIV transmission/exposure is a crime reported lower 30-day medication adherence. Among our North American participants, being of older age, of White or Hispanic ancestry, and having higher perceived social capital, were significant predictors of better HIV ART adherence.

Conclusions

Treatment approaches offer clear advantages in controlling HIV and reducing HIV transmission at the population level. These advantages, however, will have limited benefit for adherence to treatments without also addressing the social and structural challenges that allow HIV to continue to spread among society’s most vulnerable populations.
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Authors’ original file for figure 1
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