Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa

doi:10.1016/j.ijnurstu.2008.06.006

International Journal of Nursing Studies

Volume 45, Issue 12, December 2008, Pages 1757-1763

https://doi.org/10.1016/j.ijnurstu.2008.06.006 Get rights and content

Abstract

Background

A supportive social environment is critical for those with HIV/AIDS. In KwaZulu-Natal, in South Africa, antiretroviral therapy is available to some HIV-positive individuals. Antiretroviral adherence is an important issue for limiting HIV infection. Adherence to therapy may be linked to social support, particularly amidst the stigma prevalent in HIV.

Objective

The purpose of this study was to examine characteristics related to social support and antiretroviral medication adherence.

Design

This cross-sectional, descriptive study explored the nature of the relationships among social support and other selected variables, including sociodemographic variables, quality of life, and adherence.

Settings

After ethical review board approval, the sample of HIV-infected individuals who received care in outpatient clinics were recruited and completed the self-report instruments.

Participants

The sample included English and/or isiZulu-speaking (n = 149) individuals over the age of 18 years receiving treatment for HIV/AIDS. A total of 149 patients with a diagnosis of HIV/AIDS agreed to participate and completed questionnaires after completing informed consent procedures. The study participants were recruited at four outpatient settings in Durban, KwaZulu-Natal province of South Africa.

Methods

A descriptive, exploratory, cross-sectional design was utilized to explore the research questions: What are the characteristics of social support and the relationship to antiretroviral adherence in KwaZulu-Natal, South Africa? Descriptive statistics and regression analyses were used to answer the research questions.

Results

Data analyses indicated that social support scores on the Medical Outcomes Study Social Support Survey were moderate (M = 64.4; S.D. = 14.7) among the study participants. The number of close friends and family were significantly correlated with a greater sense of social support. Despite this, the lowest scores on the quality-of-life measure using the Medical Outcomes Study Short Form 36 item survey were reported on the Social Functioning Scale.

Conclusions

In summary, the study findings suggest that a supportive social network is essential for those living with HIV/AIDS. However, social functioning and quality of life amidst the stigma of living with HIV in South Africa may be a concern and require further investigation.

Section snippets

Background

In South Africa, estimates indicate that approximately 5.54 million people are living with HIV/AIDS with estimates ranging up to 6.2 million (Joint United Nations Programme on AIDS (UNAIDS, 2007)). Of these, 4.9 million (90.8%) are in the age group from 20 to 64 years. KwaZulu-Natal province accounts for 28.7% of total HIV infections and a third of HIV infections among youth and children in South Africa. Prevalence is highest among pregnant women at 40.2% (South African Department of Health,

Research design

As part of a larger study (McInerney et al., 2008, Bhengu et al., 2008), the present study utilized a descriptive, exploratory design to explore the research questions: What are the characteristics of social support and the relationship to ART adherence in KwaZulu-Natal, South Africa? Are there differences in those who have greater social support and their adherence to ART?

Institutional Review Board approval

Permission to conduct the research was obtained from the Institutional Review Boards for the MGH Institute of Health

Data analyses

Data were analyzed using Statistical Package for the Social Sciences (SPSS) for Windows software application program version 13.0. Frequencies, means, standard deviations, and Pearson correlation coefficients were calculated to describe the sample and examine the relationships among the major study variables. A multiple regression analysis was conducted to estimate the characteristics of demographic variables, social support, and adherence to antiretroviral therapy in the sample.

Demographic characteristics

Most participants were female (n = 95; 64.0%), with a mean age of 35.5 years (S.D. = 7.5; range = 21–61 years) and of Zulu background (n = 143; 96%), with over 67% having less than 12th grade education (n = 99; 67.3%). Over half of the sample were not employed (n = 86; 58%). Over one-third of the participants (n = 50; 34.3%) were married; 37.7% (n = 55) indicating that they were not married, and 28.1% (n = 41) had no partners. Over 85% (n = 126; 85.3%) of the respondents had children with the majority of these (n =

Discussion

The study findings suggest that a supportive social network is important for those living with HIV/AIDS in South Africa. Social functioning and quality of life amidst the stigma of living with HIV in KwaZulu-Natal are, however, a concern identified by participants in this study. Of note, those with co-morbid illnesses did also report significantly lower scores on social support perhaps indicating the difficulties of maintaining supportive relationships with poorer functioning (physical,

Conflict of interest

None declared.

Funding source

Partial funding for the study was provided by the US Fulbright Scholar Program.

Ethical approval

Ethical approval was received at the Massachusetts General Hospital, the University of KwaZulu-Natal, and the clinic settings.

References (26)

A.M. Battaglioli-DeNero
Strategies for improving patient adherence to therapy and long-term patient outcomes
Journal of the Association of Nurses in AIDS Care
(2007)
C. Chenard
The impact of stigma on the self-care behaviors of HIV-positive gay men striving for normalcy
Journal of the Association of Nurses in AIDS Care
(2007)
J.E. Hupcey et al.
Can a professional relationship be considered social support?
Nursing Outlook
(1997)
S.K. Plach et al.
Social roles and health in women living with HIV/AIDS: a pilot study
Journal of the Association of Nurses in AIDS Care
(2006)
S. Bakken et al.
Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS
AIDS Patient Care STDS
(2000)
R.W. Burgoyne et al.
Perceived support in newly registered HIV/AIDS clinic outpatients
AIDS Care
(2000)
Bhengu, B.R., Ncama, B.P., McInerney, P.A., Wantland, D.J., Nicholas, P.K., Corless, I.B. et al., 2008. Symptoms...
R.E. Dorrington et al.
The demographic impact of HIV/AIDS in South Africa
National and Provincial Indicators 2006
(2006)
X. Gao et al.
Congruence of three self-report measures of medication adherence among HIV patients
Annals of Pharmacotherapy
(2000)
M. Ichikawa et al.
Perceived social environment and quality of life among people living with HIV/AIDS in northern Thailand
AIDS Care
(2006)

Joint United Nations Programme on AIDS (UNAIDS), 2007. 2007 Report on the global AIDS epidemic. Retrieved on March 25,...

C. Koopman et al.

Relationships of perceived stress to coping, attachment and social support among HIV-positive persons

AIDS Care

(2000)

S.D. Lawn et al.

Burden of tuberculosis in an antiretroviral treatment programme in sub-Saharan Africa: impact on treatment outcomes and implications for tuberculosis control

AIDS

(2006)

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Social support and medication adherence in HIV disease in KwaZulu-Natal, South Africa

Abstract

Background

Objective

Design

Settings

Participants

Methods

Results

Conclusions

Section snippets

Background

Research design

Institutional Review Board approval

Data analyses

Demographic characteristics

Discussion

Conflict of interest

Funding source

Ethical approval

Journal of the Association of Nurses in AIDS Care

Journal of the Association of Nurses in AIDS Care

Nursing Outlook

Journal of the Association of Nurses in AIDS Care

Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS

AIDS Patient Care STDS

Perceived support in newly registered HIV/AIDS clinic outpatients

AIDS Care

The demographic impact of HIV/AIDS in South Africa

National and Provincial Indicators 2006

Congruence of three self-report measures of medication adherence among HIV patients

Annals of Pharmacotherapy

Perceived social environment and quality of life among people living with HIV/AIDS in northern Thailand

AIDS Care

Relationships of perceived stress to coping, attachment and social support among HIV-positive persons

AIDS Care

Burden of tuberculosis in an antiretroviral treatment programme in sub-Saharan Africa: impact on treatment outcomes and implications for tuberculosis control

AIDS