Laura M. Bogart

Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease

New treatments for HIV can improve immune functioning and decrease mortality. However, lapses in adherence may render these complex regimens ineffective. Sixty-three men and 9 women on highly active antiretroviral therapy completed measures of medication adherence, psychological characteristics, and barriers to adherence. HIV viral load, a health outcome measure of virus amount present in blood, was also obtained. The sample was 36% African American and 56% Caucasian, with 35% reporting disability. Nearly one third of patients had missed medication doses in the past 5 days, and 18% had missed doses weekly over the past 3 months. Frequency of missed doses was strongly related to detectable HIV viral loads. Depression, side-effect severity, self-efficacy, and social support distinguished patients with good and poor adherence. Barriers also varied with adherence level. Implications for interventions promoting HIV treatment adherence are discussed.

Socioeconomic status, resources, psychological experiences, and emotional responses: a test of the reserve capacity model.

The current study used ecological momentary assessment to test several tenets of the reserve capacity model (L.C. Gallo & K. A. Matthews, 2003). Women (N = 108) with varying socioeconomic status (SES) monitored positive and negative psychosocial experiences and emotions across 2 days. Measures of intrapsychic and social resources were aggregated to represent the reserve capacity available to manage stress. Lower SES was associated with less perceived control and positive affect and more social strain. Control and strain contributed to the association between SES and positive affect. Lower SES elicited greater positive but not negative emotional reactivity to psychosocial experiences. Women with low SES had fewer resources relative to those with higher SES, and resources contributed to the association between SES and daily experiences.

Feeling Superior but Threatened: The Relation of Narcissism to Social Comparison

The relationship of narcissism to naturalistic social comparison was examined in a daily diary study. Of the participants, 98 reported the social comparisons that they encountered and noticed in their everyday lives over a 3-day period. Participants reported experiencing positive affect from downward comparisons and negative affect from upward comparisons. These relationships were moderated by narcissistic personality traits, such that individuals high in narcissistic traits tended to experience more extreme affective responses to social comparison than did individuals low in narcissistic personality traits. Individuals with higher narcissism scores on the Narcissistic Personality Inventory (NPI; Raskin & Hall, 1979) experienced increased positive affect from downward comparison and increased hostility from upward comparison; individuals with higher scores on the exploitiveness or entitlement subscale of the NPI experienced bolstered positive affect and self-esteem from downward comparison. These findings suggest that narcissists extreme mood variability and reactivity, which have been observed in previous research, can be partially accounted for by their sensitivity to social comparison information.

Factors influencing physicians' judgments of adherence and treatment decisions for patients with HIV disease.

New medications for HIV reduce mortality and morbidity but require strict adherence. Thus, physicians treating HIV-positive patients must weigh both disease severity and likelihood of adherence when deciding whether to start patients on treatment. A national sample of 495 physicians surveyed via mail responded to clinical scenarios depicting HIV-positive patients and indicated whether they would start patients on medication (response rate = 53%). Scenarios varied on the patient characteristics of gender, disease severity, ethnicity, and risk group. Physicians predicted that patients with less severe disease, former injection drug users, and African American men would be less likely to adhere. Perceived adherence and disease severity influenced treatment decisions. Results are discussed in the context of attitudes about minority groups and injection drug users, which may influence adherence judgments in practice settings. Psychological research to identify better methods of predicting medication adherence may serve to inform medical decision making.

Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment

Summary: To examine influences of medical factors (e.g., viral load) and nonmedical factors (e.g., patient characteristics) on treatment decisions for highly active antiret‐roviral therapy (HAART), we sent a survey to a random sample of 995 infectious disease physicians who treat patients with HIV/AIDS in the United States in August, 1998. The response rate was 53%. Respondents were asked to report their current practices with respect to antiretroviral treatment and the extent to which each of three medical and 17 nonmedical factors would influence them for or against prescribing HAART to a hypothetical HIV‐positive patient. Most reported initiating HAART with findings of low CD4+ cell counts and high viral loads, and weighing CD4+ cell counts, viral load, and opportunistic infection heavily in their decisions to prescribe HAART. Patients prior history of poor adherence was weighed very much against initiating HAART. Patient homelessness, heavy alcohol use, injection drug use, and prior psychiatric hospitalization were cited by most physicians as weighing against HAART initiation. Thus, most physicians in this sample follow guidelines for the use of HAART, and nonmedical factors related to patients life situations are weighed as heavily as disease severity in treatment decisions. As HIV increasingly becomes a disease associated with economic disadvantage and other social health problems, it will be essential to develop interventions and care support systems to enable patients experiencing these problems to benefit from HIV treatment advances.

Is it “Sex”?: College students' interpretations of sexual behavior terminology

Little is known regarding how respondents interpret terms that are commonly used in sexual behavior surveys. The present study assessed the impact of four factors on respondents’ judgments of whether the hypothetical actors “Jim” and “Susie “ would consider a particular behavior that they had engaged in to be “sex.” The four factors were respondents gender, actors gender, type of act (vaginal, anal, or oral intercourse), and who achieved orgasm (neither, Jim only, Susie only, or both). Two hundred twenty‐three undergraduates (22.2 ± 2.2 years; 65% female) were asked to read 16 scenarios featuring Jim and Susie and to judge whether each actor would consider the described behavior to be sex. Results indicated that vaginal and anal intercourse were considered sex under most circumstances. Whether oral intercourse was labeled as sex depended on the gender and viewpoint of the actor, and whether orgasm occurred. Findings suggest that items in sexual behavior surveys need to be clearly delineated to avoid subjective interpretations by respondents.

Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals.

Previous research has reported rates of posttraumatic stress disorder (PTSD) following diagnosis with a life-threatening disease ranging from 5 to 42%. However, few studies have examined the impact of PTSD symptoms on disease markers or adherence to medical regimens. The present study represents an initial examination of the relationships among self-reported PTSD symptoms stemming from diagnosis with HIV, CD4 cell counts, salivary cortisol levels and adherence to highly active antiretroviral therapy (HAART) in 110 African-American and Caucasian individuals with HIV. Results revealed that the relationship between PTSD and disease progression is multifaceted: PTSD symptoms were related to worse adherence to HAART therapy, but were also associated with lower morning salivary cortisol levels and higher CD4 cell counts.Previous research has reported rates of posttraumatic stress disorder (PTSD) following diagnosis with a life-threatening disease ranging from 5 to 42%. However, few studies have examined the impact of PTSD symptoms on disease markers or adherence to medical regimens. The present study represents an initial examination of the relationships among self-reported PTSD symptoms stemming from diagnosis with HIV, CD4 cell counts, salivary cortisol levels and adherence to highly active antiretroviral therapy (HAART) in 110 African-American and Caucasian individuals with HIV. Results revealed that the relationship between PTSD and disease progression is multifaceted: PTSD symptoms were related to worse adherence to HAART therapy, but were also associated with lower morning salivary cortisol levels and higher CD4 cell counts.

Association of stereotypes about physicians to health care satisfaction, help-seeking behavior, and adherence to treatment.

The present research consists of three studies examining the role of patients stereotypes about health care providers in the health care decision process. Study 1 examined the association of stereotypes to health care satisfaction and help-seeking behavior among a low-income clinic sample; Study 2 examined the relationship of stereotypes to satisfaction and adherence to treatment among low-income individuals living with HIV; and Study 3 examined the association of stereotypes to satisfaction and help-seeking among a sample of homeless individuals. Overall findings indicate that individuals who held more negative stereotypes about physicians sought care less often when sick, were less satisfied with the care that they did obtain, and were less likely to adhere to physician recommendations for treatment. Moreover, African Americans, but not Whites, with more positive stereotypes reported better adherence in Study 2 and were more satisfied with their health care in Study 3. Our findings point to the need to better understand the role of patients beliefs about health care in predicting health care satisfaction and health behaviors.

Psychosocial Issues in the Era of New AIDS Treatments from the Perspective of Persons Living with HIV

In the past, HIV disease meant an almost invariably downward health course. New highly active antiretroviral therapy (HAART) regimens have improved the health outlook for many persons living with HIV/AIDS but may create new psychological and coping challenges. In this study, open-ended, in-depth interviews were undertaken with an ethnically diverse sample of 44 purposively selected men and women with HIV disease who were on HAART regimens. The interviews were transcribed and qualitatively coded to identify major themes. While patients responding well to the regimens held optimistic views for their future, some who continued to have detectable viral load exhibited depression and feelings of hopelessness. Many patients reported stress associated with the demands of adhering to complex HAART regimens. Other common themes emerging in the interviews involved concerns about employment, romantic and non-romantic relationship formation, sexual behavior and serostatus disclosure, whether to plan families, and experiences of AIDS-related discrimination. There continue to be critical roles for psychological services in the care of persons living with HIV.

Development of new group members' in-group and out-group stereotypes: changes in perceived group variability and ethnocentrism.

Changes in new members in-group and out-group stereotypes were examined, distinguishing among three stereotype components: stereotypicality, dispersion, and ethnocentrism. Pledges in 4 sororities judged their in-group and out-groups 4 times during their 8-month induction. Overall, out-groups were judged more stereotypically than in-groups at every wave. Although out-groups were initially perceived as more dispersed than in-groups, decreased out-group dispersion resulted in a shift toward out-group homogeneity. Ethnocentrism was present at every wave but decreased because of decreased in-group positivity. The authors discuss implications of these results for existing explanations of stereotype development. It is suggested that other aspects of group socialization (R.L. Moreland & J.M. Levine, 1982) are needed to explain fully the development of intergroup perceptions for new group members.