Symposia
Health Psychology / Behavioral Medicine - Adult
Noelle A. Mendez, M.S.
Graduate Student
University of Miami
Miami, Florida
Noelle A. Mendez, M.S.
Graduate Student
University of Miami
Miami, Florida
Molly Ream, M.S.
Graduate Student
University of Miami
Miami, Florida
Lacey Craker, MPH
Graduate Student
University of Miami
Miami, Florida
Jahn Jaramillo, MPH
Graduate Student
University of Miami
Miami, Florida
Audrey Harkness, Ph.D.
Research Assistant Professor
University of Miami
Miami, Florida
Sara St. George, Ph.D.
Assistant Professor
University of Miami
Miami, Florida
Steven A. Safren, Ph.D., ABPP
Professor of Psychology
University of Miami
University of Miami, Florida
Introduction: Miami-Dade County, Florida is the epicenter of the U.S. HIV epidemic. As of 2019, only 59% of individuals living with HIV had achieved viral suppression. Novel approaches to address modifiable factors associated with adherence, such as emotions and cognitions, are needed to improve adherence to antiretroviral therapy (ART) and viral suppression outcomes among priority populations experiencing syndemic effects. The purpose of this qualitative study is to describe emotional and cognitive reactions to ART and motivations related to HIV medication adherence among individuals living with HIV who were participating in a cognitive behavioral therapy (CBT) and adherence trial.
Methods: The sample consisted of 29 people with HIV who had a detectable viral load ( >20 copies/mL). The initial counseling session of the parent trial included having participants hold their ART pills in their hand and verbalize their immediate thoughts and feelings. Participants were prompted to elaborate on how their reactions might impact their behaviors or willingness to take their ART. This session was audio-recorded and transcribed. All 29 transcripts were reviewed. Using maximum variation sampling based on age, gender, and diverse lived experiences related to HIV, eight transcripts were chosen and analyzed in detail using thematic analysis.
Results: Two major themes and 5 subthemes emerged. Major themes included (1) distressing emotions arise in response to ART, with subthemes consisting of (1a) frustration and anger and (1b) sadness and shame; and (2) negative thoughts are triggered by medication, with subthemes of (2a) trauma-related memories get resurfaced, (2b) ART bottle symbolizes more than medication, and (2c) disbelief in the function of the medications.
Conclusions: Adherence interventions should include eliciting patient’s medication beliefs, cognitions, and emotions that they may have about their HIV medication. Using a trauma-informed approach, clinicians can work with the client to reframe their views of their medication to make adherence a more manageable behavior. This might be particularly important for those with other co-occurring psychosocial and structural barriers that can all contribute to a lack of health behaviors.