Relationship Power, Antiretroviral Adherence, and Physical and Mental Health Among Women Living with HIV in Rural Kenya

Springer Science and Business Media LLC - 2023
Ray E. Burger1, Craig R. Cohen2, A. Rain Mocello2, Shari L. Dworkin3, Edward A. Frongillo4, Elly Weke5, Lisa Butler6, Harsha Thirumurthy7, Elizabeth A. Bukusi5, Sheri D. Weiser8
1Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA
2Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
3School of Nursing and Health Studies, University of Washington, Bothell, USA
4Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, USA
5Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
6Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, USA
7Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
8Department of Medicine, University of California, San Francisco, USA

Tóm tắt

AbstractLittle is known about the association of gender-based power imbalances and health and health behaviors among women with HIV (WWH). We examined cross-sectional baseline data among WWH in a cluster-randomized control trial (NCT02815579) in rural Kenya. We assessed associations between the Sexual Relationship Power Scale (SRPS) and ART adherence, physical and mental health, adjusting for sociodemographic and social factors. SRPS consists of two subscales: relationship control (RC) and decision-making dominance. Women in the highest and middle tertiles for RC had a 7.49 point and 8.88 point greater Medical Outcomes Study-HIV mental health score, and a 0.27 and 0.29 lower odds of depression, respectively, compared to women in the lowest tertile. We did not find associations between SPRS or its subscales and ART adherence. Low sexual relationship power, specifically low RC, may be associated with poor mental health among WWH. Intervention studies aimed to improve RC among WWH should be studied to determine their effect on improving mental health.

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Tài liệu tham khảo

Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004;363(9419):1415–21.

Blanc AK. The effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Stud Fam Plan. 2001;32(3):189–213.

Closson K, Ndungu J, Beksinska M, Ogilvie G, Dietrich JJ, Gadermann A, Gibbs A, Nduna M, Smit J, Gray G, Kaida A. Gender, power, and health: measuring and assessing sexual relationship power equity among young sub-Saharan African women and men, a systematic review. Trauma Violence Abuse. 2020;23(3):920–37

Conroy AA, Tsai AC, Clark GM, Boum Y, Hatcher AM, Kawuma A, et al. Relationship power and sexual violence among HIV-positive women in rural Uganda. AIDS Behav. 2016;20(9):2045–53.

Pulerwitz J, Gortmaker SL, DeJong W. Measuring sexual relationship power in HIV/STD research. Sex Roles. 2000;42(7–8):637–60.

Pettifor AE, Measham DM, Rees HV, Padian NS. Sexual power and HIV risk, South Africa. Emerg Infect Dis. 2004;10(11):1996.

Siedner MJ, Tsai AC, Dworkin S, Mukiibi NF, Emenyonu NI, Hunt PW, et al. Sexual relationship power and malnutrition among HIV-positive women in rural Uganda. AIDS Behav. 2012;16(6):1542–8.

Weiser S, Tsai A, Senkugu J, Hatcher A, Emenyonu N, Kawuma A, et al. Sexual relationship power and intimate partner violence among HIV-infected women in rural Uganda. Rome: International AIDS Society; 2011.

Zembe YZTL, Thorson A, Silberschmidt M, Ekstrom AM. Intimate partner violence, relationship power inequity and the role of sexual and social risk factors in the production of violence among young women who have multiple sexual partners in a peri-urban setting in South Africa. PLoS ONE. 2015;10:e0139430.

Hatcher AM, Tsai AC, Kumbakumba E, Dworkin SL, Hunt PW, Martin JN, et al. Sexual relationship power and depression among HIV-infected women in rural Uganda. PLoS ONE. 2012;7(12):e49821.

Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.

Bangsberg DR, Hecht FM, Charlebois ED, Zolopa AR, Holodniy M, Sheiner L, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14(4):357–66.

Bangsberg DR, Perry S, Charlebois ED, Clark RA, Roberston M, Zolopa AR, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–3.

Conroy A, Leddy A, Johnson M, Ngubane T, van Rooyen H, Darbes L. ‘I told her this is your life’: relationship dynamics, partner support and adherence to antiretroviral therapy among South African couples. Cult Health Sex. 2017;19(11):1239–53.

Rogers AJ, Achiro L, Bukusi EA, Hatcher AM, Kwena Z, Musoke PL, et al. Couple interdependence impacts HIV-related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis. J Int AIDS Soc. 2016;19(1):21224.

Conroy AA, McKenna SA, Ruark A. Couple interdependence impacts alcohol use and adherence to antiretroviral therapy in Malawi. AIDS Behav. 2019;23(1):201–10.

Ketchen B, Armistead L, Cook S. HIV infection, stressful life events, and intimate relationship power: the moderating role of community resources for black South African women. Women Health. 2009;49(2–3):197–214.

McMahon JM, Volpe EM, Klostermann K, Trabold N, Xue Y. A systematic review of the psychometric properties of the Sexual Relationship Power Scale in HIV/AIDS research. Arch Sex Behav. 2015;44(2):267–94.

Giordano TP, Guzman D, Clark R, Charlebois ED, Bangsberg DR. Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale. HIV Clin Trials. 2004;5(2):74–9.

Oyugi JH, Byakika-Tusiime J, Charlebois ED, Kityo C, Mugerwa R, Mugyenyi P, et al. Multiple validated measures of adherence indicate high levels of adherence to generic HIV antiretroviral therapy in a resource-limited setting. JAIDS. 2004;36(5):1100–2.

Finitsis DJ, Pellowski JA, Huedo-Medina TB, Fox MC, Kalichman SC. Visual analogue scale (VAS) measurement of antiretroviral adherence in people living with HIV (PLWH): a meta-analysis. J Behav Med. 2016;39(6):1043–55.

Wu AW, Revicki D, Jacobson D, Malitz F. Evidence for reliability, validity and usefulness of the Medical Outcomes Study HIV Health Survey (MOS-HIV). Qual Life Res. 1997;6(6):481–93.

Stangl AL, Bunnell R, Wamai N, Masaba H, Mermin J. Measuring quality of life in rural Uganda: reliability and validity of summary scores from the medical outcomes study HIV health survey (MOS-HIV). Qual Life Res. 2012;21(9):1655–63.

Mast CT, Kigozi G, Wabwire-Mangen F, Black R, Sewankambo N, Serwadda D, et al. Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care. 2004;16(1):81–94.

Bolton P, Wilk CM, Ndogoni L. Assessment of depression prevalence in rural Uganda using symptom and function criteria. Soc Psychiatry Psychiatr Epidemiol. 2004;39(6):442–7.

Derogatis, L. R. et al. The Hopkins Symptom Checklist (HSCL): A measure of primary symptom dimensions. In P. Pichot & R. Olivier-Martin (Eds.), Psychological measurements in psychopharmacology. 1974 .

Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208–17.

Weiser SD, Bukusi EA, Steinfeld RL, Frongillo EA, Weke E, Dworkin SL, et al. Shamba Maisha: randomized controlled trial of an agricultural and finance intervention to improve HIV health outcomes. AIDS. 2015;29(14):1889–94.

Cohen CR, Steinfeld RL, Weke E, Bukusi EA, Hatcher AM, Shiboski S, et al. Shamba Maisha: pilot agricultural intervention for food security and HIV health outcomes in Kenya: design, methods, baseline results and process evaluation of a cluster-randomized controlled trial. SpringerPlus. 2015;4:122.

Harding R, Simms V, Penfold S, Downing J, Namisango E, Powell RA, et al. Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study. BMC Infect Dis. 2014;14(1):613.

Gandhi M, Ameli N, Bacchetti P, Anastos K, Gange SJ, Minkoff H, et al. Atazanavir concentration in hair is the strongest predictor of outcomes on antiretroviral therapy. Clin Infect Dis. 2011;52(10):1267–75.

Lu T, Kwena Z, Zwicker L, Bukusi E, Maura-Muira E, Dworkin S. Securing women’s property rights in the era of HIV/AIDS: barriers and facilitators of implementing a community-led structural intervention in Western Kenya. AIDS Educ Prev. 2013;25:151–63.

Dworkin SL, Treves-Kagan S, Lippman SA. Gender-transformative interventions to reduce HIV risks and violence with heterosexually-active men: a review of the global evidence. AIDS Behav. 2013;17(9):2845–63.

Dworkin SL, Fleming PJ, Colvin CJ. The promises and limitations of gender-transformative health programming with men: critical reflections from the field. Cult Health Sex. 2015;17(sup2):128–43.

Turan JM, Darbes LA, Musoke PL, Kwena Z, Rogers AJ, Hatcher AM, et al. Development and piloting of a home-based couples intervention during pregnancy and postpartum in Southwestern Kenya. AIDS Patient Care STDs. 2018;32(3):92–103.

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