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

Phillips JC, Webel A, Rose CD, Corless IB, Sullivan KM, Voss J, Wantland D, Nokes K, Brion J, Chen WT, Iipinge S, Eller LS, Tyer-Viola L, Rivero-Méndez M, Nicholas PK, Johnson MO, Maryland M, Kemppainen J, Portillo CJ, Chaiphibalsarisdi P, Kirksey KM, Sefcik E, Reid P, Cuca Y, Huang E, Holzemer WL - BMC Public Health (2013)

Bottom Line: 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.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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Health Sciences, University of Ottawa School of Nursing, 451 chemin Smyth Road, Ottawa, ON K1H 8M5, Canada. craig.phillips@uottawa.ca

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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The ecosocial context of HIV-related criminal laws, social capital, and HIV antiretroviral adherence in North America.
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Figure 1: The ecosocial context of HIV-related criminal laws, social capital, and HIV antiretroviral adherence in North America.

Mentions: Ecosocial theory [6] and social epidemiology methods were used to better understand the relationships between the criminalization of HIV at the structural level, individuals’ perceived social capital, and the health promoting behavior of HIV antiretroviral adherence among PLWH (Figure 1). Ecosocial theory equally values all stakeholder (e.g., PLWH, social network members, health care providers, public health and other government officials) perspectives and advocates for studying the influences of structural level policies (e.g., criminalization of HIV), both codified and enacted, across all levels of the ecosocial environment (e.g., individual, interpersonal, social and structural levels) and is mindful of the simultaneous and reciprocal effects across those levels [6,54]. Additionally, ecosocial theory is interested in exploring the pathways and power dynamics that contribute to health outcomes. The core constructs of ecosocial theory are embodiment; pathways of embodiment; cumulative interplay of exposure, susceptibility and resistance; and accountability and agency. Ecosocial theory seeks to integrate social and biological reasoning with a dynamic, historical and ecological perspective to understand population health phenomena [5-8,55]. It is compatible with the structural level concepts of health as a human right and the social determinants of health that influence health outcomes for all members of society, including PLWH [1,3,43,56]. Furthermore, ecosocial theory provides a mechanism for better understanding the intrinsic relationships that shape population health [5-8]. Krieger [7] described four intrinsic relationships to characterize populations: genealogical (relationships based on biological descent), internal and economical (relationships essential to daily activities to maintain life), external and ecological (relationships between populations and the environs they coinhabit), and teleological (conscious purpose–spanning from mutual benefit to exploitation) [7]. Social capital is shaped by genealogical relationships and encompasses internal and economical and external and ecological relationships. Building on these ecosocial theoretical foundations, we proposed that the structural process of criminalization of HIV exposure/transmission and individually perceived social capital influence ART adherence behaviors among PLWH. We considered HIV ART adherence over a 30 day period as a proxy measure for individual level health promotion engagement. This proxy measure is assumed to provide evidence of an individual’s ability to engage with the health care system (e.g., seek medical treatment), obtain necessary health care services (e.g., obtain clinic care and pharmacy services), and practice health promoting self-care behaviors (e.g., obtain prescriptions and take medications).


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

Phillips JC, Webel A, Rose CD, Corless IB, Sullivan KM, Voss J, Wantland D, Nokes K, Brion J, Chen WT, Iipinge S, Eller LS, Tyer-Viola L, Rivero-Méndez M, Nicholas PK, Johnson MO, Maryland M, Kemppainen J, Portillo CJ, Chaiphibalsarisdi P, Kirksey KM, Sefcik E, Reid P, Cuca Y, Huang E, Holzemer WL - BMC Public Health (2013)

The ecosocial context of HIV-related criminal laws, social capital, and HIV antiretroviral adherence in North America.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750916&req=5

Figure 1: The ecosocial context of HIV-related criminal laws, social capital, and HIV antiretroviral adherence in North America.
Mentions: Ecosocial theory [6] and social epidemiology methods were used to better understand the relationships between the criminalization of HIV at the structural level, individuals’ perceived social capital, and the health promoting behavior of HIV antiretroviral adherence among PLWH (Figure 1). Ecosocial theory equally values all stakeholder (e.g., PLWH, social network members, health care providers, public health and other government officials) perspectives and advocates for studying the influences of structural level policies (e.g., criminalization of HIV), both codified and enacted, across all levels of the ecosocial environment (e.g., individual, interpersonal, social and structural levels) and is mindful of the simultaneous and reciprocal effects across those levels [6,54]. Additionally, ecosocial theory is interested in exploring the pathways and power dynamics that contribute to health outcomes. The core constructs of ecosocial theory are embodiment; pathways of embodiment; cumulative interplay of exposure, susceptibility and resistance; and accountability and agency. Ecosocial theory seeks to integrate social and biological reasoning with a dynamic, historical and ecological perspective to understand population health phenomena [5-8,55]. It is compatible with the structural level concepts of health as a human right and the social determinants of health that influence health outcomes for all members of society, including PLWH [1,3,43,56]. Furthermore, ecosocial theory provides a mechanism for better understanding the intrinsic relationships that shape population health [5-8]. Krieger [7] described four intrinsic relationships to characterize populations: genealogical (relationships based on biological descent), internal and economical (relationships essential to daily activities to maintain life), external and ecological (relationships between populations and the environs they coinhabit), and teleological (conscious purpose–spanning from mutual benefit to exploitation) [7]. Social capital is shaped by genealogical relationships and encompasses internal and economical and external and ecological relationships. Building on these ecosocial theoretical foundations, we proposed that the structural process of criminalization of HIV exposure/transmission and individually perceived social capital influence ART adherence behaviors among PLWH. We considered HIV ART adherence over a 30 day period as a proxy measure for individual level health promotion engagement. This proxy measure is assumed to provide evidence of an individual’s ability to engage with the health care system (e.g., seek medical treatment), obtain necessary health care services (e.g., obtain clinic care and pharmacy services), and practice health promoting self-care behaviors (e.g., obtain prescriptions and take medications).

Bottom Line: 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.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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Faculty of Health Sciences, University of Ottawa School of Nursing, 451 chemin Smyth Road, Ottawa, ON K1H 8M5, Canada. craig.phillips@uottawa.ca

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.

Show MeSH
Related in: MedlinePlus