Adherence in the medical management of HIV/AIDS: Stress and coping

Advancements in research and treatment, such as the introduction of highly active antiretroviral therapy (HAART), have helped to significantly decrease the number of deaths as well as improve the quality of life of those infected by HIV or AIDS. To be effective, HAART requires strict adherence to complex regimens to manage HIV/AIDS. We investigated the association of medical adherence to perceived stress, maladaptive coping behaviors, and medical variables in a sample of HIV+ adults. We hypothesized that higher stress and greater use of maladaptive coping behaviors lead to lower adherence. Using data from 205 participants (103 males, 102 females; 50% African-Americans, 34% Euro-Americans, 13% Hispanic-Americans, and 3% others) we tested a model using hierarchical regression analysis in three blocks (medical adherence serves as the dependent variable). The first two blocks were demographic and medical variables, respectively entered stepwise. In a third block we simultaneously entered perceived stress and five maladaptive coping strategies (self-distraction, denial, substance use, behavioral disengagement, and venting). Although lacking significance on its own, maladaptive coping behaviors had a significant effect on medical adherence when mediated by perceived stress. Maladaptive coping and perceived stress as a mediator, with general HIV symptoms present and number of HIV-related diseases contracted, explained 23% of variance in medical adherence (adjusted R2=0.231, F=6.833, p<.001). To help enhance client adherence to HIV medication, we should consider implementing stress management programs for them, and discouraging their use of maladaptive behaviors, such as denial and substance use, as coping strategies.