“I'm just like everyone else, I just happen to be HIV positive”: The factors that contribute to medication adherence and risk behaviors among young HIV positive African American Women

Background: High levels of non-adherence to antiretroviral (ART) therapy persist despite ART's ability to extend a young person's life expectancy 40 years beyond medication initiation. This non-adherence is compounded by the fact that drug use and risky sexual behaviors typically occur during youth. Furthermore, compared to their HIV negative counterparts, behaviorally and perinatally infected adolescents and young adults have higher rates of cognitive impairments and mental health issues.

Purpose: This qualitative study illuminates unique factors that influence medication adherence and risky behavior among young, HIV + African American women.

Methods: Twenty semi-structured in-depth interviews were conducted with HIV+ young women (mean age =28.8, 95% African American, 50% on ART) receiving HIV care in an urban clinic. A thematic analysis of interviews was conducted independently by two study team members before reaching consensus on emergent themes.

Results: Participants experienced various tensions in their life causing them to oscillate along a continuum of medication adherence and risk taking behaviors. Factors influencing this oscillation were organized into the following themes: 1.Mental health issues (depression, anxiety, past trauma due to abuse), 2. Stigma (leading to selective/lack of disclosure, sexual/social isolation), 3. Coping mechanisms (positive reappraisal and cognitive avoidance) and 5. Future aspirations (desire to have a child, desire for independence).

Conclusion: Understanding the unique factors that cause young people to oscillate along the continuum of adherence and risk taking behavior allows us to implement strategies that can be used to move youth towards consistent medication adherence and safe behaviors.