Why HIV patients might neglect treatment

By Kate Smith, CLAS ’12

Even though most HIV patients have access to recommended treatment for their illness, only about 60 percent take advantage of it. Laramie Smith, a fifth-year doctoral student in social psychology in CLAS studies why this happens.

Smith presented her research to the UConn Board of Trustees at its September 28 meeting. Her adviser is Jeffrey Fisher, Board of Trustees Distinguished Professor of Psychology.

“I’d often find myself returning to a similar question,” says Smith. “‘What is it about an individual, their situation, of different health behaviors per se, that will cause a person to either seek health-related services in the face of multiple challenges or not utilize services that are readily available?’

“For example, why would a youth who has been homeless for the past two years not visit the dental van parked right outside the youth drop-in center, which is providing free dental care to the center’s clients, when a diabetic, chronically homeless older man who averages at least two fifths of straight vodka each day obsessively checks his blood sugar levels?”

Though treatment for HIV-infected patients is typically recommended to be between every three and six months, Smith estimates that nearly 40 percent of people who know they have HIV do not abide by these guidelines.

According to Smith, these routine visits are essential in maintaining the health of infected patients because HIV can often be coupled with other medical and even social issues such as diabetes, liver problems, depression and substance abuse. In addition to monitoring these co-occurring problems, the visits are also critical in preventing the further degradation of the immune system and preventing the onset of AIDS.

The risk of non-treatment

“Retention in HIV care is critical for monitoring and maintaining the life-enhancing effects of HIV medications,” says Smith. “These medications can really help improve patients’ health functioning and quality of life. By improving the health of people living with HIV and reducing the amount of virus in the body, we are reducing the chance that they might transmit the virus to other people.”

Failure to maintain HIV treatment can have potentially fatal results, says Smith. When medication is delivered sporadically and not on the recommended schedule, the HIV virus can mutate into a new strain that becomes resistant to medication, making AIDS an inevitable reality for patients. However, patients who maintain visits at the suggested intervals greatly reduce this risk.

Even with these dire outcomes, many patients do not take advantage of treatment available to them. Barriers include patients’ doubtful attitudes toward the success of the treatment, having other competing family and life commitments, and even not wanting to admit their infection.

A graduate career

Smith was the recipient of a $33,000 National Research Service Pre-Doctoral Fellowship Award (NRSA) from the National Institute of Mental Health earlier this year. This award, along with other smaller grants along the way, allowed Smith to fund her master’s and dissertation work.

Smith spends much of her time in Bronx, N.Y. where she works with HIV-infected patients who struggle to maintain routine medical care for their condition.

Smith has developed and piloted a questionnaire for patients to test a theoretical model of retention in HIV care. By the end of her study she will have interviewed 100 patients.

She also plans to implement and evaluate a brief intervention aimed at helping HIV positive patients who have had problems maintaining routine HIV care.

Smith began her research in the HIV/AIDS field while working at the Seattle-King County Public Heath program and later working as a research assistant at the University of Washington in Seattle. These opportunities piqued her interest in the HIV field and prompted her to pursue a graduate degree at UConn in psychology.

Social psychology at UConn has been rated the best program in the country. UConn’s Center for Health Intervention and Prevention, headed by her adviser, is internationally known for research in HIV and disease prevention research.

Smith says she was honored and a bit flustered by presenting to the trustees.

“It was actually very validating, and slightly intimidating, to be asked to do this presentation.”

“I felt like my lips were stuck to my teeth,” Smith said with a laugh. “But I really think it went great!”

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