July 6, 2009
Effects of Race and Ethnicity on HIV Medication Adherence
Hispanic and black men with HIV were more likely than white men to miss doses of their HIV medication, according to a study published online in The Journal of Acquired Immune Deficiency Syndromes (JAIDS). The JAIDS study also revealed that Hispanic and black men of Central and South American or Caribbean descent were more likely than those with European family ties to have problems with adherence.
A number of HIV studies have found differences in adherence rates to antiretroviral (ARV) therapy by race and ethnicity. Few studies, however, have focused on differences in adherence among men who have sex with men (MSM) or people from differing geographic backgrounds.
To determine the effects of race and geographic background on adherence rates among MSM, Debra Lee Oh, MSc, from the University of California in Los Angeles, and her colleagues analyzed surveys from 1,102 men enrolled in the Multicenter AIDS Cohort Study (MACS). The men were followed between April 2002 and October 2006. Fifty-eight percent of the men were white, 26 percent were black, and 14 percent were Hispanic. Significantly more men of color had incomes of less than $10,000 per year, compared with white study subjects.
After controlling for factors such as age, financial difficulties and drug use, race was a significant predictor of poorer adherence. Oh’s team found that Hispanic men were roughly two times as likely to have adherence problems as white men. Black men were about 1.5 times more likely to miss doses as white men. For white and Hispanic men, younger age and higher viral loads were associated with poorer adherence. For black men, it was skin rash, higher ARV costs, financial difficulties and crack cocaine use.
Geographic origin also affected adherence. Forty-five percent of Hispanic men with European roots—from Spain, for example— reported high adherence levels, compared with 27 percent of Central and South American men and 22 percent of Caribbean men. Adherence rates in black men were also significantly affected by family origin. Higher adherence was reported by 37 percent of black men who had European roots, while only 28 percent of those of African descent and 13 percent of those of Caribbean descent reported high adherence.
Oh and her colleagues point to the large sample size and the long follow-up period as potential strengths of the study. They acknowledge, however, that the study results may have been negatively influenced by the fact that participants self-reported race and geographic background. They also state that because participants showed high rates of personal motivation to remain in the MACS, they may be more likely to adhere to HIV treatment than men not enrolled in a study. Oh’s team recommends that future adherence studies look at ethnicity as well as race.
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