Psychological barriers keep women from seeking care

Congressional briefing focuses on support for women with HIV.

By Lisa Rabasca
Monitor staff

Though the percentage of women infected by HIV has more than doubled in the last decade, psychological barriers are keeping them from seeking treatment, experts say. In fact, at a recent congressional briefing, a group of concerned professionals who deal with AIDS urged that clinics should offer psychological help for women to overcome barriers such as low self-esteem, economic dependency and domestic violence. The June briefing was sponsored by the Policy Action Network for Women Living with HIV/AIDS (PANWHA).

One of the reasons more women are infected with HIV is the rate of heterosexual transmission has more than tripled in the last 10 years, according to Barbara Aranda-Naranjo, PhD, RN, an associate professor of nursing in San Antonio. The sharpest increase in AIDS cases is in communities of color, which represented slightly more than half of the new cases diagnosed in 1997 compared about a quarter in 1988. Nearly 8 in 10 U.S. women diagnosed with AIDS are African-American or Hispanic.

Today, AIDS is the leading cause of death in America for women ages 20 to 29 and the second leading cause of death for African-American women ages 10 to 19. However, the number of women receiving treatment has not kept pace with the rate of infection. Poor women, particularly women of color, are often denied drug therapies for HIV because doctors believe their drug addiction or their responsibility as a single parent will prevent them from taking their medication as prescribed, said Lori Valencia Greene, co-chair of the PANWHA and acting director of the public interest component of APA?s Public Policy Office. Panelists said that practitioners should provide women critical psychological support to help them comply with HIV treatment.

Child?s diagnosis is key

A majority of women with HIV find out about their virus when their child is diagnosed with HIV, said Aranda-Naranjo, who teaches at the University of the Incarnate Word. Many women living with HIV will often provide for their children while neglecting their own health. Anna Wyman, a family advocate with the University of Miami, said she was diagnosed with HIV when her son was hospitalized for pneumonia.

'No one ever told me about HIV even though I lived in a high-risk neighborhood that had poverty, crime and drugs,' she said. 'To me, HIV was a white homosexual disease.' Wyman said she did not seek treatment for HIV until four years ago because, as a single parent, it was difficult to take time off from work to visit a doctor.

Many women do not disclose that they have HIV for fear of domestic violence, Wyman said. A partner may forbid a woman from getting treatment because he does not want anyone to know the family?s HIV status. Similarly, it is not uncommon for a man who does not want to seek out his own HIV treatment to steal medication from his spouse or partner.

Unfortunately, said the panelists, these factors feed the stereotype that low-income women, particularly women who are single parents or substance abusers, are less likely to adhere to medicine regimens. Practitioners are often reluctant to provide drug therapy to anyone they believe will not take the medicine, because HIV can mutate and develop drug-resistant strains, said Andrea Barthwell, MD, president of Encounter Medical Group in Oak Park, Ill.

Treatment that discriminates

But making assumptions based on external characteristics can lead to discrimination, Barthwell said. It is the practitioner?s responsibility to understand a patient?s belief system and deliver accurate information to positively influence those beliefs.

Medical research reveals that whether treatment is for a chronic condition such as diabetes, or a short-term illness such as the flu, most patients do not follow the drug regimen prescribed by their doctors, Barthwell said. These results show that a patient?s ability to comply with treatment is not tied to external factors such as substance abuse, poverty or single parenthood.

According to Barthwell, research estimates that 20 percent to 40 percent of all patients do not comply with treatment for a short-term, acute disease. And the longer the patient needs to take medicine, the higher the likelihood the patient will not follow the drug regime.

Half of all patients do not follow the prescribed treatment for symptomatic chronic diseases such as diabetes, and almost eight in 10 patients will not follow the prescribed regimen for long-term asymptomatic diseases such as hypertension. Although it will slow down their recovery, individuals taking medication perform their own risk-benefit analysis, taking into account the effectiveness of the medication, the side effects and the difficulty of the regime.

For example, if a woman is experiencing side effects that make it difficult for her to take care of her children, she will lower or eliminate her dosage. In response, practitioners can provide support to help woman comply with their treatment by providing clear instructions, pill containers and calendars, Barthwell said.

Counseling, support groups and home visits also can provide assistance to help women take their medicine.