A population-based study of BC residents living with HIV finds that more woman than men aren’t successfully adhering to their drug therapy programs.
The study followed over 4,500 people infected with HIV over a 14 year period and found that while 77 per cent of HIV-infected men were successfully keeping to their treatment regimens, only 57 per cent of HIV-infected women were doing so successfully, a result which researchers see as evidence that more support structures are needed for women within the HIV/AIDS community.
HIV treatment has come a long way over the past 30 years, to the point now where today’s antiretroviral drugs can give a person with HIV a strong chance of never developing full-blown AIDS. But while antiretroviral therapy has been proven to reduce the risk of life-threatening HIV-related infections, it’s also known that strict adherence to the therapy is required for the benefits to manifest, meaning that a stoppage in medication can cause treatment failure – hence the importance of sticking to treatment plans and taking medications daily.
The new study led by researchers at Simon Fraser University and the BC Centre for Excellence in HIV/AIDS in Vancouver shines a light on a troubling feature of today’s HIV communities: the gender gap.
“The past decade has seen a global increase in the prevalence of HIV among women,” say the study’s authors. ”In North America and in other resource rich settings, the same gender and structural inequities that result in vulnerability to HIV infection among women may result in increased vulnerabilities to poor HIV-related health outcomes among women living with HIV.”
The authors point out that in comparison to men living with HIV, women are less frequent users of primary care services and more frequent users of emergency departments, they have a lower quality of initial HIV care and overall an increased risk of death.
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The study followed 4,534 HIV-positive individuals in BC – of whom 904 or 19.9 per cent were women – enrolled in the HAART Observation Medical Evaluation and Research (HOMER) program, a free-of-charge therapy program using a highly active form of antiretroviral therapy. Researchers tracked participants’ adherence to combination antiretroviral therapy (cART), estimated by the participant’s prescription refill dates, over an average span of five and a half years and found that women were less likely than men to optimally follow through on their cART program, at a rate of 57.0 per cent for women versus 77.1 per cent for men.
The study also looked at adherence rates among two other cohorts, those who injected drugs and those of Indigenous ancestry, finding that both factors also negatively impacted rates of adherence. Researchers found, for example, that among HIV-infected people of Indigenous ancestry who injected drugs, optimal adherence rates were only 47.8 per cent for women and 57.7 per cent for men.
“Although both Indigenous ancestry and history of injection drug use have previously been found to impact adherence,” the authors say, “our study shows that sex maintains a significant and independent effect on adherence.”
Why are women less apt to adhere to treatment plans? The researchers point to a few likely contributing factors. Physiologically, women are known to experience more adverse drug-related events and symptoms than men, which may affect adherence. As well, differences exist between the social support networks for men and women faced with HIV, and the social stigma of living with HIV is known to affect women differently than men, all factors which can impact adherence.
The researchers want to see more public health emphasis placed on women’s needs within the HIV community, saying that it’s “simply not enough to develop group-specific interventions without considering sex,” they say. “Acknowledging women’s care needs, specific barriers to entry and retention into care and adherence to therapy require more attention, both within research and in program implementation.”
The new study is published in the journal AIDS.
