The Evolution of HIV illness representation among marginally housed persons

Abstract

Many HIV-infected marginally housed individuals have difficulty engaging in health care. To investigate HIV health-related behaviour, 14 in-depth interviews with marginally housed HIV-infected individuals were conducted and analysed utilizing standard qualitative methodologies. The analysis was based on the Illness Representation Model, which describes five conceptual dimensions of illness: identification; cause; timeline; management; and consequences. A theoretical model of illness representation at two distinct time points emerged and included the two categories: ‘didn't suspect and didn't believe it’ and ‘knew but needed proof’. In this study illness representation categories were found to evolve and change over time, and were associated with engagement in HIV care. This study may help guide programmes that focus on enhancing health-promoting behaviour and improving engagement in health care among marginally housed individuals.

Acknowledgments

This study was supported by the Health Resources and Services Administration, HIV/AIDS Bureau, Special Projects of National Significance, Grant #H97 HA 00247-01, and the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center funded by the National Institutes of Health (NIH AI-51519). Dr. Cunningham is supported by the Robert Wood Johnson Foundation's Harold Amos Medical Faculty Development Program. Results of this study were presented in part at the Society of General Internal Medicine Annual Conference in April 2006, Los Angeles, CA.