HIV treatment optimism and its predictors among young adults in southern Malawi

Abstract

This study measures HIV treatment optimism and its predictors in a representative sample of young adults in southern Malawi. In 2010, 1275 women and 470 men between the ages of 16 and 26 were asked about their exposure to people on antiretroviral therapy (ART), sexual risk behavior, HIV status, and beliefs about ART. We used confirmatory factor analysis to develop a 4-item scale of the belief that HIV is a less serious health threat due to ART (reduced-severity optimism) and used a single measure to capture belief in the reduced infectivity of HIV due to ART (reduced-susceptibility optimism). Overall, respondents reported low levels of HIV treatment optimism. Being female and using ART were the largest predictors of both types of treatment optimism. We found a nonlinear relationship between exposure to people on ART and reduced-severity optimism. People who knew someone on ART but did not discuss it with them had lower levels of reduced-severity optimism than people who did not know anyone on ART and people who regularly discussed treatment with someone on ART. In multivariate regression models, HIV treatment optimism was positively associated with all measures of sexual risk behavior among men, but negatively associated with unprotected sex with a nonprimary partner among women. Our findings suggest that the spread of ART in Malawi has not led to widespread HIV treatment optimism. This may reflect the relatively recent spread of ART, the generalized nature of the HIV epidemic, or the fact that access to ART is complicated by structural limitations that delay treatment and limited availability of second-line medicines.

Keywords:

• HIV treatment optimism
• antiretroviral therapy
• sub-Saharan Africa
• Malawi
• sexual disinhibition

Acknowledgements

Data collection and some of the authors' time were funded by two grants from the National Institutes of Child Health and Human Development, R01-HD058366 and R03-HD067099. The authors are indebted to Elizabeth Morningstar, Jenny Trinitapoli, Abdallah Chilungo, and Sydney Lungu for assistance in developing the treatment optimism module.

Notes

1. Tsogolo la Thanzi is a research project designed by Jenny Trinitapoli and Sara Yeatman and funded by grant (R01-HD058366) from the National Institute of Child Health and Human Development. See: http://projects.pop.psu.edu/tlt.

2. We refer to antiretroviral therapy as ART in accordance with the scholarly literature. In Malawi, however, people refer to “ARVs” or “new tablets.” The survey questions reflect these local terms.

3. The excluded statements were: “I am less worried about getting HIV now that treatments have improved,” “If I had HIV, I could live a long and healthy life,” and “ARVs make it difficult to tell/know who has HIV and who doesn't.”

4. Women's models include controls for HIV status and ART but these did not alter the relationship between optimistic beliefs and sexual behavior.