CASE
STUDY ABSTRACT, OBJECTIVES & DESIGN
CASE
The Center for Adherence Support Evaluation
at the New York Academy of Medicine
Impact of September 11th events and their aftermath among people with HIV/AIDS on antiretroviral therapy
Learning Objectives: Determine the degree
to which the September 11th attacks and their aftermath have affected
adherence to antiretroviral therapy and HIV risk behavior among people
with HIV/AIDS. Identify the determinants of terrorism-related adverse
effects on adherence and HIV risk behavior. Develop programmatic recommendations
to assist clients who may be at risk for terrorism-related adverse effects
on adherence and HIV risk behavior.
Submitter Email: rfinkelstein@nyam.org
Statement of Purpose: The September 11th
terrorist attacks in New York City (NYC) and Washington, DC induced heightened
fear and anxiety throughout the country, but especially in cities that
sustained direct attacks. Responses in the general population -- disrupted
sleep, increased PTSD, increased drug and alcohol use, increased anxiety
and depression -- are all factors known to correlate with adherence burden
in HIV. Little is known about the ways in which these attacks have affected
adherence to HIV antiretroviral therapy (ART) and HIV risk behavior among
people living with HIV/AIDS. We added a qualitative and quantitative component
to our ongoing cross-site evaluation of HIV adherence support interventions
in 14 U.S. sites funded by HRSA's Special Projects of National Significance
to investigate the impact of these events on changes in participants'
medication-taking practices, overall outlook on life and psychological
status, quality of life, social relationships, illicit drug use and sexual
behavior, as well as responses and adaptation to these events.
Most participants in our intervention evaluation study are poor, marginalized, and socially disadvantaged and struggle to maintain stability in many aspects of their lives. The effects of terrorism may exacerbate the uncertainties, chaos and fears already faced by this fragile population, which in turn may impede adherence to ART or increase sexual and drug using risk-taking behaviors. Conversely, resilience may be noted in some individuals. Among those who use illicit drugs, stresses stemming from emotional and social dislocation are potential triggers for relapse in drug use. A supplement has been added to our routine quarterly client interviews assessing intensity of exposure to and impact of the events, depression and substance use in 4 sites (two in NYC; two outside NYC) twice over a six-month period. A one-time, in-depth qualitative interview with a convenience sample of 80 clients on ART for at least a month will be administered in the four sites.
In addition, quantitative analyses of our ongoing quarterly client interview data (n=800) are being conducted to describe trends in adherence patterns between the three-month period preceding September 11th and at least the subsequent two three-month periods immediately following the events across all 14 sites. The geographic dispersion of participating sites in relation to the attack centers allows us to examine whether intensity of exposure (e.g., personal experience; proximity; relationship with those killed, injured, or otherwise directly involved; level of media viewing of the attacks) is a key factor in adaptation. Data collection is ongoing and will be completed in August 2002.
Last updated: 4/11/02