Even though most HIV patients in the U.S. have access to recommended treatment for their illness, only about 60 percent take advantage of it. Doctoral student Laramie Smith studies why this happens.
Smith, a fifth-year doctoral student in social psychology in the College of Liberal Arts and Sciences, presented her research to the UConn Board of Trustees at its Sept. 28 meeting. Her adviser is Jeffrey Fisher, Board of Trustees Distinguished Professor of Psychology.
“I’d often find myself returning to a similar question,” said Smith. “What is it about an individual, their situation, of different health behaviors per se, that will cause a person to either seek health-related services in the face of multiple challenges or not utilize services that are readily available?
“For example, why would a youth who has been homeless for the past two years not visit the dental van parked right outside the youth drop-in center, which is providing free dental care to the center’s clients, when a diabetic, chronically homeless older man who averages at least two-fifths of straight vodka each day obsessively checks his blood sugar levels?”
Although treatment for HIV-infected patients is typically recommended to take place at regular intervals of between three and six months, Smith estimates that nearly 40 percent of people who know they have HIV do not abide by these guidelines.
Yet, she says, these routine visits are essential in maintaining the health of infected patients, because HIV can often be coupled with other medical and even social issues, such as diabetes, liver problems, depression, and substance abuse. In addition to monitoring these co-occurring problems, the visits are also critical in preventing the further degradation of the immune system and preventing the onset of AIDS.
The risk of non-treatment
Smith says retention in HIV care is critical for monitoring and maintaining the life-enhancing effects of HIV medications: “These medications can really help improve patients’ health functioning and quality of life. By improving the health of people living with HIV and reducing the amount of virus in the body, we are reducing the chance that they might transmit the virus to other people.”
Failure to maintain HIV treatment can have potentially fatal results, she adds. When medication is delivered sporadically and not on the recommended schedule, the HIV virus can mutate into a new strain that becomes resistant to medication, making AIDS an inevitable reality for patients. However, those who maintain visits at the suggested intervals greatly reduce this risk.
Even with these potentially dire outcomes, many patients do not take advantage of treatment available to them. Barriers include patients’ doubts as to whether the treatment will be successful; other competing family and life commitments; and even not wanting to admit their infection.
A graduate career
Smith received a $33,000 National Research Service Pre-Doctoral Fellowship Award (NRSA) from the National Institute of Mental Health earlier this year. This award, along with other smaller grants along the way, enabled Smith to fund her master’s and dissertation work.
Smith spends much of her time in Bronx, N.Y. where she works with HIV-infected patients who struggle to maintain routine medical care for their condition.
She has developed and piloted a questionnaire for patients to test a theoretical model of retention in HIV care. By the end of her study she will have interviewed 100 patients.
She also plans to implement and evaluate a brief intervention aimed at helping HIV positive patients who have had problems maintaining routine HIV care.
Smith began her research in the HIV/AIDS field while working at the Seattle-King County Public Heath program, and later working as a research assistant at the University of Washington in Seattle. These opportunities piqued her interest in the HIV field, and prompted her to pursue a graduate degree at UConn in psychology.
The social psychology program at UConn has been rated the best in the country. UConn’s Center for Health Intervention and Prevention, headed by Jeff Fisher, her adviser, is internationally known for research on HIV and disease prevention.
