In the United States, black women are not only more likely to acquire HIV compared to other ethnic groups, they are also the most likely to die, with mortality rates estimated to be about 17% higher than those of white women.
Crystal Chapman Lambert, Ph.D., CRNP, NP-C, FNP-BC, of the University of Alabama at Birmingham, studies the underlying reasons black women are less likely to adhere to treatment and achieve viral suppression.
Her recent paper, "The State of Adherence to HIV Care in Black Women," was named Article of the Year by the Journal of the Association of Nurses in AIDS Care during the annual meeting of the Association of Nurses in AIDS Care (ANAC) in Portland, Oregon, earlier this month.
"Why are we losing women in an era where we have one pill, one time a day?" asked Chapman Lambert, speaking at ANAC. She added, "There is a critical need to enhance retention in care and treatment adherence among black women with HIV, but first we need to figure out why."
In her paper, Chapman Lambert and her colleagues at the University of Alabama at Birmingham established two research goals. First, they would search the academic literature to better understand what factors are associated with adherence to HIV treatment among black women living with HIV.
For this part of their research, they used a framework known as the social-ecological model to map the interpersonal, intrapersonal, community, and system-level factors associated with adherence.
They conducted a literature search using words like "adherence," "HIV," and "retention in care," pulling 415 articles and 90 clinical trials. After excluding articles that did not meet their criteria, they were left with 21 articles that focused on black women living with HIV, specifically.
From these articles, they determined that black women living with HIV face a range of challenges across the social-ecological model. On an individual level, many women reported depression and HIV-related stigma as a top barrier.
As well, "Women reported God -- not necessarily Church -- as a top priority in maintaining their health and adherence behaviors," said Chapman Lambert. Discrimination was a mixed bag, with many women denying they had experienced racial discrimination, and Chapman Lambert suggesting this might be a coping mechanism, particularly in the American Southeast.
Interpersonally, women placed a premium on social bonds with health care providers.
"They wanted [the providers] to get to know them, asking questions like, 'How are your kids? You said you were going to school last month, did you enroll?' They appreciated knowing that it wasn't just about their disease," she said.
Women also value their relationships with their family members, said Chapman Lambert, noting that providers may be able to encourage women to adhere to medication by emphasizing the importance of staying healthy for the sake of children, grandchildren, or other family members.
On a system level, Chapman Lambert said the literature review reinforced the idea that issues such as poverty, transportation barriers, and community-level stigma all impact adherence.
Beyond the literature review, into the underlying reasons black women living with HIV are less likely to take medication and achieve viral suppression, Chapman Lambert and colleagues also sought to set a baseline of existing research into interventions specifically tailored for black women living with HIV.
Although they did find five studies that underscored possible interventions to bolster treatment adherence among women living with HIV of all ethnicities, they did not find a single study that focused on the experiences of black women, specifically. They found one ongoing clinical trial that was developed specifically for this population, which Chapman Lambert and her colleagues said was promising.
Chapman Lambert noted that the literature review ended in 2016, so there may be more up-to-date information. However, she added that it's obvious there's a lot more research that needs to be done to identify effective interventions for black women living with HIV.
"Researchers must develop gender-specific and culturally appropriate interventions. For me, it's my passion -- and I feel like it's an area that needs more research," Chapman Lambert said.