Older African-American women living with HIV find chronic illnesses more difficult to self-manage than HIV, according to a new study by Lari Warren-Jeanpiere, Heather Dillaway, Pilar Hamilton, Mary Young and Lakshmi Goparaju.
The study, "Taking It One Day at a Time: African American Women Aging with HIV and Co-Morbidities," was published in the journal AIDS Patient Care and STDs in July 2014.
"Co-morbidities, including diabetes and hypertension, were perceived to be more difficult to self-manage than HIV," the study found.
"This difficulty was not attributed to aging but to daily struggles such as lack of income and/or health insurance, an inflexible work schedule, and loneliness."
Qualitative data was collected through five focus groups conducted in Washington, D.C., with HIV-positive African-American women between 52 and 65 years of age.
Among the 23 women who participated in the study, only one woman did not report any comorbidities.
The majority were managing between one and five comorbidities including arthritis, cancer, depression, diabetes, heart disease, hepatitis, high blood pressure and tuberculosis.
The study found that romantic relationships and social responsibilities, including caring for family members, positively impacted participants' ability to self-manage HIV by motivating them to stay healthy.
In contrast, financial pressures, inflexible work schedules and heavy pill burdens negatively impacted women's ability to sustain medication adherence.
"Women reported that, over time, HIV has become easier to manage in comparison to their other illnesses based on advancements they have experienced in their HIV treatment regimens," the study found.
"Nonetheless, given that the majority of women in this sample have been living with HIV and taking medication for many years and are now experiencing additional chronic conditions that require medication and behavior modification, some reported growing tired of taking medicine."
The study noted that African-American women in the U.S. are disproportionately impacted by HIV and comorbidities.
"In 2010, African American women comprised 14% of the total population of U.S. women but accounted for nearly 64% of new HIV infections occurring among all women. ... Additionally, African American women are also disproportionately impacted by the nation's leading chronic illnesses including diabetes, heart disease, and cancer."
The study concluded that HIV and comorbidity self-management were inextricably linked.
"We can no longer afford to view engagement in HIV care as a single-disease issue and hope to attain optimal health and well-being in our HIV-affected populations," the study found.
"Optimal HIV self-management must be framed within a larger context that simultaneously addresses HIV and co-morbidities, while considering how social and cultural factors uniquely intersect to influence older African American women's self-management strategies."
Katherine Moriarty is a consultant and freelance writer, based in Vancouver. She has 10 years of experience in the intersecting fields of public health and community development, with a focus on bloodborne virus policy and programming.