Coping Strategies of Diverse MSM across the HIV Care Continuum Open Access

Abstract

Background. The stress of receiving the diagnosis of and living with HIV has a profound impact on the health outcomes and treatment status of people who live with HIV (PLWH). Stress management invokes a process of assessment and adoption of distinct coping strategies to manage specific HIV related stress. Although past studies have established the relationship between stress, coping strategies and HIV clinical outcomes, there is a lack of literature detailing the coping strategies used by men who have sex with men and are living with HIV (MSM-LWH) across HIV continuum stages. This research study attempts to address this gap and provide more insight toward future interventions aimed at improving retention and treatment adherence among minority men MSM-LWH.

Methods. The study team conducted interviews with 84 MSM-LWH in 2014. This study presents an analysis of 84 in-depth qualitative interviews with MSM-LWH living in five different cities: Atlanta, Baltimore, Chicago, Los Angeles and Washington, D.C. Study participants were then categorized into three HIV care continuum group typologies: care-engaged, care-inconsistent and care-detached.

Results. This study identified differences and similarities in stress-related coping strategies across the three care continuum groups. Care-engaged MSM-LWH were more likely to use problem-focused strategies that positively contribute to health promoting behaviors, while care-inconsistent and care-detached utilized emotion-focused coping strategies that diminish their ability to positively cope with their HIV status. High levels of primary (perceived threat) and secondary (perceived control, self-efficacy) appraisal had implications for use of effective coping strategies and better HIV care outcomes.

Conclusions. Problem-focused coping strategies were predominantly utilized by MSM-LWH categorized as care engaged who adopted effective HIV care behaviors; Emotion-focused coping strategies were consistently used by MSM-LWH in the other categories who exhibited behavior detrimental to their health. Study findings also imply that future care and treatment adherence interventions need to address coping issues and be tailored to the needs of MSM-LWH in each care group.

Table of Contents

Chapter 1: Introduction………………………………………………………1

Problem Definition……………………………………………………………1

Study Purpose and Justification……………………………………………6

Theoretical Framework………………………………………………………7

Research Questions………………………………………………………….10

Chapter 2: Literature Review………………………………………………12

Chapter 3: Methods………………………………………………………….20

Study Population……………………………………………………………..20

Informed Consent…………………………………………………………….23

Study Instruments……………………………………………………………23

Data Collection and Management………………………………………..24

Secondary Data Analysis……………………………………………………25

Chapter 4: Results……………………………………………………………30

Chapter 5: Discussion……………………………………………………….50

Key Findings on Research Question #1 and #2………………………..50

Public Health Implications………………………………………………...52

Study Limitations…………………………………………………………….57

Conclusion……………………………………………………………………..58

References……………………………………………………………………..60

Appendices…………………………………………………………………….69

Appendix A…………………………………………………………………….69

Appendix B…………………………………………………………………….70

Appendix C…………………………………………………………………….76

Figure 1.1. Prevalence-Based HIV Care Continuum among all PLWH, 2011...3

Figure 1.2: Transactional Model of Stress and Coping……………….8

Figure 4.1 Model of Care Engaged MSM-LWH………………………..40

Figure 4.2: Model of Care Inconsistent MSM-LWH………………….44

Figure 4.3: Model of Care Detached MSM-LWH………………………48

Table 4.1: Sample Characteristics for MSM-LWH in 5 cities, 2014 (n=84)..31

Table 4.2: Coping Strategies among MSM-LWH across HIV Continuum Groups..34

Table 5.1: Summary of Most Commonly Used Coping Strategies by HIV Continuum Care Group..53

Table 5.2: Summary of Potential Intervention by Care Continuum Group..57

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Psychology, Behavioral Health Sciences, General
Keyword	HIV Men who have sex with men HIV care continuum MSM Coping
Committee Chair / Thesis Advisor	Frew, Paula, Emory University
Committee Members	Carey, James, Centers of Disease Control and Prevention
Partnering Agencies	CDC

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