Blood pressure can kill you tomorrow, but HIV gives you time’

Illness perceptions and treatment experiences among Malawian individuals living with HIV and hypertension

Bibliographic Data

ID11491646
AuthorsMatthew Hing (0000-0001-5349-2879, University of California, Los Angeles, corresponding author), Risa M Hoffman (0000-0001-9575-4574, University of California, Los Angeles), Juliet Seleman (Partners in Hope, (Area 36/Plot 8), Lilongwe, Malawi), Florence Chibwana (Partners in Hope, (Area 36/Plot 8), Lilongwe, Malawi), Daniel Kahn (0000-0003-0342-8793, University of California, Los Angeles), Corrina Moucheraud (0000-0001-7862-7928, University of California, Los Angeles)
Year2019
Volume34
IssueSupplement_2
Pagesii36-ii44
Publication date2019-11-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czz112
PMID31723966
OpenAlexW2988498862
LanguageEN
Citations received9
References cited48

Non-communicable diseases like hypertension are increasingly common among individuals living with HIV in low-resource settings. The prevalence of hypertension among people with HIV in Malawi, e.g. has been estimated to be as high as 46%. However, few qualitative studies have explored the patient experience with comorbid chronic disease. Our study aimed to address this gap by using the health belief model (HBM) to examine how comparative perceptions of illness and treatment among participants with both HIV and hypertension may affect medication adherence behaviours. We conducted semi-structured interviews with 75 adults with HIV and hypertension at an urban clinic in Lilongwe, Malawi. Questions addressed participants’ experiences with antiretroviral and antihypertensive medications, as well as their perspectives on HIV and hypertension as illnesses. Interviews were performed in Chichewa, transcribed, translated into English and analysed using ATLAS.ti. Deductive codes were drawn from the HBM and interview guide, with inductive codes added as they emerged from the data. Self-reported medication adherence was much poorer for hypertension than HIV, but participants saw hypertension as a disease at least as concerning as HIV—primarily due to the perceived severity of hypertension’s consequences and participants’ limited ability to anticipate them compared with HIV. Differences in medication adherence were attributed to the high costs of antihypertensive medications relative to the free availability of antiretroviral therapy, with other factors like lifestyle changes and self-efficacy also influencing adherence practices. These findings demonstrate how participants draw on past experiences with HIV to make sense of hypertension in the present, and suggest that although patients are motivated to control their hypertension, they face individual- and system-level obstacles in adhering to treatment. Thus, health policies and systems seeking to provide integrated care for HIV and hypertension should be attentive to the complex illness experiences of individuals living with these diseases

Blood pressure · Developing country · Economic growth · Human immunodeficiency virus (HIV) · Intensive care medicine · Perception · Global Public Health Policies and Epidemiology · HIV-related health complications and treatments · HIV/AIDS Impact and Responses · Immunology · Internal Medicine · Medicine · Psychology · Gerontology