'Emotional closeness’ key to successful HIV treatment support

06 June 2018

The type of relationship someone living with HIV has with both their social network and a nominated ‘treatment partner’ is likely to influence whether they are virally suppressed, research from Botswana suggests.

large family sitting on the ground in Botswana

As more countries recommend the use of treatment partners to help people living with HIV adhere to their antiretroviral treatment, there is a need to understand better what makes these partnerships succeed. A recent study conducted in Botswana, suggests that individuals whose partners provided more holistic, non-medical support, were more likely to be virally suppressed.

The researchers interviewed 131 adults living with HIV and their treatment partners attending an HIV clinic in Gaborone, Botswana. Participants had been on antiretroviral treatment for at least six months and half (51%) of those selected were virally suppressed.

Participants and their treatment partners were interviewed separately. Wherein they provided details of the nature of their relationship and the characteristics of the HIV-positive person’s social network overall.

The findings suggest people who selected spouses or other intimate partners as treatment partners, and who trusted and felt close to members of thei social network as a whole, were more likely to be virally suppressed.

This is because a treatment partner who was in a close and trusted relationship with someone living with HIV has more frequent opportunities to observe that person and provide on-hand support to meet a range of needs.

The researchers also found that the treatment partners of people with suppressed HIV tended to provide more in-depth adherence support, such as dropping off medications, as well as broader, non-medical support that encouraged someone to stay healthy in ways not directly tied to medication.

For example, treatment partners of people with suppressed HIV were more likely to prepare food or baths, and proactively attend to other emotional and physical needs. They were also more likely to remind the person to eat healthily, to exercise, to avoid alcohol and drugs, and provide general support and acceptance. Overall, 69% of patients who reported receiving these kinds of nonmedical support from their treatment partner were virally suppressed.

Treatment partners of people with unsuppressed HIV tended to focus more narrowly on reminding people to take medication or attend appointments. Even when providing nonmedical support, treatment partners in this category tended to focus on medication, for example, by reminding someone to eat before taking antiretrovirals.

Citing similar findings from Uganda, researchers suggest the reason why treatment partners who took a more holistic approach were more successful was because they may have been perceived to be more caring, whereas treatment partners with a more narrow or ‘badgering’ focus on adherence were more likely to be viewed as failing to understand the wider context and challenges experienced by someone living with HIV.

At the moment, people living with HIV are rarely given guidance on who they should select, and likewise treatment partners are often not advised on how to provide effective support.

These findings suggest treatment partners not only need basic, biomedical training about HIV medication, adherence and side effects, but they could also benefit from training about what kinds of support are most effective, how to provide this support through the use of non-confrontational counselling skills, and which approaches to avoid.

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Written by Hester Phillips