HIV and HCV Health Beliefs in an Inner-city Community

K. Krauskopf; T. G. McGinn; A. D. Federman; E. A. Halm; H. Leventhal; L. K. McGinn; D. Gardenier; A. Oster; I. M. Kronish

Disclosures

J Viral Hepat. 2011;18(11):785-791. 

In This Article

Abstract and Introduction

Abstract

Chronic infection with the hepatitis C virus (HCV) is more prevalent than human immunodeficiency virus (HIV) infection, but more public health resources are allocated to HIV than to HCV. Given shared risk factors and epidemiology, we compared accuracy of health beliefs about HIV and HCV in an at-risk community. Between 2002 and 2003, we surveyed a random patient sample at a primary care clinic in New York. The survey was organized as domains of Common Sense Model of Self-Regulation: causes ('sharing needles'), timeline/consequences ('remains in body for life', 'causes cancer') and controllability ('I can avoid this illness', 'medications may cure this illness'). We compared differences in accuracy of beliefs about HIV and HCV and used multivariable linear regression to identify factors associated with relative accuracy of beliefs. One hundred and twenty-two subjects completed the survey (response rate 42%). Mean overall health belief accuracy was 12/15 questions (80%) for HIV vs 9/15 (60%) for HCV (P < 0.001). Belief accuracy was significantly different across all domains. Within the causes domain, 60% accurately believed sharing needles a risk factor for HCV compared to 92% for HIV (P < 0.001). Within the timeline/consequences domain, 42% accurately believed HCV results in lifelong infection compared to 89% for HIV (P < 0.001). Within the controllability domain, 25% accurately believed that there is a potential cure for HCV. Multivariable linear regression revealed female gender as significantly associated with greater health belief accuracy for HIV. Thus, study participants had significantly less accurate health beliefs about HCV than about HIV. Targeting inaccuracies might improve public health interventions to foster healthier behaviours and better hepatitis C outcomes.

Introduction

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) cause two of the most common chronic blood-borne infections in the United States. Over one million people in the United States are living with HIV, and an even greater number, approximately 2.7–3.9 million, are chronically infected with HCV.[1–3] While HIV is transmitted through contact with bodily fluids (semen, vaginal fluid and breast milk), both diseases are transmitted by direct contact with infected blood. As a result, HIV and HCV share risk factors– most notably injection drug use. Consequently, these diseases are also linked through common epidemiological features.

However, while the age-adjusted HIV death rate has been decreasing or stabilizing in the United States since the mid-1990s, the number of deaths caused by HCV is projected to increase two to fourfold over the next two decades.[4,5] Fewer public health resources have been directed at HCV when compared to HIV, and prior studies suggest that at-risk communities lack awareness about HCV.[3] In combination with improved biological and behavioural treatments aimed at these viruses and at behaviours such as addiction that increase their risk of being acquired, educational programmes are needed to increase awareness and promote better health behaviours related to both viruses, especially HCV. Understanding current health beliefs held by at-risk populations might be the first step in designing programmes to increase awareness and knowledge regarding both diseases.

A growing body of literature demonstrates that patients' beliefs about diseases influence their health behaviours.[6–8] Stigma associated with injection drug use, limited access to health services for injection drug users, and limited federal and public health funding for HCV-related services in general may all contribute to inaccurate beliefs about HCV. In comparison, the stigma around HIV testing and treatment has diminished significantly over time, and government resources for medical and public health support around HIV are well-established. Thus, in spite of important similarities between HCV and HIV, it is likely that at-risk populations have less accurate beliefs about HCV when compared to HIV. Understanding and comparing health beliefs about HIV and HCV may be useful in identifying erroneous beliefs most in need of modification, to improve health outcomes in these populations. The Leventhal Common Sense Self-Regulation Model has been used to understand health beliefs about common chronic conditions like asthma, hypertension, heart failure and diabetes.[7,9–11] Less has been done regarding use of the Self-Regulation model as a means of assessing health beliefs about chronic infectious diseases such as HCV and HIV. According to the Common Sense Model, individuals develop health beliefs through personal illness episodes and socio-cultural associations that can be organized into five interconnected domains: (i) identity (the label ascribed to a condition and its associated symptoms), (ii) cause (based on both biomedical and nonscientific sources), (iii) temporal features or time-line (disease rate of onset, symptom duration as acute or chronic), (iv) consequences (impacts of a disease, including physical, psychological and social) and (v) controllability or curability (the degree to which a disease may be treated or controlled).[12,13]

To date, a handful of studies evaluate or compare lay understanding (knowledge, beliefs or attitudes) of HIV and HCV in the general population or in at-risk communities (injection drug users, for example). These studies suggest that the public has variable understanding of these infections and that beliefs tend to be more concordant with the biomedical model for HIV than for HCV.[14–21] At present, we are not aware of studies that formally compare health beliefs about HIV and HCV in the United States using a theory-based model of health beliefs.

To characterize and contrast health beliefs about HIV and HCV, we surveyed patients using questions structured according to the Common Sense Model. We targeted patients from an at-risk, inner-city community where rates of HCV and HIV are disproportionately high. We hypothesized that despite the greater prevalence of HCV over HIV, health beliefs about HCV would be less accurate than beliefs about HCV.[22,23]

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