The art adherence and intimate partner violence nexus : moderating influences of meaning in life, sense of coherence, and spirituality

Abstract

In South Africa, intimate partner violence (IPV) has been associated with unfavourable outcomes for antiretroviral medication (ART) adherence, such as low treatment uptake, low ART adherence and the inadvertent virological failure, and a higher death rate. However, there is a dearth of research on factors that encourage ART adherence in people exposed to IPV. Following this backdrop, this study examined the moderating influences of meaning in life (ML), sense of coherence (SOC), and spirituality on IPV and ART adherence among adult people living with HIV (PLWH) in Johannesburg South, South Africa. Working from a post-positivistic quantitative framework, a questionnaire was developed to gauge participants’ ART adherence, exposure to IPV, perceived meaning in life, sense of coherence, and spirituality. The sample for this study was recruited through a two-stage sampling process involving purposive sampling of two ART sites, namely Diepkloof Provincial Clinic and Lenasia Nirvana Clinic, in the south of Johannesburg, and the systematic selection of participants within each ART site. The sample involved 66 men and 134 women between the ages of 19 and 51 who were receiving ART at the two sites. To establish the moderating influences of ML, SOC, and spirituality on the association between IPV and ART adherence, regression analysis and Hayes moderation were utilised. The study revealed that IPV was negatively associated with an 18% drop in adherence (p <.001). While all three types of IPV had a negative association with adherence, the presence of sexual IPV had the most pronounced reduction in adherence (30%), followed by emotional IPV with a 13% reduction. Most non-adherent participants cited being ‘away from home’ (100%), ‘being too busy’ (88%), ‘avoiding being seen taking ARVs’ (82%), and ‘depression’ (64%) among their reasons for non-adherence. Results of the moderation analysis established that spirituality (β = 0.72, p <.005) and SOC (β = 0.53, p <.005) significantly moderated the negative influence of IPV on adherence. Compared to SOC, the moderating influence of spirituality in tempering the influence of violence was more pronounced. The findings of this study underscore the pronounced negative influence of sexual IPV on ART adherence and the value of spirituality and SOC as resources that facilitate adherence for PLWH who have been exposed to IPV. In support of previous studies, this study recommends the prioritisation of IPV screening at facilities that provide ART and psychosocial services that focus on aspects of spirituality, as well as the strengthening of SOC to improve the adherence of people exposed to IPV.