RESILIENCE IN THE FIGHT AGAINST HIV/AIDS

By Crystal Molly Akinyi

People living with HIV continue to face numerous adversities at the individual (example, trauma) ,interpersonal( example, stigma), and neighborhood levels (example, socioeconomic deprivation and violence). These diversities have been linked to worse health behaviors (example, lower HIV medication adherence , poorer clinic attendance) and outcomes (example, viral suppression). Given the adversities faced by PLWH ,resilience resources may facilitate good health behaviors and outcomes, potentially enabling PLWH to overcome the negative effects of adversities.

While resilience refers to overcoming adversities, it has been defined in multiple ways and mostly as resources related to an individual personality characteristics ( Connor $ Davidson,2003 ;Leipold $Greve,2009 )However the definition of resilience incorporates recent insight from existing resilience literature (Fletcher $ Sarka ,2013) and a socioecological model of health (SMH).

A socioecological model of health (SMH) posits that health is influenced by factors at the individual ,interpersonal , neighborhood and societal or policy levels (Beral et al,2013). Therefore ,a SMH maybe beneficial in framing resilience as a multi-component construct with direct relevance to the lives of PLWH . Based on this SMH framework ,we define resilience resource as positive psychological, behavioral or social adaptation in the face of stressors and adversities that draws upon an individual’s capacity ,combined with families and communities resources to overcome serious threats to developments and health.

Resilience resources may protect the health of PLWH via promotion of positive health behaviors (example, engagement in care antiretroviral virus (ART) adherence ) and buffering of adversities (example ,trauma ) on mental health, health behavior and psychological functioning . Resilience resources are also viewed as processes that buffer against and are potentially more malleable to intervention than some of the aforementioned adversities at the individual ,interpersonal and neighborhood levels.

The multilevel adversities faced by PLWH warrant a multi- component resilience definition and study( example, individual, interpersonal ,and neighborhood component) to fully understand resilience among PLWH and intervene in a comprehensive manner to promote good health behaviors and outcome for PLWH. Moreover ,a synthesis of the evidence for how a multilevel resilience resources approach has been incorporated into HIV research is indeed. Thus the objective are to review the definition and study of resilience resources among PLWH as it relate to important health behavior and outcomes (example, ART adherence ,viral suppression ,CD4 account and clinic attendance) ;identify gaps in the existing literature on resilience and HIV related health behaviors and outcomes ; and provide recommendations for future research .

Completing these objectives may inform design and conduct of multilevel (including structural) intervention to enhance resilience and good behavioral or health outcomes among PLWH and thereby reduce HIV-related mortality and mobility.

Based on our review of the literature we conclude that there are significant gaps in the field of HIV resilience and opportunities to advance scholarship in this area. The common theme across the definition was the focus on the individual-level resilience resources. There is growing criticism that define resilience exclusively as an individual-level phenomena ignores the social context and social system in which resilience may occur.

In the commentary of Shaw et.ai, the authors underscore that the majority of the resilience research uses an individual-level definition even though resilience is complex and multilevel .Herrick and colleagues (2014) propose a multilevel resilience framework for HIV prevention and argue that resilience resources may be important in conferring positive health outcomes to gay and bisexual who face adversities .This work cites novel resilience resources (example, neighborhood affirmation) to support a multilevel definition of resilience. Also, ,the multilevel nature of resilience is supported by the grounded theoretical approach used by De saint et al.,(2013) to identify intrinsic(example, spirituality) and extrinsic (example , social support advocacy) resilience resources among PLWH.

Recent scholarship across a variety discipline support argument to define resilience at multiple levels of socioecological model of health. These research findings indicate that resilience resources exist at multiple level and that each of these level (i.e, individual ( Davidson et al, 2012), interpersonal(Herrick et al,2014), and neighborhood or community (Latkin et al, 2013)) is important.

Almost half of the article reviewed focused on resilience resources at one level of socioecological model of health .Of these articles, the majority examined interpersonal resilience resources with general social support being the resilience resources examined most often .While the evidence for association between social support and viral load was mixed (Attonito et al., 2014), the majority of the aforementioned studies found positive relationship of social support with Antiretroviral therapy (ART) adherence ,clinic attendance and disease progression.