• William C Holmes and Joseph L Pace.
• Philadelphia Veterans Affairs Medical Center and Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 19104-6021, USA. holmeswc@mail.med.upenn.edu
• J Gen Intern Med. 2002 Sep 1; 17 (9): 677683677-83.

ObjectiveThe study objective was to characterize respondents' prognostic perceptions of HIV infection and to explore how perceptions might affect medication and safe sex nonadherence.MethodsSurveys were mailed to 295 clients of an HIV-specific case management organization. Participants were asked to describe experience with HIV/AIDS right after serostatus knowledge and currently, using provided word lists, after which they were asked to assess current life expectancy. Self-reported information on antiretroviral medication and safe sex nonadherence was obtained.ResultsA total of 220 (75%) clients (66% nonwhite, 73% male, 63% gay/bisexual, 50% educated >12 years, and 53% with incomes <$10,000/year) returned surveys. Negative descriptors from word lists were significantly less common and positive descriptors significantly more common now compared to right after serostatus knowledge. Current perceptions about life expectancy indicated that most respondents thought they would live many years, many believing they would live well into old age. Whites (odds ratio [OR], 0.34; P =.01) were less likely and those with >12 years education (OR, 2.76; P =.02) and with CD4 cell counts >200 (OR, 2.70; P =.01) were more likely to have optimistic prognostic beliefs. The optimistic subgroup, when compared with the pessimistic subgroup, was more likely to report medication (26% vs 13%, P =.04) and safe sex (57% vs 29%, P =.004) nonadherence.ConclusionsSeropositive individuals, including persons of color (adjusted) as well as women and drug users (unadjusted), self-reported optimistic beliefs about their prognosis. Those with more optimism about their prognosis were significantly more likely to report medication and safe sex nonadherence. A better understanding of seropositive patients' prognostic beliefs and the factors determining them is warranted.

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