Household HIV competence and illness identity in HIV: insights from the baseline phase of the SINAKO cluster randomised controlled trial

Abstract Background Illness identity is the extent to which a chronic illness is integrated into one’s sense of self. It can significantly impact the health outcomes and well-being of people living with HIV (PLHIV). Because incorporating HIV into one’s identity is shaped by social context, particularly the household environment, we hypothesised that household HIV competence would play an important role in shaping key dimensions of illness identity: acceptance, rejection, engulfment, and enrichment. Methods Data were drawn from the baseline phase of the SINAKO cluster randomised controlled trial. A total of 316 adults living with HIV, aged 18 to 65 years (mean age = 35.49; 83% women), completed questionnaires evaluating household HIV competence and the four illness identity dimensions. Most participants (73%) had been living with HIV for more than six months. Multiple regression analyses with robust standard errors were conducted to assess associations between household HIV competence and each illness identity dimension, controlling for gender, age, and illness duration. Results In adjusted models, there was strong evidence that household HIV competence was associated with two dimensions of illness identity: higher household HIV competence was associated with greater acceptance (β = 0.06, p = 0.04) and lower rejection (β = −0.14, p = 0.002). No evidence was found of an association with engulfment (β = −0.10, p = 0.13) or enrichment (β = 0.10, p = 0.05). Conclusions These findings build on the illness identity literature by demonstrating that household HIV competence is uniquely linked to acceptance and rejection among people living with HIV. Recognising the central role of families in shaping the illness experience is vital. Strengthening household HIV competence through targeted family support may reduce rejection and promote acceptance, with the potential to improve long-term health outcomes for those living with HIV. Trial registration Pan African Clinical Trial Registry, PACTR201906476052236. Registered 6 June 2019. https://pactr.samrc.ac.za