The Costs of Silencing the Self and Divided Self in the Context of Physical Abuse, Racial/Ethnic Identity, and Medication Adherence in Women Living with HIV

Understanding the psychosocial context of employment and occupational productivity among women living with HIV: A mixed-methods study

BACKGROUND

Women living with HIV (WLHIV) are particularly vulnerable to poor employment outcomes, impacting their socioeconomic independence and personal sense of empowerment.

OBJECTIVE

This article presents the results of a mixed methods study, which examined the personal, clinical, and socioeconomic contexts associated with employment and occupational productivity among employed WLHIV (n = 164) in the Southern United States.

METHODS

The Stanford Presenteeism Scale-6 was used to assess the perceived impact of HIV disease on the ability to maintain focus and complete tasks at work. Correlational and hierarchical regression techniques were applied to examine the relationships between personal, clinical, and socioeconomic contexts and occupational productivity.

RESULTS

In this sample, 62% of women perceived no impact on their ability to work or capacity to complete work related to living with HIV. In multivariable modeling, empowerment, neurocognition, socioeconomic status, and psychological health were associated with occupational productivity. In-depth interviews (n = 29) provided rich contexts and meaning surrounding employment among WLHIV, and indicated that quality of life, work-life balance, empowerment, social support, and psychological health influenced the experience of work.

CONCLUSION

Psychosocial and structural interventions are needed to improve occupational outcomes in this vulnerable population.

Bearing (Aguantando) With Intimate Partner Violence: A Grounded Theory Study of Self-Silencing Among Hispanic Women Who Experienced Intimate Partner Violence

Hispanic women who experience intimate partner violence (IPV) face unique disparities. They have poorer health outcomes and are less likely to seek help than their non-Hispanic counterparts. When women remain in relationships where IPV occurs and refuse to disclose or seek treatment, they may resort to self-silencing, which can also worsen health outcomes. The purpose of this study was to develop a theory that explains how self-silencing evolves among Hispanic women who experience IPV. Participants were recruited from two research studies focused on Hispanic women's health, and from snowball sampling, which involved referrals by previously registered participants. Data were collected via Zoom® and included individual interviews. A total of 25 women participated in this study. Analysis followed constructive grounded theory levels of analysis described by Charmaz and constant comparative methods described by Glaser and Strauss. A grounded theory entitled Bearing (Aguantando) With Intimate Partner Violence emerged from the data. The theory explains the main strategy Hispanic women use to deal with violence while remaining in a relationship where IPV occurs. The theory is constructed of four categories with subcategories. The results of this study provide an initial framework to understand the self-silencing process among Hispanic women who experience IPV. In addition, this study identifies different levels of interventions that can be useful for researchers and healthcare providers to promote Hispanic women's ability to become empowered, use their voices, and seek help.

Gendered Racial Microaggressions, Self-silencing, Substance Use, and HIV Outcomes Among Black Women Living with HIV: A Structural Equation Modeling Approach

To better understand factors that may contribute to HIV outcomes experienced by Black women living with HIV (BWLWH), the present study examined the relationships among gendered racial microaggressions (GRM; subtle daily insults due to racism and sexism), self-silencing, substance use, antiretroviral therapy (ART) medication adherence, and viral suppression using structural equation modeling and path analysis. Self-silencing and substance use were examined as potential mediators. Participants were 119 BWLWH residing in South Florida. Results of this study showed that GRM was directly and positively associated with self-silencing and indirectly and negatively associated with medication adherence via self-silencing. GRM was directly related to higher alcohol use disorder severity. Self-silencing was directly and negatively associated with medication adherence. Medication adherence was directly and negatively related to viral suppression. The model fit the data well. Identifying the negative consequences of GRM in conjunction with self-silencing and substance use may help inform prevention and intervention strategies to improve mental health and HIV-related outcomes among BWLWH.

Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter

Background: Ending HIV/AIDS in the United States requires tailored interventions. This study is part of a larger investigation to design mCARES, a mobile technology-based, adherence intervention for ethnic minority women with HIV (MWH).

Objective: To understand barriers and facilitators of care adherence (treatment and appointment) for ethnic MWH; examine the relationship between these factors across three ethnic groups; and, explore the role of mobile technologies in care adherence.

Methods: Cross-sectional, mixed-methods data were collected from a cohort of African-American, Hispanic-American and Haitian-American participants. Qualitative data were collected through a focus group (n = 8) to assess barriers and facilitators to care adherence. Quantitative data (n = 48) surveyed women on depressive symptomology (PHQ-9), HIV-related stigma (HSS) and resiliency (CD-RISC25). We examined the relationships between these factors and adherence to treatment and care and across groups.

Findings: Qualitative analyses revealed that barriers to treatment and appointment adherence were caregiver-related stressors (25%) and structural issues (25%); routinization (30%) and religion/spirituality (30%) promoted adherence to treatment and care. Caregiver role was both a hindrance (25%) and promoter (20%) of adherence to treatment and appointments. Quantitatively, HIV-related stigma differed by ethnic group; Haitian-Americans endorsed the highest levels while African-Americans endorsed the lowest. Depression correlated to stigma (R = 0.534; p < 0.001) and resiliency (R = −0.486; p < 0.001). Across ethnic groups, higher depressive symptomology and stigma were related to viral non-suppression (p < 0.05)—a treatment adherence marker; higher resiliency was related to viral suppression. Among Hispanic-Americans, viral non-suppression was related to depression (p < 0.05), and among African-Americans, viral suppression was related to increased resiliency (p < 0.04).

Conclusion: Multiple interrelated barriers to adherence were identified. These findings on ethnic group-specific differences underscore the importance of implementing culturally-competent interventions. While privacy and confidentiality were of concern, participants suggested additional intervention features and endorsed the use of mCARES as a strategy to improve adherence to treatment and appointments.

Gendered Racial Microaggressions and Self-Silencing Associated with Suicidality Among Black Women Living with HIV

Black women represent the majority of women living with HIV in the USA and their risk for suicide may be linked to the impact of psychosocial stressors experienced at the intersection of race and gender such as gendered racial microaggressions (GRMS) and silencing the self (to maintain harmony). However, little research has been done on the relationship between microaggressions, self-silencing, and suicidality among BWLWH. As part of an intervention development study, 119 BWLWH in the Southeastern USA completed a baseline assessment consisting of a clinical interview (e.g., Mini-International Neuropsychiatric Interview) to assess suicidality, the gendered-racial microaggressions scale (GRMS), and the Silencing the Self-Scale. Multivariate linear regression analyses controlling for age and education indicated that higher microaggression appraisal scores on the GRMS scale (β = 2.80, p < .01) was associated with current suicidality and higher self-silencing was associated with current suicidality (β = 1.05, p < .01) and lifetime suicidality (β = 1.03, p < .01). Additional analyses that included major depression indicated that self-silencing uniquely contributed to suicidality above and beyond depression. Our findings support the importance of understanding how gender and race specific factors may relate to suicidality. Future research is needed to examine potential moderating factors (e.g., coping strategies) that may be enhanced through interventions and structural changes are needed to decrease acts of microaggressions.

Employment and Occupational Productivity Among Women Living With HIV: A Conceptual Framework

ABSTRACT

Women living with HIV (WLWH) have lower employment rates and more difficulty finding and keeping employment compared with their counterparts without HIV. These disparities affect physical, psychological, and socioeconomic outcomes, and they may compound the disadvantages associated with living with HIV. Although historical literature has emphasized the impact of clinical factors on employment, current evidence suggests that socioeconomic and psychosocial factors associated with HIV should be included for a more comprehensive view. Based on this broader inclusion, a conceptual framework is presented describing how socioeconomic and psychosocial characteristics influence employment acquisition and maintenance among WLWH. The framework posits that there is a reciprocal relationship between employment acquisition and occupational productivity, and psychological health, physical health, social support, and empowerment. Implications for future research and interventions include (a) an extended conceptualization of vocational rehabilitation and (b) the use of peer support groups to increase social capital, empowerment, knowledge, and resources among WLWH.