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Vu T, Manalel J, Nyhan K, Wang K, Monin J. Gender-based stigma and the prevention and treatment of HIV/AIDS among older women: A scoping review protocol. PLoS One 2024; 19:e0298024. [PMID: 38330082 PMCID: PMC10852273 DOI: 10.1371/journal.pone.0298024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION The population of women aged 50 years and older living with HIV is increasing. Older women face unique challenges in the prevention and management of HIV; however, they are often under engaged in HIV/AIDS research. One such challenge is gender-based stigma, which can be manifested through harmful gendered stereotypes, discrimination, prejudice, and sexism that could potentially hinder HIV care engagement among this population. We propose a scoping review to identify and synthesize evidence pertaining to how experiences of gender-based stigma impacts HIV prevention and care among older women. MATERIALS AND METHODS We will use the framework by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) to conduct this scoping review. We will search MEDLINE/PubMed, Web of Science, PsycINFO, CINAHL and Scopus for empirical literature published between January 1981 and the date of search commencement. Supplementary screening will be conducted using backwards citation chaining of the final list of included full-text articles. Two reviewers will independently screen all titles and abstracts for articles that meet the predetermined inclusion criteria. Two reviewers will also screen full-text articles and chart data using a standardized data collection form. RESULTS We will synthesize the findings through tables, charts, and narrative summaries. We will also identify gaps in the current literature and provide recommendations for future research. Findings will be shared at conferences and submitted to a peer-reviewed publication. DISCUSSION To our knowledge, this will be the first scoping review to examine gender-based stigma in relation to HIV prevention and care among older women. We anticipate that our results will be of interest to older women living with HIV, healthcare providers, policy makers, and community activists working to improve quality of life and care experiences for older women living with HIV.
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Affiliation(s)
- Thi Vu
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States of America
| | - Jasmine Manalel
- Brookdale Center for Health Aging, Hunter College, City University of New York, New York, NY, United States of America
| | - Kate Nyhan
- Cushing/Whitney Medical Library, Yale University, New Haven, CT, United States of America
| | - Katie Wang
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States of America
| | - Joan Monin
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, United States of America
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Vu T, Quinn M, Womack J, Monin J. 'If I don't take care of me, then I can't be there for others:' a qualitative study of caregiving relationships among older women living with HIV. Aging Ment Health 2024:1-12. [PMID: 38327025 DOI: 10.1080/13607863.2024.2313729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The population of women ages 50 years and older living with HIV is increasing. Yet, little is known about the care networks that older women living with HIV (OWLH) use to manage their health. The goal of this study was to explore the caregiving and care receiving relationships among OWLH and how these relationships impact HIV management. METHODS OWLH aged 50 years and older were recruited from clinics and community-based organizations across the U.S. We conducted semi-structured, in-depth phone interviews and performed content and thematic analysis on transcripts. RESULTS Participants (N = 23) were on average 60 years old and had been living with HIV for an average of 23.7 years. Participants 1) relied on diverse care networks; 2) were caregivers for grandchildren and parents; 3) had pride and joy in being caregivers; and 4) were highly proactive in their own HIV management. Care networks promoted self-love and acceptance. However, concerns about aging with HIV were still highly prevalent. CONCLUSION Being a caregiver and care recipient are sources of meaning and strength to help OWLH manage HIV. Public health programs should consider engaging both OWLH and their care networks in healthcare discussions and educational efforts.
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Affiliation(s)
- Thi Vu
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Marielle Quinn
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Julie Womack
- Yale University School of Nursing, New Haven, CT, USA
| | - Joan Monin
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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Stowell M, Hall A, Warwick S, Richmond C, Eastaugh CH, Hanratty B, McDermott J, Craig D, Spiers GF. Promoting sexual health in older adults: Findings from two rapid reviews. Maturitas 2023; 177:107795. [PMID: 37454470 DOI: 10.1016/j.maturitas.2023.107795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/01/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sexual health throughout the life course is increasingly recognised as important to maintaining one's overall health, wellbeing, and relationships. We aimed to provide an overview of the evidence on sexual health needs and sexual health promotion in later life. METHODS We undertook two rapid reviews, drawing on systematic review evidence. Searches were conducted in Epistemonikos. Studies were eligible if they reported evidence about the sexual health needs of, or sexual health promotion interventions for, people aged 50+ years. Evidence was quality assessed and summarised in a narrative synthesis. RESULTS Fifteen systematic reviews were included in Review 1 (sexual health needs) and 12 in Review 2 (interventions). Key concerns and needs of older adults included the impacts of cultural stigma/misperceptions, barriers to sexual expression, and a need for tailored support in a welcoming environment. Key concerns and needs of health and social care professionals included mixed attitudes towards and knowledge of later-life sexuality and a need for more training and education. Approaches to promoting sexual health in later life included training and workshops for care home professionals, education for older people at risk of/living with HIV, and interventions to address sexual health-related symptoms of menopause. Gaps in the evidence from current reviews and methodological issues in primary studies were identified. CONCLUSION Older people have specific needs relating to their sexual health. Health and social care professionals working with older people may benefit from education/training around sexuality in later life. Evidence on effective interventions and strategies is limited.
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Affiliation(s)
- Melanie Stowell
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK.
| | - Alex Hall
- School of Health Sciences, University of Manchester, Manchester M13 9NT, UK
| | - Stephanie Warwick
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Catherine Richmond
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Claire H Eastaugh
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Barbara Hanratty
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Jane McDermott
- School of Health Sciences, University of Manchester, Manchester M13 9NT, UK
| | - Dawn Craig
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Gemma Frances Spiers
- Population and Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
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Conway R, Evangeli M. How is Aging Perceived to Affect Well-being in Women Older than 50 Years Living With HIV? A Qualitative Systematic Review. J Assoc Nurses AIDS Care 2023; 34:409-431. [PMID: 37543735 DOI: 10.1097/jnc.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
ABSTRACT Advances in HIV treatment have led to more people with HIV living to 50 years and older. No reviews have qualitatively analyzed and synthesized the literature relevant to theory and practice for well-being specifically in Women living with HIV (WLWH) aged 50 years and older. Sixteen eligible qualitative studies were critically appraised and thematically synthesized to investigate how aging was perceived to affect well-being in WLWH aged 50 years and older. Six themes demonstrated how HIV-related stigmas negatively affected social well-being, and how adjusting to living and aging with HIV negatively affected psychological and physical well-being of older WLWH. Holding caring roles also negatively affected physical well-being of WLWH. Globally, majority women aging with HIV were found to experience additional stigmas. Further research could elucidate how HIV-related stigma affects the well-being of global majority women living and aging with HIV. Recommendations are made for future HIV-related clinical practice and theory development.
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Affiliation(s)
- Rebecca Conway
- Rebecca Conway, DClinPsy, is a Clinical Psychologist, Affiliated with Royal Holloway, University of London, Surrey, United Kingdom. Michael Evangeli, DClinPsy, is a Clinical Psychologist and Professor of Clinical Psychology at Royal Holloway, University of London, Surrey, United Kingdom
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Mwangala PN, Wagner RG, Newton CR, Abubakar A. Navigating Life With HIV as an Older Adult on the Kenyan Coast: Perceived Health Challenges Seen Through the Biopsychosocial Model. Int J Public Health 2023; 68:1605916. [PMID: 37398632 PMCID: PMC10308997 DOI: 10.3389/ijph.2023.1605916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives: This study explores the perceptions of adults living with HIV aged ≥50 years (recognized as older adults living with HIV-OALWH), primary caregivers and healthcare providers on the health challenges of ageing with HIV at Kilifi, a low literacy setting on the coast of Kenya. Methods: We utilized the biopsychosocial model to explore views from 34 OALWH and 22 stakeholders on the physical, mental, and psychosocial health challenges of ageing with HIV in Kilifi in 2019. Data were drawn from semi-structured in-depth interviews, which were audio-recorded and transcribed. A framework approach was used to synthesize the data. Results: Symptoms of common mental disorders, comorbidities, somatic symptoms, financial difficulties, stigma, and discrimination were viewed as common. There was also an overlap of perceived risk factors across the physical, mental, and psychosocial health domains, including family conflicts and poverty. Conclusion: OALWH at the Kenyan coast are perceived to be at risk of multiple physical, mental, and psychosocial challenges. Future research should quantify the burden of these challenges and examine the resources available to these adults.
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Affiliation(s)
- Patrick N. Mwangala
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles R. Newton
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
| | - Amina Abubakar
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
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Walsh JL, John SA, Quinn KG, Hirshfield S, O’Neil A, Petroll AE. Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States. J Rural Health 2023; 39:488-498. [PMID: 36510755 PMCID: PMC10038895 DOI: 10.1111/jrh.12730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions. METHODS Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions. FINDINGS Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress. CONCLUSIONS In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.
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Affiliation(s)
- Jennifer L. Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Andrew O’Neil
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Psaros C, Stanton AM, Goodman GR, Raggio G, Briggs ES, Lin N, Robbins GK, Park ER. Adapting, testing, and refining a resilience intervention for older women with HIV: An open pilot study. J Women Aging 2022:1-21. [PMID: 35787146 PMCID: PMC9879572 DOI: 10.1080/08952841.2022.2094163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Half of persons with HIV in the United States (US), many of whom are women, are over age 50. Aging women with HIV (WWH) face unique biopsychosocial challenges, including stigma, the physiological effects of aging, and illness-associated stressors. Resilience interventions can build awareness of such stressors and aid in facilitating the relaxation response; however, no existing interventions specifically cater to the needs of older WWH. The content of the Relaxation Response Resiliency Program, which teaches positive psychology strategies, relaxation techniques, and cognitive behavioral skills, was adapted for older WWH. Thirteen WWH over 50 participated in an open pilot of the adapted intervention to iteratively refine the program and its procedures. Participants attended either 8 or 10 weekly group sessions; three groups were conducted in total. Pre- and post-intervention assessments and qualitative exit interviews were conducted. Among completers, an increase in resilience was observed. Though significance testing was not conducted, social support also increased, and depression, anxiety, and HIV stigma decreased from pre- to post-intervention. Over half of eligible women enrolled; completers reported high satisfaction with the program. However, retention was difficult; six participants withdrew or were lost to follow-up. Mean number of sessions attended was 3.5 in the 8-session group and 5 in the 10-session groups. In this small sample, the adapted intervention led to a clinically meaningful increase in resilience, though recruitment and retention were challenging. Further refinements to the intervention are needed to minimize attrition and increase acceptability before additional testing is initiated.
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Affiliation(s)
- Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA
| | - Amelia M. Stanton
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA,The Fenway Institute, Fenway Health, Boston MA
| | - Georgia R. Goodman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA,The Fenway Institute, Fenway Health, Boston MA
| | - Greer Raggio
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA
| | - Elsa S. Briggs
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA
| | - Nina Lin
- Boston Medical Center, Boston MA
| | - Gregory K. Robbins
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston MA
| | - Elyse R. Park
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston MA,Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston MA,Mongan Institute for Health Policy, Massachusetts General Hospital, Boston MA
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A Qualitative Study on the Social Determinants of HIV Treatment Engagement Among Black Older Women Living With HIV in the Southeastern United States. J Assoc Nurses AIDS Care 2022; 33:211-223. [PMID: 35195612 DOI: 10.1097/jnc.0000000000000299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Black older women living with HIV (BOWLH) in the United States are disproportionately affected by HIV infection and poor treatment engagement rates, often caused by multiple social determinants of health. In this descriptive qualitative study, we interviewed 17 BOWLH to investigate the facilitators and barriers to HIV treatment engagement. Data were analyzed using the socioecological framework. Findings demonstrate the positive influences of supportive social networks, perceived benefits, HIV-related knowledge, raising HIV awareness in communities, and impact of HIV state laws. The highlighted barriers were mainly low income, substance use, HIV-related stigma, influence of stereotypes and assumptions about older women living with HIV, and health insurance. Religion, managing comorbidities, attitude toward, HIV disclosure, and caregiving roles had both positive and negative influences on engagement. These findings illuminate factors of HIV treatment engagement that might be culturally founded; disseminating these factors to health care professionals is a critical intervention to support this population.
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Meanley S, Choi SK, Thompson AB, Meyers JL, D'Souza G, Adimora AA, Mimiaga MJ, Kempf MC, Konkle-Parker D, Cohen MH, Teplin LA, Murchison L, Rubin LH, Rubtsova AA, Weiss DJ, Aouizerat B, Friedman MR, Plankey MW, Wilson TE. Short-term binge drinking, marijuana, and recreational drug use trajectories in a prospective cohort of people living with HIV at the start of COVID-19 mitigation efforts in the United States. Drug Alcohol Depend 2022; 231:109233. [PMID: 34998247 PMCID: PMC8709730 DOI: 10.1016/j.drugalcdep.2021.109233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/23/2021] [Accepted: 10/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND At the start of the COVID-19 pandemic, HIV experts suggested that an increase in mental health diagnoses and substance use among people living with HIV (PLHIV) may be an unintended consequence of COVID-19 mitigation efforts (e.g., limiting social contact). We evaluated short-term trajectories in binge drinking, marijuana, and recreational drug use in a prospective cohort of PLHIV. METHODS Data (N = 2121 PLHIV) consist of survey responses on substance use behaviors from two pre-COVID-19 (October 2018-September 2019) and one COVID-19-era (April 2020-September 2020) timepoints within the MACS/WIHS Combined Cohort Study (MWCCS). We conducted group-based trajectory models, triangulated with generalized linear mixed models, to assess changes in binge drinking, daily marijuana use, and recreational drug use at the start of the pandemic. Controlling for age and race/ethnicity, we tested whether trajectories differed by sex and early-pandemic depressive symptoms, loneliness, and social support. RESULTS Group-based trajectory models yielded two trajectory groups for binge drinking (none vs. any), marijuana (none/infrequent vs. daily), and recreational drug use (none vs. any). Binge drinking and recreational drug use decreased at the beginning of the pandemic. Generalized linear mixed model supported these trends. Consistent with prior research, male sex and having depressive symptoms early pandemic were positively associated with each substance use outcomes. Social support was inversely associated with recreational drug use. CONCLUSIONS Contrary to hypotheses, problematic substance use behaviors decreased from pre-pandemic to the post-pandemic follow-up in our sample of PLHIV. Ongoing surveillance is needed to assess whether this pattern persists as the pandemic continues.
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Affiliation(s)
- Steven Meanley
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, PA, United States.
| | - Seul Ki Choi
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, PA, United States.
| | - Azure B Thompson
- SUNY Downstate Health Sciences University School of Medicine School of Public Health, Department of Community Health Sciences, Brooklyn, NY, United States.
| | - Jacquelyn L Meyers
- SUNY Downstate Health Sciences University School of Medicine, Department of Psychiatry, Brooklyn, NY, United States.
| | - Gypsyamber D'Souza
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States.
| | - Adaora A Adimora
- University of North Carolina School of Medicine, Division of Infectious Diseases, Chapel Hill, NC, United States.
| | - Matthew J Mimiaga
- University of California - Los Angeles Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, United States.
| | - Mirjam-Colette Kempf
- University of Alabama at Birmingham, School of Nursing, Medicine and Public Health Birmingham, AL, United States.
| | - Deborah Konkle-Parker
- The University of Mississippi Medical Center, Schools of Nursing, Medicine, and Population Health, Jackson, MS, United States.
| | - Mardge H Cohen
- Rush University Department of Medicine and Stroger Hospital of Cook County, Chicago, IL, United States.
| | - Linda A Teplin
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, United States.
| | - Lynn Murchison
- Albert Einstein College of Medicine/Montefiore Medical Center, Division of General Internal Medicine, Bronx, NY, United States.
| | - Leah H Rubin
- Johns Hopkins University School of Public Health, Department of Epidemiology, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Departments of Neurology and Psychiatry and Behavioral Sciences, Baltimore, MD, United States.
| | - Anna A Rubtsova
- Emory University Rollins School of Public Health, Department of Behavioral, Social, Health Education Sciences, Atlanta, GA, United States.
| | - Deborah Jones Weiss
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, United States.
| | - Brad Aouizerat
- New York University College of Dentistry, Department of Oral and Maxillofacial Surgery and Bluestone Center for Clinical Research, New York, NY, United States.
| | - Mackey R Friedman
- University of Pittsburgh Graduate School of Public Health, Department of Infectious Diseases and Microbiology, Pittsburgh, PA, United States.
| | - Michael W Plankey
- Georgetown University Medical Center, Division of Infectious Diseases, Washington, DC, United States.
| | - Tracey E Wilson
- SUNY Downstate Health Sciences University School of Public Health, Department of Community Health Sciences, Brooklyn, NY, United States.
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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Allen A, Zaviryukha I, Kiriazova T, Shenoi S, Rozanova J. The Lived Experience of a Newly Diagnosed Older Person With HIV in Ukraine. QUALITATIVE HEALTH RESEARCH 2021; 31:2290-2303. [PMID: 34414837 PMCID: PMC8930274 DOI: 10.1177/10497323211026914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Low- and middle-income countries are home to 80% of older people with HIV (OPWH). Ukrainian OPWH experience higher mortality and decreased antiretroviral therapy (ART) initiation than younger patients, but there is little data examining OPWH's perspectives around new diagnosis and impact on care. In this study, we examined accounts of 30 newly diagnosed OPWH in Ukraine, exploring challenges faced in the peri-diagnosis period. Themes emerged representing the longitudinal coping process: OPWH (1) viewed themselves as low risk before diagnosis; (2) experienced HIV diagnosis as a traumatic event challenging their self-image; (3) used disclosure to seek support among a small circle of family, friends, or health care providers; (4) avoided disclosure to outsiders including primary care providers for fears of stigma and breaches in confidentiality; (5) viewed age as an asset; and (6) used HIV diagnosis as starting point for growth. These findings highlight the need for age-specific programming to increase HIV knowledge and coping, increase screening, and improve long-term planning.
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Affiliation(s)
- Amy Allen
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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12
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Herron LM, Mutch A, Lui CW, Kruizinga L, Howard C, Fitzgerald L. Enduring stigma and precarity: A review of qualitative research examining the experiences of women living with HIV in high income countries over two decades. Health Care Women Int 2021; 43:313-344. [PMID: 34534051 DOI: 10.1080/07399332.2021.1959589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The lived experience of HIV for women remains poorly understood. In particular, there has been little attention to the consequences for women living with HIV (WLHIV) of changing social, epidemiological, biomedical and policy contexts, or to the implications of long-term treatment and aging for the current generation of HIV-positive women. We reviewed qualitative research with WLHIV in selected high-income countries (Australia, Canada, New Zealand, the UK and the USA) to identify the most prevalent experiences of HIV for women and trends over time. Our synthesis highlights the relative consistency of experiences of a diverse sample of WLHIV, particularly the enduring prevalence of gendered HIV-related stigma, sociostructural barriers to healthcare and support, and negative encounters with health professionals. We also identified gaps in knowledge. Understanding women's experiences, particularly their changing needs and strategies for coping as they live long-term with HIV, is key to effective support and services for WLHIV.
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Affiliation(s)
- Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Allyson Mutch
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Chi-Wai Lui
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lara Kruizinga
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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13
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Psychosocial Mechanisms of Self-rated Successful Aging with HIV: A Structural Equation Model. AIDS Behav 2021; 25:2875-2885. [PMID: 34115265 DOI: 10.1007/s10461-021-03340-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 02/06/2023]
Abstract
This study tested a conceptual psychosocial model of self-rated successful aging (SRSA) with HIV. Our sample (n = 356) included older women living with HIV (OWLH): average age 56.5 years, 73% Black. SRSA was assessed using a research-based 10-point scale (higher scores = better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables-protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and psychological distress (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ2(58) = 76, p = 0.06; RMSEA = 0.03; CFI = 0.99). Increased protective attributes were associated with improved SRSA both directly and mediated by improved coping with stress. While psychological distress did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes and via decreased coping with stress. Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors in OWLH.
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14
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Villegas N, Cianelli R, De Oliveira G, Toledo C, Jacobson F, Davenport E, Webb D, Wolf B. Exploring Intimate Partner Relationships before and after HIV Diagnosis among Minority Older Women. Clin Gerontol 2021; 44:273-287. [PMID: 33126832 DOI: 10.1080/07317115.2020.1838682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Literature shows that sexual activity remains important at older age and is a valued part of life. However, little is known about the intimate partner relationships (IPR) among minority older women living with Human Immunodeficiency Virus (HIV). The purpose of this study is to explore the effect HIV diagnosis had on the intimate partner relationships (IPR) among minority older women living with HIV (MOWH). METHODS Qualitative descriptive study. A total of 28 MOWH (Black and Latinas) aged 50 years and older participated in face to face semi-structured in-depth interviews. Interviews were analyzed using content analysis. RESULTS Three themes emerged from the analysis: (a)"Intimate partner relationships before HIV diagnosis" that revealed sexual practices increasing the risk for HIV in their intimate relationships; (b)"Facing relationship consequences of HIV disclosure after diagnosis" explored the consequences of HIV disclosure, and how disclosure determined the future of their intimate relationships; and (c) "Intimate partner relationships after HIV diagnosis" described the quality of intimate partner relationships and changes after HIV diagnosis. CONCLUSIONS Results from this study contribute to understanding and increasing awareness of the effect of HIV on the intimacy of MOWH. CLINICAL IMPLICATIONS Education provided by health care workers and interventions targeting MOWH should address the effect of HIV in IPR, address MOWH's concerns about it, and help them to improve their overall health.
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Affiliation(s)
- Natalia Villegas
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA.,School of Nursing, Pontificia Universidad Catolica de Chile
| | - Giovanna De Oliveira
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Christine Toledo
- College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Forest Jacobson
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Eloise Davenport
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Dana Webb
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Bryce Wolf
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
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15
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Siegler EL, Moxley JH, Glesby MJ. Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation. HIV AIDS (Auckl) 2021; 13:467-474. [PMID: 33958897 PMCID: PMC8096415 DOI: 10.2147/hiv.s306532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE People with HIV (PWH) are living longer lives and likely experiencing accentuated aging. Comprehensive geriatric assessment (CGA) has been proposed as a way to identify and help meet each individual patient's needs. PATIENTS AND METHODS We performed a retrospective review of the results of CGA in an HIV clinic in New York City. CGA included assessment of basic and instrumental activities of daily living, screens for depression, anxiety, frailty, cognition, and quality of life, along with general discussion of concerns and goals. We compared the group of PWH referred for CGA to those of comparable age who were not referred to determine the factors that were associated with referral. We carried out a descriptive analysis of those undergoing CGA, along with regression to determine factors associated with poorer PHQ-2 depression scores and higher VACS score. RESULTS A total of 105 patients underwent full CGA during the study period. Mean age of referred patients was 66.5 years, ranging from 50 to 84 years (SD 7.99). More than 92% were virally suppressed. Compared with their non-referred counterparts over 50, referred patients were older and had more functional comorbidities like cerebrovascular disease, neuropathy, and urinary incontinence. More than half complained of fatigue, and 2/3 noted poor memory. Almost 60% were frail or prefrail. Ninety patients were asked about their goals, and the most commonly cited were related to health or finances; fifteen patients were unable to articulate any goals. Having fewer goals and noting weight loss or fatigue were predictive of higher scores on the PHQ-2 depression screen. CONCLUSION Although most older PWH undergoing CGA can manage their ADL, many have concerns and deficits beyond their comorbidities. CGA offers an important window into the psychosocial concerns and needs of older PWH.
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Affiliation(s)
- Eugenia L Siegler
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Jerad H Moxley
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Marshall J Glesby
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, 10065, USA
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16
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Raggio G, Goodman G, Robbins GK, Looby SE, Labbe A, Psaros C. Developing a pilot lifestyle intervention to prevent cardiovascular disease in midlife women with HIV. HIV Res Clin Pract 2021; 22:1-13. [PMID: 33616022 DOI: 10.1080/25787489.2021.1883957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Background: Women with HIV (WWH) are at elevated risk for cardiovascular disease (CVD) compared to men with HIV. Lifestyle interventions, like the Diabetes Prevention Program (DPP), may reduce CVD risk, but most fail to address barriers to healthy behaviors facing WWH. OBJECTIVE Objective: To inform the adaptation of the DPP for midlife WWH, pilot the modified intervention, and assess feasibility, acceptability, and implementation barriers. METHODS Methods: Interviews were conducted with cisgender, English-speaking WWH ages 40-59 to assess intervention preferences. The adapted DPP was piloted and evaluated. CVD knowledge, CVD risk perception, quality of life, and physical activity were assessed pre- and post-intervention. RESULTS Results: Eighteen WWH completed interviews. Adaptations included reducing the number of sessions and adding HIV, CVD, stress, aging, menopause, and smoking content. Of 14 women contacted for the pilot, seven completed a baseline, five attended group sessions, and five completed a post-treatment assessment. Attendance barriers included transportation access and costs. Satisfaction was moderate; informal exit interviews indicated that women would recommend the program. CVD knowledge, perceived risk, and physical activity increased, and fatigue and mental health improved. Content on nutrition, aging, HIV, and stress was seen as most useful; suggested changes included group exercises and additional content on recipes, HIV management, and aging. CONCLUSIONS Conclusions: Midlife WWH reported benefits from our adapted intervention. Increases in CVD knowledge and perceived CVD risk suggest improved awareness of the impact of lifestyle behaviors. Retention was adequate; socioeconomic barriers were common. Intervention feasibility and acceptability may be improved via remote access and further content customization.
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Affiliation(s)
- Greer Raggio
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,National Center for Weight and Wellness, Washington, DC, USA
| | - Georgia Goodman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gregory K Robbins
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sara E Looby
- Metabolism Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Labbe
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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17
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Bhochhibhoya A, Harrison S, Yonce S, Friedman DB, Ghimire PS, Li X. A systematic review of psychosocial interventions for older adults living with HIV. AIDS Care 2020; 33:971-982. [PMID: 33300368 DOI: 10.1080/09540121.2020.1856319] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The rapidly growing segment of older adults living with HIV faces unique set of psychosocial challenges that may differ from their younger counterparts. The objective of this review is to systematically examine current published literature on interventions designed to improve the psychosocial wellbeing of older adults living with HIV. A pre-specified search strategy was applied to four databases: PubMed, CINAHL Plus with Text, PsycINFO, and Health Source. Authors reviewed published studies on psychosocial interventions for older adults with HIV and reported psychosocial variables as primary outcomes of the interventions. The final review included nine intervention studies. Psychosocial outcomes measured across multiple studies included depression, quality of life, social support, cognitive functioning, and coping skills. Some studies also measured physical activity, HIV-related discrimination, lack of affordable housing, and access to substance abuse treatment. Our study suggests a paucity of psychosocial intervention research on adults aging with HIV. This review suggests that most psychosocial interventions had small to moderate effects in improving the psychosocial wellbeing of older people living with HIV. Findings highlight the need for clinical, community, and home-based interventions to ensure that individuals can achieve a higher quality of life while aging with HIV.
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Affiliation(s)
| | - Sayward Harrison
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Pragya Sharma Ghimire
- Department of Physical Education and Exercise Science, Lander University, Greenwood, SC, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
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18
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Kteily-Hawa R, Warren L, Kazemi M, Logie CH, Islam S, Kaida A, Conway T, Persad Y, de Pokomandy A, Loutfy M. Examining Multilevel Factors Associated with the Process of Resilience among Women Living with HIV in a Large Canadian Cohort Study: A Structural Equation Modeling Approach. J Int Assoc Provid AIDS Care 2020; 18:2325958219871289. [PMID: 31552790 PMCID: PMC6900626 DOI: 10.1177/2325958219871289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: We examined how multiple, nested, and interacting systems impact the protective process
of resilience for women living with HIV (WLWH). Methods: Using data from a Cohort Study, we conducted univariate analyses, multivariable
logistic regression, and a 2-step structural equation modeling for the outcome, high
resilience (N = 1422). Results: Participants reported high overall resilience scores with a mean of 62.2 (standard
deviation = 8.1) and median of 64 (interquartile range = 59-69). The odds of having high
resilience were greater for those residing in Quebec compared to Ontario (adjusted odds
ratio [aOR] = 2.1 [1.6, 2.9]) and British Columbia (aOR = 1.8 [1.3, 2.5]). Transgender
women had increased odds of high resilience than cisgender women (aOR = 1.9 [1.0, 3.6]).
There were higher odds of resilience for those without mental health diagnoses (aOR =
2.4 [1.9, 3.0]), non-binge drinkers (aOR=1.5 [1.1, 2.1]), and not currently versus
previously injecting drugs (aOR = 3.6 [2.1, 5.9]). Structural equation modeling
confirmed that factors influencing resilience lie at multiple levels: micro, meso, exo,
and macro systems of influence. Conclusion: There is a need to consider resilience as the interaction between the person and their
environments, informing the development of multilevel interventions to support
resilience among WLWH.
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Affiliation(s)
- Roula Kteily-Hawa
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Faculty of Education, Queen's University, Kingston, Ontario, Canada
| | - Laura Warren
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Carmen H Logie
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Shazia Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Alliance for South Asian AIDS Prevention, Toronto, Ontario, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Tracey Conway
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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19
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Prevalence and Correlates of Self-Rated Successful Aging Among Older Women Living With HIV. J Acquir Immune Defic Syndr 2020; 82 Suppl 2:S162-S169. [PMID: 31658205 PMCID: PMC6830959 DOI: 10.1097/qai.0000000000002175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite marked gains in longevity attributable to antiretroviral therapy (ART), older women living with HIV (OWLH) experience substantial health challenges, and few studies addressed whether they can achieve successful aging (SA). This is among the first studies examining prevalence and psychosocial correlates of self-rated SA (SRSA) among OWLH and women at risk of HIV.
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20
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Kteily-Hawa R, Andany N, Wang Y, Logie CH, Tharao W, Conway T, Webster K, de Pokomandy A, Kaida A, Hogg R, Loutfy M. Quality of life of older women living with HIV: comparative assessment of physical and mental health-related markers using a large Canadian Sexual and Reproductive Health Cohort Study. HIV Res Clin Pract 2020; 20:35-47. [PMID: 31303141 DOI: 10.1080/15284336.2018.1554373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: This study assessed and compared physical and mental health components of quality of life (QoL) for older and younger women living with HIV (WLWH). Method: Using survey data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study, demographic, well-being, and physical and mental health-related QoL (HR-QoL) variables were compared between older (≥50 years) and younger (<50 years) WLWH. As the only significantly different QoL component, bivariate analyses and linear regression were used to assess factors associated with physical HR-QoL of older women. Results: The sample frame comprised 1,422 women (28.0% older women). Younger WLWH's mean age was 37.8 years (SD = 7.4) compared to older WLWH (55.8 years, SD = 5.3). Compared to younger WLWH, older WLWH had poorer physical HR-QoL (40.0 vs. 50.7; p < 0.001) but similar mental HR-QoL (42.7 vs. 42.1; p > 0.001). Older WLWH had lower social support (p < 0.001) with no significant differences in depressive symptoms or resilience. Resilience was associated with improved physical HR-QOL. Food insecurity, poorer mental HR-QoL and depressive symptoms were associated with poorer physical health. Discussion: Compared to younger WLWH, older WLWH had poorer physical HR-QoL, which was associated with resilience, food insecurity and mental health factors, highlighting the complex interactions of health-related social-ecological factors impacting aging WLWH.
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Affiliation(s)
- Roula Kteily-Hawa
- a Women's College Research Institute, University of Toronto , Toronto , Ontario , Canada.,b Faculty of Education , Queen's University , Kingston , Ontario , Canada
| | - Nisha Andany
- c Division of Infectious Diseases , Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada.,d Department of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Ying Wang
- e Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Carmen H Logie
- a Women's College Research Institute, University of Toronto , Toronto , Ontario , Canada.,e Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Wangari Tharao
- f Women's Health in Women's Hands , Toronto , Ontario , Canada
| | - Tracey Conway
- a Women's College Research Institute, University of Toronto , Toronto , Ontario , Canada.,g Canadian Positive People Network , Dunrobin , Ontario , Canada
| | - Kath Webster
- h Faculty of Health Sciences , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Alexandra de Pokomandy
- i Department of Family Medicine , McGill University , Montreal , Québec , Canada.,j Chronic Viral Illness Service , McGill University Health Centre , Montreal , Québec , Canada
| | - Angela Kaida
- h Faculty of Health Sciences , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Robert Hogg
- h Faculty of Health Sciences , Simon Fraser University , Vancouver , British Columbia , Canada.,k BC Centre for Excellence in HIV/AIDS , Vancouver , British Columbia , Canada
| | - Mona Loutfy
- a Women's College Research Institute, University of Toronto , Toronto , Ontario , Canada.,d Department of Medicine , University of Toronto , Toronto , Ontario , Canada
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21
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Marg LZ, Ruiz G, Chagolla F, Cabral A, Taylor J, Christensen C, Martin M, Picou B, Brown B. "We are becoming older women and then we have two stigmas": voicing women's biopsychosocial health issues as they age with HIV. J Women Aging 2020; 32:365-388. [PMID: 32310730 DOI: 10.1080/08952841.2020.1751566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In April 2019, nine older women (age 50+) living with HIV in Palm Springs, California, participated in a 90-minute focus group to identify their major health issues, strengths, and HIV and aging-related health priorities. Using the rigorous and accelerated data reduction (RADaR) technique, we identified four major themes: (1) mental health, (2) HIV comorbidities, (3) social determinants of health, and (4) resiliencies. These results reinforce the need to conduct additional research focused on women aging with HIV, an understudied population that requires more effective, tailored interventions to promote better quality of life and healthy aging.
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Affiliation(s)
- Logan Z Marg
- Department of Sociology, University of California, Riverside , Riverside, California, USA
| | - Griselda Ruiz
- Department of Public Health, University of California, San Diego , San Diego, California, USA
| | - Fidel Chagolla
- Department of Sociology, University of California, Riverside , Riverside, California, USA
| | - Alejandra Cabral
- Department of Community Health Sciences, UCLA Fielding School of Public Health , Los Angeles, California, USA
| | - Jeff Taylor
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA
| | - Chris Christensen
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA
| | - Marjorie Martin
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA
| | - Bridgette Picou
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA.,Desert AIDS Project , Palm Springs, California, USA
| | - Brandon Brown
- Center for Healthy Communities, School of Medicine, University of California, Riverside , Riverside, California, USA
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22
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Halpin SN, Ge L, Mehta CC, Gustafson D, Robertson KR, Rubin LH, Sharma A, Vance D, Valcour V, Waldrop-Valverde D, Ofotokun I. Psychosocial Resources and Emotions in Women Living With HIV Who Have Cognitive Impairment: Applying the Socio-Emotional Adaptation Theory. Res Theory Nurs Pract 2020; 34:49-64. [PMID: 31937636 PMCID: PMC8062986 DOI: 10.1891/1541-6577.34.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Decreased cognitive function is related to undesirable psychological outcomes such as greater emotional distress and lower quality of life, particularly among women living with HIV who experience cognitive impairment (WLWH-CI). Yet, few studies have examined the psychosocial resources that may attenuate these negative emotional outcomes. The current study sought to identify the interrelated contributions of social relationships and psychological resources in 399 WLWH-CI by applying Socio-Emotional Adaptation (SEA) theory using data from the Women's Interagency HIV Study (WIHS). Cognitive impairment (CI) was defined as impairment on two or more cognitive domains. Logistic regression models were used to estimate the odds of experiencing specific emotions due to a combination of four psychosocial resources. Emotions (i.e., depression, apathy, fear, anger, and acceptance) were related to a combination of binary (positive/negative) psychosocial resources including relationship with an informal support partner, relationship with a formal caregiver, coping, and perceived control. Understanding the conditions that may influence emotions in WLWH-CI is important for identifying and appropriately addressing the needs of this population. As CI increases, these individuals experience increasing challenges with articulating their care needs and having their needs met. As such, it becomes increasingly important to identify possible triggers for emotional responses to best address these underlying challenges.
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Affiliation(s)
| | - Lin Ge
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Christina C Mehta
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | | | - Kevin R Robertson
- AIDS Neurological Center, Department of Neurology.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leah H Rubin
- Departments of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Anjali Sharma
- Albert Einstein College of Medicine, Yeshiva University, New York, NY
| | - David Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Victor Valcour
- Global Brain Health Institute, San Franscisco, CA.,Department of Neurology, University of California San Fransisco, San Fransisco, CA
| | | | - Igho Ofotokun
- Emory University School of Medicine, Division of Infectious Disease, Atlanta, GA
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23
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Chen D, Duan L, Chen X, Zhang Q, Chen Y, Yuan Z, Li X. Coping strategies and associated factors among older Chinese people living with HIV/AIDS. PSYCHOL HEALTH MED 2019; 25:898-907. [PMID: 31452383 DOI: 10.1080/13548506.2019.1659983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Coping strategies play a prominent role in maintaining mental health, but little is known about the main coping strategies and potential influential factors among older Chinese adults with HIV/AIDS. Cross-sectional data of 254 older with HIV/AIDS aged 50 ~ 84 years (160 males and 94 females) from Hunan, China were analyzed to evaluate influential factors associated with coping strategies. The scores of all participants in the different sub-scales of confrontation, avoidance and acceptance-resignation were 15.16 ± 4.03, 16.44 ± 2.70, and 11.06 ± 4.00, respectively. For the confrontation coping strategy, higher scores were obtained by those with a higher education level, non-sexually transmitted HIV, and a first diagnosis at less than 50 years old. Avoidance as a coping strategy was significantly associated with a longer period living with the diagnosis. The participants who were females, unemployed, annual income less than 1000 yuan, had lived with HIV for a longer period, and had disclosed their infection status to their family members were more likely to adopt the acceptance-resignation coping strategy in response to HIV/AIDS. These preliminary findings can provide evidence for effective interventions to improve coping capacity and psychological status in this population.
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Affiliation(s)
- Dan Chen
- Xiang Ya School of Public Health, Central South University , Changsha, People's Republic of China
| | - Luxi Duan
- Xiang Ya School of Public Health, Central South University , Changsha, People's Republic of China
| | - Xi Chen
- Department of AIDS/STD Control and Prevention, Hunan Provincial Center for Disease Prevention and Control , Changsha, People's Republic of China
| | - Qiang Zhang
- Xiang Ya School of Public Health, Central South University , Changsha, People's Republic of China
| | - Yingyi Chen
- Xiang Ya School of Public Health, Central South University , Changsha, People's Republic of China
| | - Zhipei Yuan
- Xiang Ya School of Public Health, Central South University , Changsha, People's Republic of China
| | - Xingli Li
- Xiang Ya School of Public Health, Central South University , Changsha, People's Republic of China
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24
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Dopaminergic impact of cART and anti-depressants on HIV neuropathogenesis in older adults. Brain Res 2019; 1723:146398. [PMID: 31442412 DOI: 10.1016/j.brainres.2019.146398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 01/21/2023]
Abstract
The success of combination antiretroviral therapy (cART) has transformed HIV infection into a chronic condition, resulting in an increase in the number of older, cART-treated adults living with HIV. This has increased the incidence of age-related, non-AIDS comorbidities in this population. One of the most common comorbidities is depression, which is also associated with cognitive impairment and a number of neuropathologies. In older people living with HIV, treating these overlapping disorders is complex, often creating pill burden or adverse drug-drug interactions that can exacerbate these neurologic disorders. Depression, NeuroHIV and many of the neuropsychiatric therapeutics used to treat them impact the dopaminergic system, suggesting that dopaminergic dysfunction may be a common factor in the development of these disorders. Further, changes in dopamine can influence the development of inflammation and the regulation of immune function, which are also implicated in the progression of NeuroHIV and depression. Little is known about the optimal clinical management of drug-drug interactions between cART drugs and antidepressants, particularly in regard to dopamine in older people living with HIV. This review will discuss those interactions, first examining the etiology of NeuroHIV and depression in older adults, then discussing the interrelated effects of dopamine and inflammation on these disorders, and finally reviewing the activity and interactions of cART drugs and antidepressants on each of these factors. Developing better strategies to manage these comorbidities is critical to the health of the aging, HIV-infected population, as the older population may be particularly vulnerable to drug-drug interactions affecting dopamine.
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George Dalmida S, Kraemer KR, Ungvary S, Di Valerio E, Koenig HG, Holstad MM. The Psychosocial and Clinical Well-Being of Women Living with Human Immunodeficiency Virus/AIDS. Nurs Clin North Am 2019; 53:203-225. [PMID: 29779514 DOI: 10.1016/j.cnur.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study examined factors impacting the psychological well-being of women living with human immunodeficiency virus/AIDS and the impact of depression on clinical outcomes. Nearly two-thirds of participants in this cross-sectional study reported significant depressive symptoms. Compared with women living with human immunodeficiency virus/AIDS without depressive symptoms, those with depression reported significantly poorer health outcomes. Health care providers should regularly screen these women for and adequately treat depression, and must collaborate with mental health providers and pastoral care counselors to address the mental health needs of women living with human immunodeficiency virus/AIDS to optimize their human immunodeficiency virus-related outcomes.
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Affiliation(s)
- Safiya George Dalmida
- University of Alabama, Capstone College of Nursing, 650 University Boulevard, Tuscaloosa, AL 35487, USA.
| | - Kyle R Kraemer
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Stephen Ungvary
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Elizabeth Di Valerio
- Department of Biological Sciences, University of Alabama, Box 870344, Tuscaloosa, AL 35487, USA
| | - Harold G Koenig
- Department of Psychiatry, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA; Department of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Marcia McDonnell Holstad
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA
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Schneiderman N, McIntosh RC, Antoni MH. Psychosocial risk and management of physical diseases. J Behav Med 2019; 42:16-33. [PMID: 30632000 PMCID: PMC6941845 DOI: 10.1007/s10865-018-00007-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/18/2018] [Indexed: 12/24/2022]
Abstract
During the 40 years since the Yale conference on Behavioral Medicine and the founding of the Journal of Behavioral Medicine considerable progress has been made in understanding the role of psychosocial risk and management of physical diseases. We here describe the development of these fundamental concepts from early research on stress through studies of the Type A behavior pattern to more contemporary approaches to the relationship between psychosocial risks and benefits in relation to disease processes. This includes the relationship of psychosocial risk to cancers, cardiovascular diseases (CVD), cardiometabolic disorders, Human Immunodeficiency Virus (HIV)/Acquired Human Immune Deficiency Syndrome. During the past 40 years the effects of prolonged distress responses in the pathogenesis of some cancers and CVD have been well-established and modifiable behavioral, cognitive and social factors have been shown to produce favorable outcome components in the management of such diseases as breast cancer, coronary heart disease and HIV.
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Affiliation(s)
- Neil Schneiderman
- Health Division, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33124, USA.
| | - Roger C McIntosh
- Health Division, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33124, USA
| | - Michael H Antoni
- Health Division, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33124, USA
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Siedner MJ. Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework. J Aging Health 2017; 31:109-138. [PMID: 28831864 DOI: 10.1177/0898264317724549] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. METHODS A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. RESULTS We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. CONCLUSIONS Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.
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Affiliation(s)
- Mark J Siedner
- 1 Harvard Medical School, Boston, MA, USA.,2 Massachusetts General Hospital, Boston, MA, USA.,3 Mbarara University of Science and Technology, Mbarara, Uganda
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