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Mangum LC, Aidoo-Frimpong G, Alexander I, Waddell A, Whitfield DL. "We Take Care of Our Young, No Matter What," Experiences of Engagement in HIV Care Among Black Mothers Parenting Dependent Children in Southwestern Pennsylvania: A Retrospective Descriptive Qualitative Study. J Assoc Nurses AIDS Care 2024:00001782-990000000-00103. [PMID: 38574350 DOI: 10.1097/jnc.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT This retrospective descriptive study sought to explore the lived experiences of Black mothers with HIV navigating HIV medical care while parenting dependent children. Six themes were generated from the semi-structured interviews conducted with mothers (N = 9) related to motherhood, interactions with health care systems and providers, coping, social support, HIV self-management, and HIV prevention. Findings suggested that supportive interpersonal relationships with HIV health care providers, HIV nondisclosure to family and friends, and social network support, inclusive of health care providers, were protective factors in achieving optimal treatment adherence and viral suppression. Findings may inform interventions for improving social support and reducing stigma in HIV care for Black mothers with HIV who are parenting dependent children.
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Affiliation(s)
- Laurenia C Mangum
- Laurenia Mangum, PhD, MPH, LMSW, is an Assistant Professor, Jane Addams College of Social Work, University of Illinois, Chicago, Illinois, USA. Gloria Aidoo-Frimpong, PhD, MPH, MA, is a Postdoctoral Fellow, Center for Interdisciplinary Research on AIDS, Yale AIDS Prevention Program, Yale School of Public Health, New Haven, Connecticut, USA. Ivana Alexander, MSW, MEd, LICSW, is a Doctoral Candidate, University of Maryland School of Social Work, Baltimore, Maryland, USA. Ashley Waddell, LCSW, is a Licensed Clinical Social Worker and Executive Director of Wholistic Alignment, LLC, Richmond, Virginia, USA. Darren L. Whitfield, PhD, MSW, is an Associate Professor, University of Maryland School of Social Work, Baltimore, Maryland, USA
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Moore ED, Caiola C, Cary M, Humphreys J. A Qualitative Study of the Social Relationship Experiences Across the Life Course Among Black/African American Women Aging With HIV in the South. J Assoc Nurses AIDS Care 2024:00001782-990000000-00091. [PMID: 38261540 DOI: 10.1097/jnc.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
ABSTRACT Black/African American women continue to be disproportionately affected by HIV, facing multiple intersecting challenges that influence how they age and effectively manage their health. Supportive social relationships have been shown to help mitigate challenges and improve health in women with HIV, but little is known about Black/African American women's perceptions of social relationships. Guided by Life Course Theory, in-depth life history interviews were conducted with 18 Black/African American women aged 50+ years. In older adulthood, most important relationships among Black/African American women were with their adult children and grandchildren, intimate partners, God, and friends from the community. Factors that influenced relationships over time included: (a) a desire to build a community; (b) a need to empower oneself and give back; (c) yearning to engage the younger generation; and (d) battling HIV stigma. Older Black/African American women with HIV played a critical role in the education of the younger generation.
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Affiliation(s)
- Elizabeth D Moore
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
| | - Courtney Caiola
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
| | - Michael Cary
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
| | - Janice Humphreys
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
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Nawfal ES, Gray A, Sheehan DM, Ibañez GE, Trepka MJ. A Systematic Review of the Impact of HIV-Related Stigma and Serostatus Disclosure on Retention in Care and Antiretroviral Therapy Adherence Among Women with HIV in the United States/Canada. AIDS Patient Care STDS 2024; 38:23-49. [PMID: 38150524 PMCID: PMC10794841 DOI: 10.1089/apc.2023.0178] [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] [Indexed: 12/29/2023] Open
Abstract
This systematic review explores the roles of HIV stigma and disclosure of HIV serostatus in antiretroviral therapy (ART) adherence and retention in care (RIC) among women with HIV (WHIV) in the United States and Canada. We conducted a systematic search of electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Google scholar) to identify peer-reviewed articles published between January 1996 and December 2022. The search yielded 1120 articles after duplicates were removed. Of these, 27 articles met the inclusion criteria. The majority (89%) of the studies were conducted in the United States. The studies included WHIV from diverse racial/ethnic groups, residing in both urban and rural areas. Most of the studies suggested that internalized stigma, perceived community stigma, and fear of disclosure were important barriers to ART adherence and RIC among WHIV. HIV-related stigma experienced within the health care setting was also reported as a factor impacting health care utilization. A few studies identified mental health distress as a potential mechanism accounting for the association and suggested that social support and resilience may buffer the negative effects of stigma and disclosure on ART adherence and RIC among WHIV. Our review indicates that stigma and concerns about disclosure continue to significantly affect HIV health outcomes for WHIV in high-income countries. It underscores the importance of integrated HIV care services and interventions targeting mental health, resilience building, and improved patient-provider relationships for WHIV to enhance ART adherence and RIC. Longitudinal studies and investigations into additional mechanisms are needed to advance understanding and inform women-centered interventions.
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Affiliation(s)
- Ekpereka Sandra Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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Small LA, Godoy SM, Lau C. Perceptions of healthcare accessibility and medical mistrust among Black women living with HIV in the USA. CULTURE, HEALTH & SEXUALITY 2023; 25:1295-1309. [PMID: 36571392 PMCID: PMC10558086 DOI: 10.1080/13691058.2022.2155706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Black women living with HIV in the USA frequently endure structural racism, racial biases and discrimination in healthcare that affect their access to care. To explore their experiences in healthcare settings as they relate to HIV-treatment accessibility and medical mistrust we used intersectionality and structural intersectionality as guiding frameworks. Four focus groups were conducted with 20 low-income Black women living with HIV in a large urban region. Using thematic analysis, we identified four themes: (1) multilevel stigma and discrimination; (2) medical mistrust of providers across multiple settings; (3) varying responses to stigma, discrimination, and medical mistrust; and (4) preferences for patient-provider relationships. Participants described how medical providers, nurses and other healthcare staff perpetuated negative treatment, including multiple forms of discrimination and stigmatisation based on their HIV diagnosis, race, class and gender. The stigma, discrimination and resulting mistrust experienced often caused hurt feelings and decisions to disengage from treatment or remain with providers while feeling unwelcome. Participants described the strong desire to feel seen, supported and validated by healthcare providers. Narratives reveal that feelings of being discriminated against can cultivate mistrust not only towards doctors, but other provider types and settings. Findings can inform care models for low-income Black women living with HIV.
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Affiliation(s)
- Latoya A. Small
- Luskin School of Public Affairs, Department of Social Welfare, University of California, Los Angeles, California, USA
| | - Sarah M. Godoy
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caitlin Lau
- Luskin School of Public Affairs, Department of Social Welfare, University of California, Los Angeles, California, USA
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Sommer S, Barroso J. A qualitative metasynthesis of stigma in women living with HIV in the United States. Int J Equity Health 2023; 22:158. [PMID: 37605194 PMCID: PMC10441719 DOI: 10.1186/s12939-023-01969-5] [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: 06/08/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
Our goal was to synthesize qualitative studies on HIV-related stigma as experienced by women living with HIV (WLWH) in the U.S. Qualitative metasynthesis techniques as developed by Sandelowski et al. (Res Nurs Health 30(1):99-111, 2007) were used to integrate and update findings on stigma in WLWH in the U.S. in 43 reports of qualitative studies conducted between 2004 and 2023 with 1118 participants. Developed themes explored a collective narrative of women first surviving the intersectionality of multiple sources of stigma, discovering non-linear pathways to transcend their stigma, and finally experiencing resilience through their transcendence of stigma. While this metasynthesis revealed similarities to an earlier metasynthesis in the ubiquity and persistence of stigma, they differ primarily in women's abilities to find agency in managing and opposing their stigma. This cognitive reframing of their stigma helped women to redefine stigma as ignorance and move towards a more positive assessment of the self. In doing so, they separated themselves from their stigma and the damaging effects of it. Findings from this metasynthesis may serve as a useful tool for the development of stigma reduction interventions specific to the needs and experiences of WLWH in the U.S.
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Affiliation(s)
- Sadie Sommer
- School of Nursing, Vanderbilt University, 461 21st Ave, S, Nashville, TN, 37240, USA.
| | - Julie Barroso
- School of Nursing, Vanderbilt University, 461 21st Ave, S, Nashville, TN, 37240, USA
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Goldstein MH, Moore S, Mohamed M, Byrd R, Curtis MG, Rice WS, Camacho-Gonzalez A, Zanoni BC, Hussen SA. A qualitative analysis examining intersectional stigma among young adults living with HIV in Atlanta, Georgia. PLoS One 2023; 18:e0289821. [PMID: 37561729 PMCID: PMC10414665 DOI: 10.1371/journal.pone.0289821] [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: 01/20/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
HIV-related stigma is a barrier to engagement in care for young adults living with HIV. Other intersecting forms of stigma (e.g., racism, sexism, homophobia), may worsen HIV-related stigma and impact engagement in care. From November 2020 to February 2021, we conducted 20 in-depth qualitative interviews among young adults living with HIV attending a large, comprehensive HIV care center in Atlanta, Georgia. Semi-structured interview guides based on Earnshaw and Chaudoir's HIV Stigma Framework and the theory of intersectionality facilitated discussion around experiences with various forms of stigma and its possible influence on healthcare engagement. Using the social-ecological model, we used thematic analysis to contextualize how young adults living with HIV experienced intersectional stigma and enacted, anticipated, and internalized HIV stigma in both healthcare and non-healthcare settings. Most participants identified as male, Black/African American, and gay. Participants described stigma at intrapersonal, interpersonal, clinic, and community levels. Intrapersonal stigma was associated with delayed care seeking, isolation, and fear of disclosure. Interpersonal stigma included discrimination from family and friends and avoidance of close relationships to elude disclosure. At the clinic level, stigma included negative experiences with staff in HIV and non-HIV healthcare settings, which contributed to decreased engagement in care. Stigma in the community included differential treatment from employers, community leaders, and religious community and was associated with feelings of helplessness related to current societal inequalities. Coping/motivating mechanisms for stigma included prioritizing health, eliciting support from the medical care team and peers. Our findings show different intersecting stigmas are barriers to healthcare at multiple levels for young adults living with HIV, potentially exacerbating existing health and social disparities. To improve engagement in care among young adults living with HIV, future interventions should address the different mechanisms of stigma at community, clinic, interpersonal and intrapersonal levels by enhancing social support and improving healthcare structural competency.
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Affiliation(s)
- Madeleine H. Goldstein
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Shamia Moore
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Munira Mohamed
- College of Arts and Sciences, Emory University, Atlanta, GA, United States of America
| | - Rosalind Byrd
- School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Michael G. Curtis
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Andres Camacho-Gonzalez
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Brian C. Zanoni
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Sophia A. Hussen
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Bryant JV, Carcioppolo N, Lun D, Potter J. Entertainment-education to reduce internalized stigma, increase intimate partner status disclosure intentions, and increase antiretroviral medical adherence intentions: A randomized controlled trial targeting black women living with HIV in the Southern U.S. Soc Sci Med 2023; 327:115945. [PMID: 37182297 DOI: 10.1016/j.socscimed.2023.115945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Black women in the Southern U.S. account for 67% of all new HIV diagnoses across women of all races and ethnicities. In comparison to women of other racial and ethnic identities, Black women disproportionately experience internalized stigma, lower levels of disclosure self-efficacy, and lower rates of medical adherence. The disclosure processes model hypothesizes that persons living with HIV can be disclosure avoidance oriented or disclosure approach oriented. Disclosure avoidance is facilitated by various forms of stigma and negative outcome expectations. While disclosure approach orientation is facilitated by factors such as positive disclosure attitudes and disclosure self-efficacy. Despite the important role of disclosure in ending the HIV epidemic, extant interventions are limited. Recent research suggests entertainment-education (EE) may be an effective intervention for HIV status disclosure. Entertainment-education is a persuasive strategy that consists of intentionally embedding health and social messages into entertaining content. METHODS The present study evaluated the comparative efficacy of the 90 DAYS film for improving internalized HIV stigma, disclosure beliefs, positive disclosure attitudes, disclosure self-efficacy, HIV disclosure intentions, and medical adherence intentions. A randomized controlled trial was employed consisting of 130 Black women living with HIV in the Southern U.S. Participants were recruited primarily via a Qualtrics panel and randomly assigned to either view the 90 DAYS film or a standard of care brochure. RESULTS Results indicated the EE condition significantly outperformed the brochure condition on the following outcomes: disclosure beliefs (p = .046), positive disclosure attitudes (p = .008), disclosure self-efficacy (p = .007), and intentions to disclose to an intimate partner (p = .038). Statistically significant differences were not observed for internalized stigma or medical adherence intentions. CONCLUSION Findings suggest that EE is an effective strategy for improving psychosocial influences of disclosure and disclosure intentions. Theoretical and practical implications of this work are discussed.
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Affiliation(s)
- Jazmyne V Bryant
- Division of Health Science, Florida A&M University, 334 Palmer Avenue, Tallahassee, FL, 32307, USA.
| | - Nick Carcioppolo
- Dept of Communication Studies, University of Miami, 5100 Brunson Dr, Coral Gables, FL, 33146, USA
| | - Di Lun
- Dept of Health Disparities Research, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - JoNell Potter
- Dept of Obstetrics and Gynecology, University of Miami, 8932 SW 97th Ave, Miami, FL, 33176, USA
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Philbin MM, Menza TW, Legrand SH, Muessig KE, Hightow-Weidman L. Structural-Level Racial-, Sexual Orientation-, and HIV-Related Discrimination and Subsequent Criminal Justice Involvement Among Young, Black, Men Who Have Sex With Men in North Carolina. STIGMA AND HEALTH 2023; 8:170-178. [PMID: 37456791 PMCID: PMC10348694 DOI: 10.1037/sah0000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Multiple aspects of Black young men who have sex with men's (YMSM) identities cause them to be differentially targeted for arrest and incarceration. However, limited research has explored structural drivers of Black YMSM' criminal justice involvement, particularly co-occurring forms of discrimination. This article examines the temporal relationship between perceived racial discrimination, perceived sexual orientation discrimination, and community-level HIV discrimination and criminal justice involvement among Black YMSM in North Carolina. The study followed 465 Black YMSM from November 2013 to October 2016 who were recruited for a randomized controlled trial to test an internet-based intervention for Black YMSM living with, and at risk for HIV; participants completed online surveys at baseline, 3, 6, and 12 months. Logistic regression was used to explore the relationship between the three predictors at baseline (i.e., perceived racism and sexual orientation discrimination and community-level HIV discrimination) and criminal justice involvement at follow-up. All three predictor variables were significantly associated with subsequent criminal justice involvement in separate regression models that adjusted for other covariates: HIV discrimination (aOR = 1.06 [1.01-1.11]), perceived sexual orientation discrimination (aOR = 1.12 [1.00-1.27]), and perceived racism (aOR = 1.26 [1.12-1.42]). Perceived racism remained significant in the model with all three predictors (aOR = 1.29 [1.07-1.55]). Racism did not modify the relationship between HIV discrimination and perceived sexual orientation discrimination and criminal justice involvement. This study expands existing research by exploring racism as a structural driver of criminal justice involvement; we subsequently examined whether racism modified the effect of the two other predictors. It also contributes to research on co-occurring discrimination by examining their impact on an underrepresented population.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health
| | | | | | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill
| | - Lisa Hightow-Weidman
- Division of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill
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9
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Religiosity and Engagement in HIV Care Among African American People Living with HIV. J Racial Ethn Health Disparities 2023; 10:560-572. [PMID: 35079959 DOI: 10.1007/s40615-022-01246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
HIV continues to disproportionately impact Black/African Americans. New and innovative strategies are needed to increase and enhance engagement in HIV care. The Black/African American church is a powerful institution with the potential to enhance HIV care among congregants. This study examines perceptions on incorporating religiosity into engagement in HIV care for African Americans living with HIV among Black/African Americans persons living with HIV, church leaders and members, and HIV health and service providers. Findings indicated Black/African Americans living with HIV would be willing to engage in religiously tailored, joint church-health initiatives to increase engagement in care. Church leaders and members and HIV health and service providers also reported a willingness to provide religiously tailored services, and that providing these services would be both acceptable and feasible for implementation. These findings should be considered in future research designed to enhance engagement in HIV care for Black/African Americans living with HIV.
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Khan M, MacEntee K, Kiptui R, Van Berkum A, Oudshoorn A, Ayuku DO, Apondi E, Lee EOJ, Abramovich A, MacDonald SA, Braitstein P. Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya. BMC Public Health 2022; 22:1901. [PMID: 36224566 PMCID: PMC9555255 DOI: 10.1186/s12889-022-14290-7] [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: 12/17/2021] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services. Methods Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM). Results Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services. Conclusion Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14290-7.
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Affiliation(s)
- Momina Khan
- Division of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Katie MacEntee
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Reuben Kiptui
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Amy Van Berkum
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - David O Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Alex Abramovich
- Division of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Division of Child and Youth Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, ON, Canada. .,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. .,Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Eldoret, Kenya.
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11
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Moseholm E, Wilken-Jensen C, Weis N. HIV-related stigma among healthcare providers working within infectious diseases and gynecology and obstetrics at a large teaching hospital in Denmark. AIDS Care 2022; 35:705-713. [PMID: 36161975 DOI: 10.1080/09540121.2022.2121955] [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: 10/14/2022]
Abstract
HIV-related stigma experienced in healthcare settings may be particularly detrimental to people with HIV (PWH). This study aims to examine the drivers of stigma and enacted HIV-related stigma among healthcare providers working in HIV and non-HIV care at a large teaching hospital in Denmark. In total, 162 providers working in gynecology and obstetrics, and 57 providers working in infectious diseases completed the "Measuring HIV stigma and discrimination among health facility staff" questionnaire. Compared to providers working in infectious diseases, providers working in gynecology and obstetrics had less training in infection control, HIV, and stigma, and although their level of worry and negative attitudes toward PWH was overall low, they were more like to use extra precaution measures (e.g., double gloves) when caring for PWH (20% versus 0%). Addressing HIV-related stigma in healthcare is important, as any amount of HIV-related stigma from providers has the potential to compromise the patients' engagement in care and health outcomes.
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Affiliation(s)
- E Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark.,Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - C Wilken-Jensen
- Department of Gynecology and Obstetrics, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - N Weis
- Department of Infectious Diseases, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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12
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Ali S, Stanton M, Keo BS, Stanley M, McCormick K. HIV and Mental Health Services in the US South: A Meso Analysis. Community Ment Health J 2022; 58:1146-1156. [PMID: 35048220 DOI: 10.1007/s10597-021-00925-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023]
Abstract
The US South is disproportionately impacted by HIV. Social, cultural, economic, and political characteristics of the South shape access to mental health services leaving adverse impacts on health and wellness outcomes among People Living with HIV. The aim of this paper was to: (a) identify meso factors (at individual, organizational and community-level manifestations) which impact mental health services among People living with HIV in the South of those factors and (b) pose community-articulated recommendation and strategies. Through qualitative interviews with People Living with HIV and service providers, this study found that the meso factors of restricted funding and compounding stigma shaped mental health services in the South. Given the disproportionate rate of HIV, lack of mental health care, and landscape of socio-political factors unique to the region, attention to intervenable meso factors and community-based strategies are needed to enhance mental health services and respond to the HIV epidemic in the US South.
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Affiliation(s)
- Samira Ali
- University of Houston Graduate College of Social Work, 3511 Cullen Blvd., Room 402, Houston, TX, 77204-4013, USA.
| | - Megan Stanton
- Eastern Connecticut State University, Social Work, Willimantic, CT, USA
| | - Bec Sokha Keo
- University of Houston Graduate College of Social Work, Houston, TX, USA
| | - Marcus Stanley
- University of Houston Graduate College of Social Work, Houston, TX, USA
| | - Katie McCormick
- University of Houston Graduate College of Social Work, Houston, TX, USA
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Bailey DE, Caiola C, Adimora AA, Ramirez C, Holt L, Johnson R, Koch A, McGee K, McMillian-Bohler JM, Randolph SD, Ritchwood TD, Relf MV. Adaptive Challenges, Adaptive Work, and Adaptive Leadership Among Women Living With HIV in the Southern United States: Findings From a Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:259-269. [PMID: 35500057 PMCID: PMC9244859 DOI: 10.1097/jnc.0000000000000288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Women living with HIV have a higher burden of non-AIDS comorbidities and prevalence of chronic conditions. The Adaptive Leadership Framework for Chronic Illness clarifies living with complex health challenges by delineating the technical work of health care providers as well as the adaptive work and leadership behaviors of patients and their providers. We conducted a descriptive, qualitative study of women residing in the Southern United States who were participating in the Women's Interagency HIV Study in North Carolina. Twenty-two participants (mean age = 52.2 years; 90.9% self-identifying as Black or African American) completed semi-structured qualitative interviews. We identified adaptive challenges (e.g., affective and disclosure challenges) and adaptive work and leadership behaviors. Women learned skills to care for their health and support their families and to work with their providers to manage their care. Findings support the importance of identifying leadership behaviors for the purpose of developing person-centered interventions.
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Affiliation(s)
- Donald E. Bailey
- Duke University School of Nursing, Durham, North Carolina, USA. Courtney Caiola
| | - Courtney Caiola
- East Carolina University, School of Nursing, Greenville, North Carolina, USA
| | - Adaora A. Adimora
- Sarah Graham Kenan Distinguished Professor of Medicine, School of Medicine, and Professor of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- School of Medicine, and Project Director, Women’s Interagency HIV Study, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lauren Holt
- Duke University School of Nursing, Durham, NorthCarolina, USA
| | - Ragan Johnson
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Amie Koch
- Duke University School of Nursing, and Palliative Care and Hospice Family Nurse Practitioner, Transitions LifeCare, and a COVID Nurse Practitioner, Lincoln Community Health Clinic, Durham, North Carolina, USA
| | - Kara McGee
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | | | - Tiarney D. Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham,NorthCarolina,USA
| | - Michael V. Relf
- Associate Dean for Global and Community Health Affairs, Duke University School of Nursing, and an Associate Professor, Duke Global Health Institute, Durham, North Carolina, USA
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Sauermilch D, Siegel K, Hoppe T, Roth G, Meunier É. Attitudes Toward HIV-Positive Status Disclosure Among U=U-Aware Sexual and Gender Minority Individuals in the USA: a Consensual Qualitative Research Approach. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:692-704. [PMID: 35369684 PMCID: PMC8962277 DOI: 10.1007/s13178-022-00710-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 05/28/2023]
Abstract
Introduction The U=U (i.e., undetectable equals untransmittable) campaign is founded upon biomedical advancements that have positioned HIV as a manageable condition with effectively zero risk of transmission. In spite of these developments, attitudes of sexual and gender minority populations regarding the necessity of seropositive status disclosure remain unexamined. Methods The current study analyzed qualitative data regarding the necessity of seropositive status disclosure from 62 sexual minority men as well as transgender and gender non-conforming individuals who have sex with men from 2020 to 2021. Results The majority of participants believed disclosure to be necessary and invoked several social and structural factors that informed their attitudes. Participants cited HIV criminalization laws, the ethics of non-disclosure, and disclosure as a means of educating sex partners when appraising the necessity of disclosure. Participants also presented concerns regarding U=U efficacy and HIV stigma. Conclusions Findings indicate that the disclosure of seropositive status to sex partners is still important to U=U-aware sexual and gender minority individuals. The majority of the study sample, irrespective of HIV status, believed seropositive status disclosure was necessary in advance of sex. Policy Implications Findings suggest opportunities for public health messaging to remediate concerns about U=U efficacy, combat misinformation, and clarify out-of-date information on HIV criminalization.
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Affiliation(s)
- Daniel Sauermilch
- Department of Psychology, Long Island University, 1 University Plaza, Brooklyn, NY 11201 USA
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, 10032 USA
| | - Trevor Hoppe
- Department of Sociology, University of North Carolina at Greensboro, 337 Frank Porter Graham Building, PO Box 26170, Greensboro, NC 27402-6170 USA
| | - Grant Roth
- Whitman-Walker Institute, Washington, DC USA
| | - Étienne Meunier
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, 10032 USA
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15
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Williams RS, Stetten NE, Cook C, Cook R, Ezenwa MO, Lucero R. The Meaning and Perceptions of HIV-Related Stigma in African American Women Living With HIV in Rural Florida: A Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:118-131. [PMID: 33782240 PMCID: PMC9744244 DOI: 10.1097/jnc.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT African Americans are disproportionally affected by HIV/AIDS compared with other races/ethnicities, yet few studies have examined the cultural and/or attitudinal precursors that can make African American women vulnerable to HIV-related stigma in the rural South. This study qualitatively explored the meaning and perceptions of HIV-related stigma among African American women in Florida. Thirteen semi-structured interviews were conducted using an empirical phenomenological approach. Five observer perspectives and 26 participant perspectives emerged. Participants described stigma through self-conceptualizations (e.g., ignorance), experiences (e.g., judgments), psychological dysfunction (e.g., mental health), intersectionality (e.g., race, disability), and overcoming stigma (e.g., advocacy). Our findings reveal that HIV-related stigma is unpleasant for African American women. However, over time, women in this study developed strategies to combat stigma. Elements of stigma reduction described in this study may be an important starting point for designing a culturally targeted intervention for African American women living with HIV.
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Affiliation(s)
- Renessa S. Williams
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Nichole E. Stetten
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Christa Cook
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Robert Cook
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Miriam O. Ezenwa
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
| | - Robert Lucero
- Renessa S. Williams, PhD, RN, is a Postdoctoral Associate, Miller School of Medicine, Department of Surgery, University of Miami, Coral Gables, Florida, USA. Nichole E. Stetten, PhD, MPH, CPH, is a Research Assistant Professor, College of Public Health and Health Professions, Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA. Christa Cook, PhD, RN, FAAN, is an Associate Professor, College of Nursing, University of Central Florida, Orlando, Florida, USA. Robert Cook, MD, MPH, is a Professor, College of Public Health and Health Professions & College of Medicine, Department of Epidemiology, University of Florida, Gainesville, Florida, USA. Miriam O. Ezenwa, PhD, RN, FAAN, is an Associate Professor, College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA. Robert Lucero, PhD, MPH, RN, FAAN, is an Associate Professor, College of Nursing, Department of Family, Community and Health Systems Science, University of Florida, Gainesville, Florida, USA
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Reif S, Rao D, Wilson E, Beckwith N, Frey S, Cooper H, Ward D, Belden M. Adaptation and Preliminary Testing of an Intervention to Reduce Stigma among Individuals Living with HIV in the Deep South. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:1-13. [PMID: 34464238 DOI: 10.1080/19371918.2021.1965937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
HIV-related stigma has been implicated as a contributor to the disproportionate impact of HIV in the US Deep South. However, effective interventions aimed at reducing HIV-related stigma are limited in the region. This study adapted and piloted an HIV-related stigma reduction intervention, the UNITY Workshop, for use among people living with HIV in the Deep South following a modified framework of the ADAPT-ITT model and the five principles of Corrigan's Model of Strategic Stigma Change. The adapted intervention, named the YOUNITY Workshop, was conducted in an experiential, group format and focused on enhancing stigma coping skills. Workshop satisfaction was high, and most participants reported acquiring new skills for coping with HIV-related stigma and HIV status disclosure. Participants also reported benefitting from the social support generated from the workshop and desired additional opportunities to connect with others in the future. This pilot study demonstrated the feasibility and positive preliminary outcomes of conducting a group-based HIV stigma reduction workshop in the Deep South. Future rigorous testing of the YOUNITY Workshop is planned to better examine health outcomes associated with participation.
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Affiliation(s)
- Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, United States
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, United States
| | - Elena Wilson
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, United States
| | - Nicole Beckwith
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, United States
| | - Sarah Frey
- Department of Global Health, University of Washington, Seattle, United States
| | - Haley Cooper
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, United States
| | | | - Micha Belden
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, United States
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17
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Huertas-Zurriaga A, Palmieri PA, Aguayo-Gonzalez MP, Dominguez-Cancino KA, Casanovas-Cuellar C, Linden KLV, Cesario SK, Edwards JE, Leyva-Moral JM. Reproductive decision-making of Black women living with HIV: A systematic review. WOMEN'S HEALTH 2022; 18:17455057221090827. [PMID: 35404192 PMCID: PMC9006353 DOI: 10.1177/17455057221090827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Black women living with HIV account for a higher proportion of new HIV diagnoses than other groups. These women experience restricted access to reproductive services and inadequate support from healthcare providers because their position in society is based on their sexual health and social identity in the context of this stigmatizing chronic disease. By recognizing the analytical relevance of intersectionality, the reproductive decision-making of Black women can be explored as a social phenomenon of society with varied positionality. Objective: The purpose of this review was to synthesize the evidence about the reproductive decision-making of Black women living with HIV in high-income countries from the beginning of the HIV epidemic to the present. Methods: This systematic review was guided by the JBI evidence synthesis recommendations. Searches were completed in seven databases from 1985 to 2021, and the review protocol was registered with PROSPERO (CRD420180919). Results: Of 3503 records, 22 studies were chosen for synthesis, including 19 observational and three qualitative designs. Nearly, all studies originated from the United States; the earliest was reported in 1995. Few studies provided detailed sociodemographic data or subgroup analysis focused on race or ethnicity. Influencing factors for reproductive decision-making were organized into the following seven categories: ethnicity, race, and pregnancy; religion and spirituality; attitudes and beliefs about antiretroviral therapy; supportive people; motherhood and fulfillment; reproductive planning; and health and wellness. Conclusion: No major differences were identified in the reproductive decision-making of Black women living with HIV. Even though Black women were the largest group of women living with HIV, no studies reported a subgroup analysis, and few studies detailed sociodemographic information specific to Black women. In the future, institutional review boards should require a subgroup analysis for Black women when they are included as participants in larger studies of women living with HIV.
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Affiliation(s)
- Ariadna Huertas-Zurriaga
- Àrea de Suport a la Recerca en Cures, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
| | - Patrick A Palmieri
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- South American Center for Qualitative Research, Universidad Norbert Wiener, Lima, Perú
- College of Graduate Health Studies, A.T. Still University, Kirksville, MO, USA
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
| | - Mariela P Aguayo-Gonzalez
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Department d’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Karen A Dominguez-Cancino
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Escuela de Enfermería, Universidad Científica del Sur, Lima, Perú
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | - Cristina Casanovas-Cuellar
- Àrea de Suport a la Recerca en Cures, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department d’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Kara L Vander Linden
- Department of Research, Saybrook University, Pasadena, CA, USA
- Glaser Center for Grounded Theory, Institute for Research and Theory Methodologies, Poway, CA, USA
| | - Sandra K Cesario
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, Houston, TX, USA
| | - Joan E Edwards
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, Houston, TX, USA
| | - Juan M Leyva-Moral
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
- Department d’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Spain
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18
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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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Duthely LM, Sanchez-Covarrubias AP, Brown MR, Thomas TE, Montgomerie EK, Dale S, Safren SA, Potter JE. Pills, PrEP, and Pals: Adherence, Stigma, Resilience, Faith and the Need to Connect Among Minority Women With HIV/AIDS in a US HIV Epicenter. Front Public Health 2021; 9:667331. [PMID: 34235129 PMCID: PMC8255796 DOI: 10.3389/fpubh.2021.667331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Lunthita M Duthely
- Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alex P Sanchez-Covarrubias
- Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Megan R Brown
- Medical Education, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Tanya E Thomas
- Medical Education, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Emily K Montgomerie
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sannisha Dale
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - JoNell E Potter
- Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States
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20
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Taylor S, Qiao S, Weissman S, Li X. Attitudes toward a mindfulness-based intervention from African American women living with HIV: A qualitative study. SAGE Open Med 2021; 9:20503121211025144. [PMID: 34188932 PMCID: PMC8212361 DOI: 10.1177/20503121211025144] [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: 07/29/2020] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Mindfulness-based interventions train participants to pay attention to their
own emotions in the current moment without judging themselves. This study
aims to assess the attitudes toward a mindfulness-based stress reduction
intervention among African American women living with HIV. Methods: We collected qualitative data from three focus group discussions with 18
African American women living with HIV who were purposely recruited from the
Palmetto Health-USC Immunology Center in South Carolina, United States. The
participants discussed how they coped with stress, and then were given a
presentation on mindfulness-based stress reduction and a sample
mindfulness-based stress reduction mini workshop with follow-up discussion
about their thoughts and opinions on the information presented to them. Results: Participants said that mindfulness could be a useful technique and they were
interested in participating in a mindfulness-based stress reduction program.
Their main concerns included physical ability to perform some of the
mindfulness techniques (e.g. yoga) and logistic barriers, such as schedule
constraints. They also provided some suggestions to further tailor the
mindfulness-based stress reduction, such as modifying yoga, using familiar
terms, and combining both in-person and online components. These results
suggest that African American women living with HIV showed strong interest
in mindfulness-based stress reduction and a high level of willingness to
participate in mindfulness-based stress reduction, but the existing
mindfulness-based stress reduction program needs to be tailored to address
challenges and barriers these women may face for attendance and
completion. Conclusion: The next step is to further test the feasibility, acceptability, and efficacy
through a pilot study for African American women living with HIV to practice
a tailored mindfulness-based stress reduction for this group.
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Affiliation(s)
- Slone Taylor
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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21
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Reinius M, Zeluf Andersson G, Svedhem V, Wettergren L, Wiklander M, Eriksson LE. Towards a new understanding of HIV-related stigma in the era of efficient treatment- A qualitative reconceptualization of existing theory. J Adv Nurs 2021; 77:2472-2480. [PMID: 33599309 DOI: 10.1111/jan.14774] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/03/2020] [Accepted: 01/16/2021] [Indexed: 11/29/2022]
Abstract
AIM To further develop Earnshaw and Chaudoir's HIV stigma framework by describing the experiences of HIV-related stigma among people living with viral suppression in a context where HIV is well controlled and to investigate how these experiences correspond to the stigma mechanisms of the framework. DESIGN Qualitative study using interviews and a framework approach to analysis. METHODS People living with virally suppressed HIV in Sweden were recruited through an outpatient clinic and interviewed about their experiences of social aspects of living with HIV. The interviews were audio recorded, transcribed and analysed using a framework approach. RESULTS Fifteen participants (eight women and seven men, aged 30-64 years) were interviewed from March to September 2017. They described stigma around HIV as a barrier in many situations. Anticipated and enacted stigma were found to be more complex than is described in the existing literature. Being labelled as a person with HIV was found to be an important and persistent part of the stigma experience. Disclosure was found to be context-related and a result of a process of negotiating and weighing the relevance of disclosing HIV, perceiving HIV as a private matter and feeling a responsibility to disclose one's HIV status to others. An important reason for nondisclosure was to avoid being labelled with HIV, which would then become their most defining feature. CONCLUSIONS The HIV stigma framework could benefit from revision for people living with virally suppressed HIV. IMPLICATIONS The present findings, which indicate the role of health professionals in relation to disclosure and labelling, may guide nurses and other healthcare personnel in providing counselling and support for people who live with virally suppressed HIV and experience stigma.
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Affiliation(s)
- Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Lena Wettergren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,School of Health Sciences, City, University of London, London, UK
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22
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Parish CL, Feaster DJ, Pereyra MR, Alcaide ML, Weber KM, Cohen MH, Levin S, Gustafson D, Merenstein D, Aouizerat BE, Donohue J, Webster-Cyriaque J, Wingood G, Kempf MC, Metsch LR. Women's HIV disclosure to the dentist: Does frequent contact matter? J Public Health Dent 2020; 81:65-76. [PMID: 33049081 DOI: 10.1111/jphd.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/29/2020] [Accepted: 09/10/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Research has shown inconsistent patterns of patients' HIV serostatus disclosure to their dentists. Common barriers to disclosure have included confidentiality concerns, fear of treatment refusal, and discrimination. This study evaluated the prevalence of HIV serostatus disclosure to the dentist, whether the frequency of dental care utilization is associated with disclosure, and reasons for nondisclosure among women living with HIV. METHODS We administered a cross-sectional oral health survey to 1,526 women living with HIV in the Women's Interagency HIV Study including questions regarding HIV serostatus disclosure to dentists. Logistic regression models were used to analyze the association between dental care utilization (at least annually versus less than annually) and HIV serostatus disclosure to dentists. RESULTS Overall, 83 percent of women reported that they disclosed their HIV serostatus to their dentist. The most common reasons for nondisclosure were: a) the dentist did not ask, b) believing that the dentist did not need to know, and c) not having a consistent dentist. In the multivariable logistic regression model, at least annual dental care utilization, compared to less than annual, led to a 59 percent reduction in the odds of HIV nondisclosure to the dentist. DISCUSSION Study findings highlight that dentists who see their patients infrequently should consider methods for overcoming barriers to HIV nondisclosure and the possibility that their patient's HIV serostatus is undisclosed. Educating women living with HIV about how disclosure to dentists is a critical component of their dental assessment and treatment, and how preventive dental treatment can improve overall health outcomes, is important.
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Affiliation(s)
- Carrigan L Parish
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Daniel J Feaster
- Miller School of Medicine, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Maria L Alcaide
- Miller School of Medicine, Department of Medicine, University of Miami, Miami, FL, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Mardge H Cohen
- Cook County Bureau of Health Services, Department of Medicine, Stroger Hospital, Chicago, IL, USA
| | | | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Services University, Brooklyn, NY, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University, Washington, DC, USA
| | - Bradley E Aouizerat
- College of Dentistry Department of Oral and Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University, New York, NY, USA
| | - Jessica Donohue
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer Webster-Cyriaque
- Department of Dental Ecology, University of North Carolina, School of Dentistry, Chapel Hill, NC, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lisa R Metsch
- School of General Studies and Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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23
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Etowa J, Etowa E, Nare H, Mbagwu I, Hannan J. Social Determinants of Breastfeeding Preferences among Black Mothers Living with HIV in Two North American Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6893. [PMID: 32967193 PMCID: PMC7557830 DOI: 10.3390/ijerph17186893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022]
Abstract
The study is motivated by the need to understand the social determinants of breastfeeding attitudes among HIV-positive African, Caribbean, and Black (ACB) mothers. To address the central issue identified in this study, analysis was conducted with datasets from two North American cities, where unique country-specific guidelines complicate infant feeding discourse, decisions, and practices for HIV-positive mothers. These national infant feeding guidelines in Canada and the US present a source of conflict and tension for ACB mothers as they try to navigate the spaces between contradictory cultural expectations and national guidelines. Analyses in this paper were drawn from a broader mixed methods study guided by a community-based participatory research (CBPR) approach to examine infant feeding practices among HIV-positive Black mothers in three countries. The survey were distributed through Qualtrics and SPSS was used for data cleaning and analysis. Results revealed a direct correlation between social determinants and breastfeeding attitude. Country of residence, relatives' opinion, healthcare providers' advice and HIV-related stigma had statistically significant association with breastfeeding attitude. While the two countries' guidelines, which recommend exclusive formula feeding, are cardinal in preventing vertical transmission, they can also be a source of stress. We recommend due consideration of the cultural contexts of women's lives in infant feeding guidelines, to ensure inclusion of diverse women.
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Affiliation(s)
- Josephine Etowa
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Egbe Etowa
- Department of Sociology, Anthropology & Criminology, Faculty of Arts, Humanities & Social Sciences, University of Windsor, Windsor, ON N9B 3P4, Canada;
| | - Hilary Nare
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Ikenna Mbagwu
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Academic Centre 3, Florida International University, Miami, FL 33199, USA;
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24
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Kedia SK, Dillon PJ, Basu A. A Qualitative Exploration of "Mother First" Identity and Antiretroviral Adherence among African American Women Living with HIV in the Mid-South Region of the United States. HEALTH COMMUNICATION 2020; 35:1190-1199. [PMID: 31167571 DOI: 10.1080/10410236.2019.1623641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The majority of African American women living with HIV are of child-bearing age and large numbers of these women express a desire to have children. Extant research suggests that motherhood provides HIV-positive women with a sense of hope and normalcy and, in some cases, is associated with positive HIV-related health behaviors. Guided by the tenets of the culture-centered approach (CCA), this qualitative study sought to understand the relationship between motherhood identity and ART adherence among a sample of 50 African American women living with HIV in the Mid-South region of the United States. Our theoretically-informed thematic analysis of in-depth interviews with all 50 women produced three primary themes: (1) experiencing HIV through the lens of motherhood, (2) the physical and social realities of the "mother first" orientation while living with HIV, and (3) the impact of the "mother first" orientation on ART adherence and self-care. These findings identify how participants' "mother first" identity orientation interacts with their sociocultural environment to enable and constrain their attempts at ART adherence. The findings also provide empirical evidence to support the CCA's theorizing regarding the ways in which the materiality of structures interact with symbolic cultural meanings to (re)produce health inequalities.
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Affiliation(s)
- Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis
| | | | - Ambar Basu
- Department of Communication, University of South Florida
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25
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Fletcher FE, Sherwood NR, Rice WS, Yigit I, Ross SN, Wilson TE, Weiser SD, Johnson MO, Kempf MC, Konkle-Parker D, Wingood G, Turan JM, Turan B. Resilience and HIV Treatment Outcomes Among Women Living with HIV in the United States: A Mixed-Methods Analysis. AIDS Patient Care STDS 2020; 34:356-366. [PMID: 32757978 DOI: 10.1089/apc.2019.0309] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Resilience is defined as the ability and process to transform adversity into opportunities for growth and adaptation. Resilience may be especially important for people living with HIV (PLWH), who are susceptible to anxiety and depressive disorders, which are commonly linked to risk behaviors (i.e., alcohol and drug abuse), poor adherence to medical regimens, increased risk of morbidity and mortality, and related stigma and discrimination. To date, few studies have examined the impact of resilience on health-related behaviors and outcomes among PLWH, particularly among minority women living with HIV (WLWH) who are dealing with multiple stressors impacting their health. This study used a convergent parallel mixed-methods design to collect, analyze, and integrate qualitative and quantitative data from a subsample of WLWH enrolled in the Women's Interagency HIV Study (WIHS). The aims of the study were to (1) qualitatively examine the resilience perspectives of 76 marginalized WLWH, and; (2) quantitatively assess the associations of resilience with HIV health outcomes-adherence to antiretroviral therapy and viral suppression-in the context of differing levels of internalized HIV-related stigma and depressive symptoms (n = 420). Findings from this mixed-methods study suggest that resilience is an important resource that can aid WLWH in coping constructively with adversity by capitalizing on intrapersonal traits and states, interpersonal and institutional resources, and spiritual and/or religious practices. Given the complex medical and social needs of marginalized WLWH, intervention strategies should focus on mitigating psychosocial burdens of stigma and depression, in addition to building resilience.
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Affiliation(s)
- Faith E. Fletcher
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicholas R. Sherwood
- The Jimmy & Rosalynn Carter School for Peace and Conflict Resolution, George Mason University, Fairfax, Virginia, USA
| | - Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ibrahim Yigit
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shericia N. Ross
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Mirjam-Colette Kempf
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Family, Community and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine and University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
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A Systematic Mixed Studies Review of the Intersections of Social-Ecological Factors and HIV Stigma in People Living With HIV in the U.S. South. J Assoc Nurses AIDS Care 2020; 30:330-343. [PMID: 31021963 DOI: 10.1097/jnc.0000000000000076] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The role of stigma on psychological wellness and treatment outcomes in people living with HIV (PLWH) has been well documented. However, within the context of the southern United States, the intersection between HIV-related stigma and social-ecological factors has been understudied. Thus, a results-based convergent, mixed synthesis design was used to examine the manifestations of HIV-related stigma in PLWH in the U.S. South. A literature search was conducted using PsycINFO, PubMed (includes MEDLINE), and CINAHL. The first level of screening by title and abstract was administered on 1,829 articles. A full-text screening of 169 studies was completed, and a total of 30 relevant articles were extracted. The mixed synthesis highlighted intervention strategies that can reduce HIV-related stigma while promoting positive health-behavior change. The findings of this review underscored the uniqueness of PLWH in the south and demonstrated the crucial role of intersectionality in investigating HIV-related stigma in treating and preventing HIV.
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27
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Hampton CJ, Gillum TL. 'Today I feel strong': African American women overcoming HIV-related stigma. Psychol Health 2020; 35:1440-1458. [PMID: 32372665 DOI: 10.1080/08870446.2020.1761978] [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: 10/24/2022]
Abstract
Objective: African American account for more than 60% of women living with HIV/AIDS in the United States. This population is disproportionately affected in areas of diagnosis, treatment, and morbidity. HIV-related stigma has been found to play a pivotal role in the experiences of African American women living with HIV/AIDS (WLWHA) impacting self-perception, treatment adherence, depression, interpersonal relationships, and overall quality of life. Limited studies have explored the ways in which HIV-related stigma impacts the self-perceptions of African American WLWHA. To explore these experiences, this study examined the ways in which HIV-related stigma impacts the intrapersonal experiences of African American WLWHA.Design: A phenomenological investigation was conducted to explore the experiences of African American WLWHA.Main Outcome Measure: In-depth, semi-structured qualitative interviews.Results: Interpretive phenomenological analysis revealed four emergent themes: (1) increased vulnerability; (2) processing the diagnosis of HIV/AIDS; (3) surviving HIV/AIDS; and (4) quality of life.Conclusion: Findings of this study contribute to existing literature by highlighting the intricacies of the lived experiences of African American WLWHA from initial diagnosis to present day. Exploring the trajectory of the illness among this population allows for a deeper understanding of the ways in which HIV/AIDS impacts the intrapersonal experiences and self-perceptions of WLWHA.
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Affiliation(s)
| | - Tameka L Gillum
- Department of Psychology, Russell Sage College, Troy, NY, USA
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28
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Religiosity, Social Support, and Ethnic Identity: Exploring "Resilience Resources" for African-American Women Experiencing HIV-Related Stigma. J Acquir Immune Defic Syndr 2020; 81:175-183. [PMID: 30865171 DOI: 10.1097/qai.0000000000002006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION African-American women living with HIV report substantial HIV-related stigma and depression. Resilience resources are strength-based resources that may moderate the effects of HIV-related stigma on poor psychosocial outcomes such as depression. OBJECTIVE To evaluate whether religiosity, social support, and ethnic identity moderate the effects of HIV-related stigma on depression among African-American women living with HIV. METHODS We used baseline data (May 2013-October 2015) from a randomized controlled trial testing the efficacy of an HIV-related stigma-reduction intervention among African-American women living with HIV in Chicago, IL, and Birmingham, AL, who were older than 18 years and currently receiving HIV services. To assess whether religiosity (7-item Religious Beliefs and Behaviors survey), social support (select subscales from the Medical Outcomes Study Social Support Survey), and ethnic identity (Commitment subscale from the Multigroup Ethnic Identity Measure) modified the relationship between HIV-related stigma (Stigma Scale for Chronic Illness) and depression (8-item Patient Health Questionnaire), we conducted 3 separate moderation analyses using linear regression with interactions between HIV-related stigma and each moderator of interest, adjusted for study site, age, time since diagnosis, and education. RESULTS Among 226 African-American women living with HIV, greater levels of HIV-related stigma were associated with greater depression in all 3 models (P < 0.05). Only religiosity modified this association (P = 0.04), with a weaker association among women reporting higher levels of religiosity. CONCLUSIONS The protective effects of religiosity may be leveraged in interventions for African-American women living with HIV struggling with HIV-related stigma.
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Lipira L, Williams EC, Huh D, Kemp CG, Nevin PE, Greene P, Unger JM, Heagerty P, French AL, Cohn SE, Turan JM, Mugavero MJ, Simoni JM, Andrasik MP, Rao D. HIV-Related Stigma and Viral Suppression Among African-American Women: Exploring the Mediating Roles of Depression and ART Nonadherence. AIDS Behav 2019; 23:2025-2036. [PMID: 30343422 PMCID: PMC6815932 DOI: 10.1007/s10461-018-2301-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We used baseline data from a sample of African-American women living with HIV who were recruited to participate in a stigma-reduction intervention in Chicago and Birmingham (2013-2015) to (1) evaluate the relationship between HIV-related stigma and viral suppression, and (2) assess the role of depression and nonadherence to antiretroviral therapy (ART) as mediators. Data from women were included in this secondary analysis if they were on ART, had viral load data collected within 8-weeks of study entry and had complete covariate data. We used logistic regression to estimate the total effect of HIV-related stigma (14-item Stigma Scale for Chronic Illness) on viral suppression (< 200 copies/mL), and serial mediation analysis to estimate indirect effects mediated by depressive symptoms (8-item Patient Health Questionnaire) and ART nonadherence (number of days with missed doses). Among 100 women who met study inclusion criteria, 95% reported some level of HIV-related stigma. In adjusted models, higher levels of HIV-related stigma were associated with lower odds of being virally suppressed (AOR = 0.93, 95% CI = 0.89-0.98). In mediation analysis, indirect effects through depression and ART nonadherence were not significant. Findings suggest that HIV-related stigma is common among African-American women living with HIV, and those who experience higher levels of stigma are less likely to be virally suppressed. However, the mechanisms remain unclear.
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Affiliation(s)
- Lauren Lipira
- Department of Health Services, University of Washington, Seattle, WA, USA.
- Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660, USA.
| | - Emily C Williams
- Department of Health Services, University of Washington, Seattle, WA, USA
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - David Huh
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Paul E Nevin
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Joseph M Unger
- Department of Health Services, University of Washington, Seattle, WA, USA
- Fred Hutch, Seattle, WA, USA
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Audrey L French
- Stroger Hospital of Cook County and Ruth M. Rothstein CORE Center, Chicago, IL, USA
| | - Susan E Cohn
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michele P Andrasik
- Department of Global Health, University of Washington, Seattle, WA, USA
- Fred Hutch, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
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30
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Abstract
OBJECTIVE African-American women are more likely than other women in the United States to experience poor HIV-related health; HIV stigma may contribute to these outcomes. This study assessed the relationship between HIV stigma and viral load, over time, among a sample of African-American women receiving treatment for HIV, and explored social support and depressive symptoms as mediators. DESIGN Secondary analysis of longitudinal data. METHODS Data came from a randomized trial of an intervention to reduce HIV stigma among African-American women in HIV care in Chicago, Illinois and Birmingham, Alabama. Sociodemographic and psychosocial data were collected at up to six study visits over 14 months. Viral loads were extracted from medical records during the study period. Generalized linear mixed effects models were used to estimate associations among overall, internalized, and enacted HIV stigma and viral load over time. Mediation analyses were used to estimate indirect effects via social support and depressive symptoms. RESULTS Data from 234 women were analyzed. Overall HIV stigma was significantly associated with subsequent viral load (adjusted β = 0.24, P = 0.005). Both between-subject (adjusted β = 0.74, P < 0.001) and within-subject (adjusted β = 0.34, P = 0.005) differences in enacted stigma were associated with viral load. Neither social support nor depressive symptoms were statistically significant mediators. CONCLUSION Ongoing experiences of HIV stigmatization may contribute to increased viral load among African-American women in primary HIV care. Interventions should aim to alleviate the consequences of stigma experienced by patients and prevent future stigmatization.
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31
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Gary FA, Yarandi H, Hassan M, Killion C, Ncube M, Still C, Hopps J. A Power Conundrum: Black Women and Their Sexual Partners in the Midwest. Issues Ment Health Nurs 2019; 40:431-436. [PMID: 30917081 DOI: 10.1080/01612840.2018.1547804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this research was to determine the extent to which women of African ancestry manifested power in their relationships regarding sexual activities and to examine the influence that specific variables had on their sexual partnerships. A sample (N = 200) of midlife women aged 40-65, who lived in the Midwest participated in this research. The Sexual Relationship Power Scale was used to examine these relationships. Face-to-face interviews occurred in community settings. Multiple regression equations were used to examine the potential impact of specific variables on sexual functioning. Results of the analysis revealed that variables such as mental quality of life, decision-making, and health promotion were positively associated with sexual relationships. Conversely, depression and life stress scores were negatively linked to sexual relationships. Knowledge gained from this research could be used to explore the phenomena of power as expressed in the daily lives of women of African descent. The research can also be discussed from the perspective of a "Black tax," that has burdened Black women for centuries and is manifested through years of discrimination, bias, and the lack of equity in most domains of American institutions.
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Affiliation(s)
- Faye A Gary
- a Frances Payne Bolton School of Nursing , Case Western Reserve University , Cleveland , USA
| | - Hossein Yarandi
- b Center for Health Research , Wayne State University , Detroit , USA
| | - Mona Hassan
- c College of Nursing , Prairie View A&M University , Prairie View , Houston , USA
| | - Cheryl Killion
- d Frances Payne Bolton School of Nursing , Case Western Reserve University , Cleveland , USA
| | - Mothusi Ncube
- e University of Botswana School of Nursing , Gaborone , Botswana
| | - Carolyn Still
- d Frances Payne Bolton School of Nursing , Case Western Reserve University , Cleveland , USA
| | - June Hopps
- f School of Social Work , University of Georgia , Athens , USA
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Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, Pescosolido B, Murray SM. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med 2019; 17:7. [PMID: 30764816 PMCID: PMC6376691 DOI: 10.1186/s12916-018-1246-9] [Citation(s) in RCA: 333] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND 'Intersectional stigma' is a concept that has emerged to characterize the convergence of multiple stigmatized identities within a person or group, and to address their joint effects on health and wellbeing. While enquiry into the intersections of race, class, and gender serves as the historical and theoretical basis for intersectional stigma, there is little consensus on how best to characterize and analyze intersectional stigma, or on how to design interventions to address this complex phenomenon. The purpose of this paper is to highlight existing intersectional stigma literature, identify gaps in our methods for studying and addressing intersectional stigma, provide examples illustrating promising analytical approaches, and elucidate priorities for future health research. DISCUSSION Evidence from the existing scientific literature, as well as the examples presented here, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and corresponding health behaviors. As different stigmas are often correlated and interrelated, the health impact of intersectional stigma is complex, generating a broad range of vulnerabilities and risks. Qualitative, quantitative, and mixed methods approaches are required to reduce the significant knowledge gaps that remain in our understanding of intersectional stigma, shared identity, and their effects on health. CONCLUSIONS Stigmatized identities, while often analyzed in isolation, do not exist in a vacuum. Intersecting forms of stigma are a common reality, yet they remain poorly understood. The development of instruments and methods to better characterize the mechanisms and effects of intersectional stigma in relation to various health conditions around the globe is vital. Only then will healthcare providers, public health officials, and advocates be able to design health interventions that capitalize on the positive aspects of shared identity, while reducing the burden of stigma.
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Affiliation(s)
- Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA.
| | | | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Swagata Banik
- Department of Public Health & Prevention Sciences, Baldwin Wallace University, Berea, OH, USA
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kaylee B Crockett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kutnick AH, Leonard NR, Gwadz MV. "Like I Have No Choice": A Qualitative Exploration of HIV Diagnosis and Medical Care Experiences While Incarcerated and Their Effects. Behav Med 2019; 45:153-165. [PMID: 31343965 PMCID: PMC6730550 DOI: 10.1080/08964289.2019.1591338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
It is estimated that one in six Black and Latino adult persons living with HIV (PLWH) spend time in correctional institutions each year. Yet after release, PLWH of color evidence poor HIV health outcomes across the HIV care continuum. This study, guided by an ecological approach and Critical Race Theory, sought to understand the lived experiences of socioeconomically disadvantaged PLWH of color who received an HIV diagnosis and/or medical care while incarcerated, and the ways in which those experiences influenced engagement in medical care after release. Drawn from a larger study in Brooklyn, NY, in 2013-2016, a subset of 28 participants who received in-depth qualitative interviews were purposively sampled for a secondary analysis of participants who received an HIV diagnosis and/or medical care while incarcerated. Using an Interpretive Phenomenological Analysis, we found participant's experiences were shaped by longstanding mistrust of the medical establishment. While incarcerated, lack of autonomy, substandard medical care, and poor social support exacerbated medical mistrust and avoidance of HIV medical care long after release. Engagement in HIV medical care and treatment were also impacted by a dynamic interplay of factors including substance use, prolonged periods of denial, poverty, and repeated bouts of incarceration. Given that experiences of HIV diagnosis and medical care while incarcerated have long-ranging, adverse effects, we argue that a better understanding of the ways in which PLWH of color experience HIV diagnosis and medical care while incarcerated may serve to inform intervention efforts within correctional institutions to improve HIV health outcomes.
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Affiliation(s)
- Alexandra H. Kutnick
- Center for Drug Use and HIV/HCV Research, NYU Global College of Public Health, New York University, New York, NY, USA
| | - Noelle R. Leonard
- Center for Drug Use and HIV/HCV Research, NYU Global College of Public Health, New York University, New York, NY, USA,Silver School of Social Work, New York University, New York, NY, USA
| | - Marya V. Gwadz
- Center for Drug Use and HIV/HCV Research, NYU Global College of Public Health, New York University, New York, NY, USA,Silver School of Social Work, New York University, New York, NY, USA
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Fletcher FE, Rice WS, Ingram LA, Fisher CB. Ethical Challenges and Lessons Learned from Qualitative Research with Low-Income African American Women Living with HIV in the South. J Health Care Poor Underserved 2019; 30:116-129. [PMID: 31735725 PMCID: PMC7509837 DOI: 10.1353/hpu.2019.0122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
African American women living with HIV (WLWH) in the U.S. South encounter heightened marginalization due to the complex intersections of race, gender, poverty, and HIV status. Social vulnerabilities experienced by individuals and communities in daily life have the potential to sharpen ethical tensions in the context of research. Thus, conducting ethical research requires attention to the contextual challenges and concerns of diverse research populations to tailor participant protections to a particular sociocultural context. Using principles from the Belmont Report, the present report draws on data from a qualitative study with 42 African American WLWH in the South by highlighting the first author's accounts of ethical challenges that emerged during data collection. Findings suggest that engaging participants in their natural environments can inform the development of ethical research strategies germane to women's lived experiences. Study findings also contribute to empirical guidance for investigators engaging marginalized populations in scientific research.
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Fletcher FE, Vidrine DJ, Trejo MB, Molina Y, Sha BE, Floyd BR, Sarhene N, Mator J, Matthews AK. "You Come Back to the Same Ole Shit:" A Qualitative Study of Smoking Cessation Barriers among Women Living with HIV: Implications for Intervention Development. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2019; 12:106-122. [PMID: 32963893 PMCID: PMC7505055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although tobacco use among women living with HIV (WLWH) is decreasing, the prevalence is more than double that of women in the general population and remains an important health behavior to target among WLWH. Few smoking cessation interventions specifically focus on the unique social and medical needs of WLWH. Thus, the investigative team engaged WLWH (N=18) in qualitative focus groups to: 1) understand barriers and facilitators to smoking cessation; and 2) inform intervention structure and content priorities. Participants identified salient reasons for smoking and barriers to smoking cessation, which included coping with multiple life stressors, HIV-related stress, HIV-related stigma and social isolation. Further, WLWH highlighted the importance of long-term smoking cessation support, peer support, mental health content, religion/spirituality, and targeted risk messaging in smoking cessation intervention development. Study findings provide concrete, operational strategies for future use in a theory-based smoking cessation intervention, and underscore the importance of formative research to inform smoking cessation interventions for WLWH.
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Affiliation(s)
| | | | | | - Yamile' Molina
- University of Illinois at Chicago School of Public Health
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Flickinger TE, DeBolt C, Xie A, Kosmacki A, Grabowski M, Waldman AL, Reynolds G, Conaway M, Cohn WF, Ingersoll K, Dillingham R. Addressing Stigma Through a Virtual Community for People Living with HIV: A Mixed Methods Study of the PositiveLinks Mobile Health Intervention. AIDS Behav 2018; 22:3395-3406. [PMID: 29882048 PMCID: PMC6153974 DOI: 10.1007/s10461-018-2174-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Stigma has negative consequences for quality of life and HIV care outcomes. PositiveLinks is a mobile health intervention that includes a secure anonymous community message board (CMB). We investigated discussion of stigma and changes in stigma scores. Of 77 participants in our pilot, 63% were male, 49% Black, and 72% had incomes below the federal poverty level. Twenty-one percent of CMB posts (394/1834) contained stigma-related content including negative (experiencing stigma) and positive (overcoming stigma) posts addressing intrapersonal and interpersonal stigma. Higher baseline stigma was positively correlated with stress and negatively correlated with HIV care self-efficacy. 12-month data showed a trend toward more improved stigma scores for posters on the CMB versus non-posters (- 4.5 vs - 0.63) and for posters of stigma-related content versus other content (- 5.1 vs - 3.3). Preliminary evidence suggests that a supportive virtual community, accessed through a clinic-affiliated smartphone app, can help people living with HIV to address stigma.
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Affiliation(s)
- Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Claire DeBolt
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alice Xie
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Alison Kosmacki
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Marika Grabowski
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ava Lena Waldman
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Mark Conaway
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
- UVA Center for Global Health, P.O. Box 801379, Charlottesville, VA, 22908, USA.
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Rice WS, Logie CH, Napoles TM, Walcott M, Batchelder AW, Kempf MC, Wingood GM, Konkle-Parker DJ, Turan B, Wilson TE, Johnson MO, Weiser SD, Turan JM. Perceptions of intersectional stigma among diverse women living with HIV in the United States. Soc Sci Med 2018; 208:9-17. [PMID: 29753137 PMCID: PMC6015551 DOI: 10.1016/j.socscimed.2018.05.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/28/2018] [Accepted: 05/02/2018] [Indexed: 10/17/2022]
Abstract
Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) are barriers to HIV prevention, treatment, and wellbeing among women living with HIV. Other coexisting forms of stigma (e.g., racism, sexism) may worsen the effects of HIV-related stigma, and may contribute to persistent racial and gendered disparities in HIV prevention and treatment. Few studies examine perceptions of intersectional stigma among women living with HIV. From June to December 2015, we conducted 76 qualitative interviews with diverse women living with HIV from varied socioeconomic backgrounds enrolled in the Women's Interagency HIV Study (WIHS) in Birmingham, Alabama; Jackson, Mississippi; Atlanta, Georgia; and San Francisco, California. Interview guides facilitated discussions around stigma and discrimination involving multiple interrelated identities. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Interviewees shared perceptions of various forms of stigma and discrimination, most commonly related to their gender, race, and income level, but also incarceration histories and weight. Women perceived these interrelated forms of social marginalization as coming from multiple sources: their communities, interpersonal interactions, and within systems and structures. Our findings highlight the complexity of social processes of marginalization, which profoundly shape life experiences, opportunities, and healthcare access and uptake among women living with HIV. This study highlights the need for public health strategies to consider community, interpersonal, and structural dimensions across intersecting, interdependent identities to promote the wellbeing among women living with HIV and to reduce social structural and health disparities.
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Affiliation(s)
- Whitney S Rice
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, Birmingham, AL, USA.
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, Canada.
| | - Tessa M Napoles
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Melonie Walcott
- School of Health Sciences, The Sage Colleges, Albany, NY, USA.
| | | | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, USA.
| | - Gina M Wingood
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, USA.
| | - Deborah J Konkle-Parker
- Department of Medicine and School of Nursing, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, USA.
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, Birmingham, AL, USA.
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY, USA.
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Janet M Turan
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, USA.
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Amutah-Onukagha N, Mahadevan M, Opara I, Rodriguez M, Trusdell M, Kelly J. Project THANKS: Examining HIV/AIDS-Related Barriers and Facilitators to Care in African American Women: A Community Perspective. AIDS Patient Care STDS 2018; 32:119-128. [PMID: 29630851 PMCID: PMC5972771 DOI: 10.1089/apc.2017.0215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Project THANKS, (Turning HIV/AIDS into Knowledge for Sisters), is an evidence-based intervention that utilizes a community-based participatory and empowerment building approach for African American female substance abusers living with HIV and other chronic diseases. This qualitative study sought to gain insight from women living with HIV on how to improve Project THANKS. African American women living with substance abuse disorders, HIV, and other comorbidities were recruited from three community based health centers in New Jersey (N = 31). Ninety minute focus group sessions were implemented in each health center. The focus group sessions were designed to understand the perceived factors influencing the participants' ability to self-manage their health conditions and challenges they are currently facing regarding their diagnoses. The barriers and suggestions presented by participants included addressing stigmatization, managing mental health symptoms, improving physician-patient trust, accessing health education, educating community members, and proper nutrition. In addition, an engaged and trusting relationship with their healthcare provider and having positive sources of support were cited as motivators to adhering to their HIV treatment regimen. Participants living with HIV/AIDS also expressed more concern with difficulty treating their comorbidities than participants with only HIV/AIDS. Receiving input from African American women living with HIV related comorbidities was essential in improving the intervention to include a behavioral and primary health approach. Future programmatic interventions of Project THANKS will include a targeted focus on addressing mental health needs in women by offering meditation services and mental health referrals. In addition, Project THANKS will incorporate activities to improve communication with physicians, families, and media outlets to empower women to take an active role in their primary and social support needs.
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Affiliation(s)
- Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, New Jersey
| | - Ijeoma Opara
- Department of Family Science and Human Development, Montclair State University, Montclair, New Jersey
| | - Monica Rodriguez
- Department of Public Health, Montclair State University, Montclair, New Jersey
| | - Megan Trusdell
- Department of Public Health, Montclair State University, Montclair, New Jersey
| | - Jessica Kelly
- Department of Public Health, Montclair State University, Montclair, New Jersey
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Geter A, Sutton MY, Hubbard McCree D. Social and structural determinants of HIV treatment and care among black women living with HIV infection: a systematic review: 2005-2016. AIDS Care 2018; 30:409-416. [PMID: 29376409 DOI: 10.1080/09540121.2018.1426827] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Black/African American (black) women comprised 59% of women living with HIV at the end of 2014 and 61% of HIV diagnoses among women in 2015. Black women living with HIV infection (BWLH) have poorer health outcomes compared with women of other races/ethnicities; social and structural determinants are often cited as barriers and facilitators of care. The objective of this qualitative review was to identify social and structural barriers and facilitators of HIV treatment and care among BWLH. The systematic review was conducted in six-stages using databases such as PubMed, PsycINFO, and Google Scholar: 1) searched for studies that enrolled BWLH published between January 2005 and December 2016, 2) excluded unpublished reports and commentaries, 3) limited the search to our primary keywords, 4) limited our search to studies that included participants living with HIV infection that were >60% black and 100% female, 5) extracted and summarized the data, and 6) conducted a contextual review to identify common themes. Of 534 studies retrieved, 16 were included in the final review. Studies focused on: ART medication adherence (n = 5), engagement/retention in care (n = 4), HIV care and treatment services (n = 3), viral suppression (n = 1), and addressing multiple HIV care outcomes (n = 3). Main barrier themes included lack of family and/or social support, poor quality HIV services, and HIV-related stigma, particularly from healthcare providers; facilitator themes included resilience, positive relationships between case management and support services, high racial consciousness, and addressing mental health. Interventions that decrease these noted barriers and strengthen facilitators may help improve care outcomes for BWLH. Also, more HIV stigma-reduction training for healthcare providers may be warranted.
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Affiliation(s)
- Angelica Geter
- a Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Madeline Y Sutton
- a Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Donna Hubbard McCree
- a Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Sheehan DM, Fennie KP, Mauck DE, Maddox LM, Lieb S, Trepka MJ. Retention in HIV Care and Viral Suppression: Individual- and Neighborhood-Level Predictors of Racial/Ethnic Differences, Florida, 2015. AIDS Patient Care STDS 2017; 31:167-175. [PMID: 28414260 DOI: 10.1089/apc.2016.0197] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to estimate racial/ethnic differences in retention in HIV care and viral suppression and to identify related individual and neighborhood determinants. Florida HIV surveillance records of cases aged ≥13 years diagnosed during the years 2000-2014 were analyzed. Retention in care was defined as evidence of ≥2 or more laboratory tests, receipts of prescription, or clinical visits at least 3 months apart during 2015. Viral load suppression was defined as a viral load of <200 copies/mL for the last test in 2015. Multi-level logistic regressions were used to estimate adjusted odds ratios (AORs). Of 65,735 cases, 33.3% were not retained in care, and 40.1% were not virally suppressed. After controlling for individual and neighborhood factors, blacks were at increased odds of nonretention in HIV care [AOR 1.29, 95% confidence interval (CI) 1.23-1.35] and nonviral suppression (AOR 1.55, 95% CI 1.48-1.63) compared with whites. Black and Latino males compared with their female counterparts had higher odds of nonretention and nonviral suppression. Compared with their US-born counterparts, foreign-born blacks and whites, but not Latinos, had higher odds of nonretention and nonviral suppression. Blacks and whites in urban compared with rural areas had higher odds of both outcomes. Disparities in retention in care and viral suppression persist and are not accounted for by differences in age, sex, transmission mode, AIDS diagnosis, neighborhood socioeconomic status, rural/urban residence, or neighborhood racial composition. Further, predictors of poor retention in care and viral suppression appear to differ by race/ethnicity.
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Affiliation(s)
- Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Kristopher P. Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Daniel E. Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Lorene M. Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, Florida
| | - Spencer Lieb
- Florida Consortium for HIV/AIDS Research/The AIDS Institute, Tampa, Florida
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
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