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Fowler JA, Warzywoda S, Franks N, Mendis M, Lazarou M, Bisshop F, Wood P, Dean JA. Highs, Lows, and Hormones: A Qualitative Metasynthesis of Transgender Individuals' Experiences Undergoing Gender-Affirming Hormone Therapy. J Homosex 2024; 71:1652-1683. [PMID: 36884002 DOI: 10.1080/00918369.2023.2186759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Gender Affirming Hormone Therapy (GAHT) is a key therapeutic approach which aims to help trans and gender diverse (or simply "trans") individuals' transition from their sex-presumed-at-birth to their experienced gender identity. Previous reviews have focused on synthesizing quantitative experiences; however, a qualitative lens is important to understand the personal journey of GAHT. This review provides a qualitative meta-synthesis of the experiences of trans people around the world who have undergone GAHT to elicit contextualized understanding of the changes experienced. Systematic searches of eight databases identified an initial 2670 papers, refined to a final 28 papers. Overall, findings suggested that the GAHT journey is unique and elicited a myriad of changes which, whilst challenging at times, were life-changing and brought about positive psychological, physical, and social changes. Other themes explored GAHT not being treated as a fix-all for associated mental health issues, the rules that govern appraisal of physical changes, how privilege and social identity evolve, and the power of affirmation. This work offers important recommendations to improve the care offered to trans people undergoing GAHT. Namely, person-centered support is essential, and peer-navigation may be a useful future direction to explore.
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Affiliation(s)
- James A Fowler
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Sarah Warzywoda
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Nia Franks
- School of Psychology and Counselling, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Marini Mendis
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Mattea Lazarou
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Fiona Bisshop
- Holdsworth House Medical Practice, Brisbane, Queensland, Australia
| | - Penny Wood
- Alexander Heights Family Practice, Perth, Western Australia, Australia
| | - Judith A Dean
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
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Chang K, Wu Y, Shan S, Han S, Wang X, Wu D, Quan X, Han J, Zhang L. Exploring the experiences of peer support participation for HIV peer volunteers: A meta-synthesis of qualitative research. Int J Nurs Stud 2024; 153:104715. [PMID: 38447487 DOI: 10.1016/j.ijnurstu.2024.104715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 12/14/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Gaining insights and feedback from HIV peer volunteers about their peer support practice is crucial for optimizing and enhancing the effectiveness and sustainability of peer support for people with HIV. There is a dearth of systematic reviews that explore the experiences of HIV peer volunteers about their peer support experience. This study aims to consolidate qualitative research on the experiences of peer support participation for HIV peer volunteers, to provide inspiration and reference for HIV peer support practice. METHODS A meta-aggregation approach was employed to synthesize qualitative studies. Electronic databases were searched for peer-reviewed and gray literature published in English and Chinese between 1996 and September 2022. Two independent reviewers assessed the methodological quality and extracted data from the included studies. The meta-aggregation approach developed by the Joanna Briggs Institute (JBI) was utilized to synthesize the findings. RESULTS A total of 2610 studies were initially identified through the database search, and twenty-two eligible studies were included in the meta-synthesis. Among the included studies, five presented synthesized findings on the following topics: firstly, taking people with HIV as HIV peer volunteers shows specific motivations and advantages when engaging in peer support practice. Secondly, HIV peer volunteers reinforce the connections between people with HIV and medical institutions, ensuring continuity of care and compensating for the limited availability of medical resources. Thirdly, HIV peer volunteers are capable of providing people with HIV with a higher level of support. Additionally, participating in peer support practice can also yield personal benefits for HIV peer volunteers. Finally, HIV peer support programs face both opportunities and challenges. CONCLUSION It is necessary to take more flexible and effective approaches to address resource allocation and social support for people with HIV. Peer support presents a mutually beneficial option that holds significant implications for public health systems, clinical healthcare providers, people with HIV, and HIV peer volunteers. It is imperative to develop effective models for HIV peer support practice. Collaborative efforts between relevant departments and personnel, alongside HIV peer volunteers, should be undertaken to formulate support strategies. Additionally, efforts should be made to identify and guide people with HIV into the healthcare system, facilitating comprehensive treatment and care continuity. These measures aim to further reduce HIV transmission, improve the quality of life for people with HIV, and advance the "normalization" of HIV.
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Affiliation(s)
- Keyi Chang
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, China
| | - Yangfeng Wu
- School of Nursing, Peking University, Beijing, China
| | - Sikai Shan
- School of Nursing, Peking University, Beijing, China
| | - Shuyu Han
- School of Nursing, Peking University, Beijing, China.
| | - Xiaomeng Wang
- School of Nursing, Peking University, Beijing, China
| | - Dongxia Wu
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, China
| | - Xiaoli Quan
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, China
| | - Jianing Han
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, China
| | - Lili Zhang
- Department of Nursing, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, China.
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Krulic T, Brown G, Graham S, McCarthy A, Bourne A. Stepping out of secrecy: heterosexuality, quality of life, and experiences of HIV peer navigation in Australia. Cult Health Sex 2024:1-16. [PMID: 38349774 DOI: 10.1080/13691058.2024.2308667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
Heterosexual people make up a small, but growing proportion of people living with HIV in Australia. This article draws on semi-structured interviews with thirteen heterosexual men and women living with HIV to examine the bearing that sexual identity had on their participation in a peer navigation programme. Our analyses consider the influence of sexuality and gender on the quality of peer relations and the effects of HIV-related stigma on health service engagement and quality of life. Gender and sexuality were significant factors in establishing understanding, acceptance, and community for participants. Having their heterosexuality mirrored by a peer was affirming for men. Women instead emphasised their gendered experiences of HIV. Otherwise, participants' narratives suggested that an experienced peer could reassure, guide interactions with community and services, and ease treatment-related and nonclinical aspects of life. We see peer navigation as a promising intervention to improve the quality of life for heterosexual people living with HIV. Person-centred support from a peer may be particularly important in HIV service environments adapting to the needs of heterosexual people. Peer navigation programmes should promote choice and employ peers of diverse experiences. Implications for referral and the improvement of social services for heterosexual people living with HIV are discussed.
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Affiliation(s)
- Timothy Krulic
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Living Positive Victoria, Melbourne, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Sara Graham
- Living Positive Victoria, Melbourne, Australia
| | - Anthony McCarthy
- Heterosexual Men's Advocacy Network (HetMAN), Melbourne, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Han S, Zhang Y, Yang X, Chai X, Guo J, Zhang L, Shao Y, Ma J, Li K, Wang Z. The effectiveness and sustainability of peer support interventions for persons living with HIV: a realist synthesis. BMJ Glob Health 2023; 8:bmjgh-2022-010966. [PMID: 36804731 PMCID: PMC9943909 DOI: 10.1136/bmjgh-2022-010966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Peer support is an important supplement to medical resources for persons living with HIV (PLHIV). However, previous studies have shown mixed results about intervention effects. It is necessary to explain the mechanism of peer support interventions' effectiveness and sustainability to help design more valid peer support interventions. OBJECTIVE To identify and explain the mechanisms that drive the effectiveness and maintain the sustainability of peer support interventions. METHODS A preliminary theoretical framework was developed through a scoping review of the grey literature and international project frameworks in five professional websites. We then refined the framework by systematically searching evidence in databases including PubMed, EMBASE, Web of Science, ProQuest, CINAHL, CNKI and Wanfang. Qualitative methods were used to generate codes and themes relating to the studies' context, mechanisms and outcomes. We checked chains of inference (connections) across extracted data and themes through an iterative process. RESULTS A total of 6345 articles were identified, and 52 articles were retained for final synthesis. The refined theoretical framework presents five areas of peer support, including informational support, instrumental support, emotional support, affiliational support and appraisal support; five types of outcomes that peer support can improve for PLHIV, including physiological outcomes, psychological outcomes, behavioural outcomes, cognitive outcomes and social outcomes; the effectiveness mechanism coding system from peer volunteers and the relationship between peer volunteers and PLHIV; and the sustainability mechanism coding system in terms of peer volunteers, PLHIV and study context. CONCLUSIONS Given that peer support has huge potential human resources, that is, all the qualified PLHIV, irreplaceable advantages in dealing with barriers to HIV-related discrimination and potential comprehensive benefits for PLHIV, it is necessary to develop and organise more peer support projects for PLHIV. Our study highlights that the expansion of peer support projects should be based on their effectiveness and sustainability. PROSPERO REGISTRATION NUMBER CRD42022339079.
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Affiliation(s)
- Shuyu Han
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Yizhu Zhang
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Xianxia Yang
- School of Public Health, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Xinru Chai
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Jinzheng Guo
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Lili Zhang
- Department of Nursing, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, People's Republic of China
| | - Ying Shao
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, People's Republic of China
| | - Jianhong Ma
- Department of Infection, Beijing Youan Hospital Affiliated with Capital Medical University, Beijing, People's Republic of China
| | - Ke Li
- Department of Emergency, Peking University First Hospital, Beijing, People's Republic of China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, People's Republic of China
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Krulic T, Brown G, Graham S, Hoy J, Bourne A. Revealing an enabling environment: How clinical community and clinical stakeholders understand peer navigation to improve quality of life for people living with HIV in Australia. Front Public Health 2023; 11:1101722. [PMID: 37151586 PMCID: PMC10157390 DOI: 10.3389/fpubh.2023.1101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
People living with HIV have unique resources to offer each other and health systems. This study investigated how peer navigation might contribute to a socially supportive, health enabling environment in Victoria, Australia. We used semi-structured interviews with 30 program staff, management, peer workers and clinician stakeholders. Our analyses considered the interplay between the program, users, HIV-related stigma and discrimination and the health service environment. Peer relationships offered reassurance, acceptance and belonging, which people living with HIV can use to create personal change. Peer engagement coproduced insights for life with HIV and may help to overcome stigma and structural barriers to access services and community support. As a partnership between peer and clinical services, participants described how the program fostered appreciation of peer practices and insights, which were used to improve the quality and continuity of care offered in the state. These findings allude to the value of the community engagement and policy alignment peer responses produce and can be used to guide implementation of similar programs elsewhere.
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Affiliation(s)
- Timothy Krulic
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
- Living Positive Victoria, Melbourne, VIC, Australia
- *Correspondence: Timothy Krulic,
| | - Graham Brown
- The Centre for Social Impact, UNSW, Sydney, NSW, Australia
| | - Sara Graham
- Living Positive Victoria, Melbourne, VIC, Australia
| | - Jennifer Hoy
- Alfred Hospital Infectious Diseases Clinic, Melbourne, VIC, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
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Wells N, Philpot SP, Murphy D, Ellard J, Howard C, Rule J, Fairley C, Prestage G. Belonging, social connection and non-clinical care: Experiences of HIV peer support among recently diagnosed people living with HIV in Australia. Health Soc Care Community 2022; 30:e4793-e4801. [PMID: 35717630 PMCID: PMC10946990 DOI: 10.1111/hsc.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/08/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Effective HIV treatments have transformed the medical needs of people living with HIV (PLHIV) to a chronic condition. However, stigma, poorer mental health outcomes and social isolation remain significant challenges for many PLHIV. HIV peer support programs have assisted PLHIV in navigating the clinical, emotional and social aspects of living with HIV. We draw on semi-structured interviews with 26 recently diagnosed PLHIV in Australia to explore experiences of HIV peer support services. Our thematic analysis identified three overarching themes. First, participants commonly reported that peer support programs offered a sense of belonging and connection to a broader HIV community. This established a network, sometimes separate to their existing social networks, of other PLHIV with whom to share experiences of HIV. Second, peer-based programs provided an opportunity for participants to hear firsthand, non-clinical perspectives on living with HIV. While participants valued the clinical care they received, the perspectives of peers gave participants insights into how others had managed aspects of living with HIV such as disclosure, sex and relationships. Finally, participants highlighted important considerations around ensuring referrals were made to socially and culturally appropriate support programs. Peer support programs fill an important gap in HIV care, working alongside and extending the work of the clinical management of HIV. Incorporating formal referrals to peer support services as part of the HIV diagnosis process could assist recently diagnosed PLHIV in adjusting to a positive diagnosis.
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Affiliation(s)
- Nathanael Wells
- Kirby InstituteUNSW SydneyKensingtonNew South WalesAustralia
| | | | - Dean Murphy
- Kirby InstituteUNSW SydneyKensingtonNew South WalesAustralia
| | - Jeanne Ellard
- Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Chris Howard
- Queensland Positive People (QPP)East BrisbaneQueenslandAustralia
| | - John Rule
- National Association of People with HIV AustraliaNewtownNew South WalesAustralia
| | - Christopher Fairley
- Melbourne Sexual Health CentreMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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Brown G, Reeders D, Cogle A, Allan B, Howard C, Rule J, Chong S, Gleeson D. Tackling structural stigma: a systems perspective. J Int AIDS Soc 2022; 25 Suppl 1:e25924. [PMID: 35818874 PMCID: PMC9274342 DOI: 10.1002/jia2.25924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Structural stigma in the global HIV response is a “moving target” that constantly evolves as the epidemic changes. Tackling structural stigma requires an understanding of the drivers and facilitators of stigma in complex community, policy and health systems. In this paper, we present findings from a study adopting a systems perspective to understand how to tackle structural stigma via the Meaningful Involvement of People with HIV/AIDS (MIPA), while highlighting the challenges in demonstrating peer leadership from people living with HIV (PLHIV). Methods Through a long‐term ongoing community‐research collaboration (2015–2023), the study applied systems thinking methods to draw together the insights of over 90 peer staff from 10 Australian community and peer organizations. We used hypothetical narratives, affinity methods and causal loop diagrams to co‐create system maps that visualize the factors that influence the extent to which peer leadership is expected, respected, sought‐out and funded in the Australian context. We then developed draft indicators of what we should see happening when PLHIV peer leadership and MIPA is enabled to challenge structural stigma. Results Participants in the collaboration identified the interactions at a system level, which can enable or constrain the quality and influence of PLHIV peer leadership. Participants identified that effective peer leadership is itself affected by structural stigma, and peer leaders and the programmes that support and enable peer leadership must navigate a complex network of causal pathways and strategic pitfalls. Participants identified that indicators for effective PLHIV peer leadership in terms of engagement, alignment, adaptation and influence also required indicators for policy and service organizations to recognize their own system role to value and enable PLHIV peer leadership. Failing to strengthen and incorporate PLHIV leadership within broader systems of policy making and health service provision was identified as an example of structural stigma. Conclusions Incorporating PLHIV leadership creates a virtuous cycle, because, as PLHIV voices are heard and trusted, the case for their inclusion only gets stronger. This paper argues that a systems perspective can help to guide the most productive leverage points for intervention to tackle structural stigma and promote effective PLHIV leadership.
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Affiliation(s)
- Graham Brown
- Centre for Social Impact, University of New South Wales, Sydney, New South Wales, Australia.,Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Western Australia, Australia
| | - Daniel Reeders
- School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia.,National Association of People Living with HIV Australia, Sydney, New South Wales, Australia
| | - Aaron Cogle
- National Association of People Living with HIV Australia, Sydney, New South Wales, Australia
| | - Brent Allan
- Qthink Consulting, Melbourne, Victoria, Australia.,Formerly of Living Positive Victoria, Melbourne, Victoria, Australia
| | - Chris Howard
- Queensland Positive People, Brisbane, Queensland, Australia
| | - John Rule
- National Association of People Living with HIV Australia, Sydney, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Chong
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Krulic T, Brown G, Bourne A. A Scoping Review of Peer Navigation Programs for People Living with HIV: Form, Function and Effects. AIDS Behav 2022. [PMID: 35672548 DOI: 10.1007/s10461-022-03729-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/01/2022]
Abstract
This scoping review maps recent research into peer navigation programs for people living with HIV. Four databases were systematically searched in June 2020. Results were screened according to defined criteria and were not restricted to any design, outcome or country. Six papers drew from randomised control trials, five from quasi-experimental or pragmatic trials, and four panel, eight qualitative, three mixed method and one cross-sectional designs were included for review. Programs incorporated health systems navigation and social support. Authors provided strong theoretical bases for peers to enhance program effects. Studies primarily reported program effects on continuum of care outcomes. Further research is required to capture the role HIV peer navigators play in preventing disease and promoting quality of life, mental health, and disease self-management in diverse settings and populations. Peer programs are complex, social interventions. Future work should evaluate detailed information about peer navigators, their activities, the quality of peer engagement as well as employee and community support structures to improve quality and impact.
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