Self-care of women growing older with HIV and/or AIDS

A resiliency intervention adapted for older women with HIV: Results from a pilot randomized controlled trial in the northeastern US

Aging with HIV often results in psychosocial and health-related challenges for women; however, no resiliency interventions exist for older women with HIV (WWH). WWH aged ≥50 were randomized to 10 group sessions of an adapted resiliency intervention or time-matched supportive psychotherapy. Assessments were conducted at three timepoints. Feasibility and acceptability metrics were defined a priori; differences in resilience, stress coping, anxiety, and depression across timepoints were assessed. Overall, 44 WWH enrolled; participants were 58 years old on average, and 56.4% identified as Black/African American. Among those who attended any sessions, all feasibility metrics were met, and the intervention was acceptable. The interaction of study arm and time was associated with significant decreases in depression and a trend toward significant decreases in anxiety. The intervention was not associated with changes in resilience or stress coping. Adjusting delivery modality may further reduce barriers to attendance, improving feasibility and clinical outcomes.

How is Aging Perceived to Affect Well-being in Women Older than 50 Years Living With HIV? A Qualitative Systematic Review

ABSTRACT

Advances in HIV treatment have led to more people with HIV living to 50 years and older. No reviews have qualitatively analyzed and synthesized the literature relevant to theory and practice for well-being specifically in Women living with HIV (WLWH) aged 50 years and older. Sixteen eligible qualitative studies were critically appraised and thematically synthesized to investigate how aging was perceived to affect well-being in WLWH aged 50 years and older. Six themes demonstrated how HIV-related stigmas negatively affected social well-being, and how adjusting to living and aging with HIV negatively affected psychological and physical well-being of older WLWH. Holding caring roles also negatively affected physical well-being of WLWH. Globally, majority women aging with HIV were found to experience additional stigmas. Further research could elucidate how HIV-related stigma affects the well-being of global majority women living and aging with HIV. Recommendations are made for future HIV-related clinical practice and theory development.

Mental Health, Social Connectedness, and Fear During the COVID-19 Pandemic: A Qualitative Perspective from Older Women with HIV

Older women with HIV (WWH) confront significant biopsychosocial challenges that may be exacerbated by the COVID-19 pandemic. Between May 2020 and April 2021, following a resiliency intervention conducted as part of a randomized parent trial, 24 cisgender WWH (M = 58 years old) completed quantitative assessments and qualitative interviews exploring the impact of COVID-19 on mental health. Qualitative data were analyzed via rapid analysis. Most participants were Black (62.5%) and non-Hispanic or Latina (87.5%). Emergent themes included (1) increased anxiety and depression; (2) a loss of social connectedness; (3) fear of unknown interactions among COVID-19, HIV, and other comorbidities; and (4) the use of largely adaptive strategies to cope with these issues. Findings suggest that older WWH face significant COVID-19-related mental health challenges, compounding existing stressors. As the pandemic persists, it will be important to assess the impact of these stressors on wellbeing, identify effective coping strategies, and provide increased support to mitigate COVID-19-related mental health issues over time. Trial Registration: ClinicalTrials.gov identifier: NCT03071887.

The experienced positive and negative influence of HIV on quality of life of people with HIV and vulnerable to HIV in the Netherlands

This qualitative study aimed to explore the experienced influence of HIV on the quality of life (QoL) of people with HIV (PHIV) and key populations without but are vulnerable to HIV in the Netherlands. We conducted and thematically analyzed interviews with 29 PHIV and 13 participants from key populations without HIV (i.e., men who have sex with men). PHIV and key populations shared positive meaningful experiences regarding HIV, i.e., feeling grateful for ART, life, and the availability of PrEP, being loved and supported in the light of HIV, and providing support to the community. Negative predominant experiences regarding HIV were described by both PHIV and key populations as the negative effects of ART, challenges with regards to disclosing HIV, social stigmatization, and self-stigma. It remains important to support HIV community organizations in their efforts to reduce social stigmatization and to continue improving biomedical interventions for HIV.

Adapting, testing, and refining a resilience intervention for older women with HIV: An open pilot study

Half of persons with HIV in the United States (US), many of whom are women, are over age 50. Aging women with HIV (WWH) face unique biopsychosocial challenges, including stigma, the physiological effects of aging, and illness-associated stressors. Resilience interventions can build awareness of such stressors and aid in facilitating the relaxation response; however, no existing interventions specifically cater to the needs of older WWH. The content of the Relaxation Response Resiliency Program, which teaches positive psychology strategies, relaxation techniques, and cognitive behavioral skills, was adapted for older WWH. Thirteen WWH over 50 participated in an open pilot of the adapted intervention to iteratively refine the program and its procedures. Participants attended either 8 or 10 weekly group sessions; three groups were conducted in total. Pre- and post-intervention assessments and qualitative exit interviews were conducted. Among completers, an increase in resilience was observed. Though significance testing was not conducted, social support also increased, and depression, anxiety, and HIV stigma decreased from pre- to post-intervention. Over half of eligible women enrolled; completers reported high satisfaction with the program. However, retention was difficult; six participants withdrew or were lost to follow-up. Mean number of sessions attended was 3.5 in the 8-session group and 5 in the 10-session groups. In this small sample, the adapted intervention led to a clinically meaningful increase in resilience, though recruitment and retention were challenging. Further refinements to the intervention are needed to minimize attrition and increase acceptability before additional testing is initiated.

'Staying alive' with antiretroviral therapy: a grounded theory study of people living with HIV in Peru

BACKGROUND

To achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America.

METHODS

A constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas.ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality.

RESULTS

The core category 'staying alive' emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers.

CONCLUSION

Adherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.

Enduring stigma and precarity: A review of qualitative research examining the experiences of women living with HIV in high income countries over two decades

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.

Qualitative longitudinal study of episodic disability experiences of older women living with HIV in Ontario, Canada

OBJECTIVES

To examine the episodic disability experiences of older women living with HIV over time.

DESIGN

Qualitative longitudinal study, conducting semistructured in-depth interviews on four occasions over a 20-month time frame. Inductive thematic analyses were conducted cross-sectionally and longitudinally.

SETTING

Participants were recruited from HIV community organisations in Canada.

PARTICIPANTS

10 women aged 50 years or older living with HIV for more than 6 years.

RESULTS

Two major themes related to the episodic nature of the women's disability. Women were living with multiple and complex sources of uncertainty over time including: unpredictable health challenges, worrying about cognition, unreliable weather, fearing stigma and the effects of disclosure, maintaining housing and adequate finances, and fulfilling gendered and family roles. Women describe strategies to deal with uncertainty over time including withdrawing and limiting activities and participation and engaging in meaningful activities.

CONCLUSIONS

This longitudinal study highlighted the disabling effects of HIV over time in which unpredictable fluctuations in illness and health resulted in uncertainty and worrying about the future. Environmental factors, such as stigma and weather, may put older women living with HIV at a greater risk for social isolation. Strategies to promote dealing with uncertainty and building resilience are warranted.

Ageing and healthy sexuality among women living with HIV

Populations around the world are rapidly ageing and effective treatment for HIV means women living with HIV (WLHIV) can live longer, healthier lives. HIV testing and screening programmes and safer sex initiatives often exclude older sexually active WLHIV. Systematically reviewing the literature to inform World Health Organization guidelines on the sexual and reproductive health and rights (SRHR) of WLHIV, identified four studies examining healthy sexuality among older WLHIV. In Uganda, WLHIV reported lower rates of sexual activity and rated sex as less important than men. In the United States, HIV stigma, disclosure, and body image concerns, among other issues, were described as inhibiting relationship formation and safer sexual practices. Sexual activity declined similarly over time for all women, including for WLHIV who reported more protected sex, while a significant minority of WLHIV reported unprotected sex. A single intervention, the "ROADMAP" intervention, demonstrated significant increases in HIV knowledge and decreases in HIV stigma and high risk sexual behaviour. WLHIV face ageist discrimination and other barriers to remaining sexually active and maintaining healthy sexual relationships, including challenges procuring condoms and seeking advice on safe sex practices, reduced ability to negotiate safer sex, physical and social changes associated with menopause, and sexual health challenges due to disability and comorbidities. Normative guidance does not adequately address the SRHR of older WLHIV, and while this systematic review highlights the paucity of data, it also calls for additional research and attention to this important area.

A metasynthesis of factors affecting self-management of chronic illness

AIM

To identify factors that may serve as facilitators and barriers to self-management described by adults living with chronic illness by conducting a qualitative metasynthesis.

BACKGROUND

Self-management is an individuals' active management of a chronic illness in collaboration with their family members and clinicians.

DESIGN

Qualitative metasynthesis.

DATA SOURCES

We analysed studies (N = 53) published between January 2000-May 2013 that described factors affecting self-management in chronic illness as reported by adults aged over 18 years with chronic illness.

REVIEW METHODS

Sandelowsi and Barroso approach to qualitative metasynthesis: literature search; quality appraisal; analysis and synthesis of findings.

RESULTS

Collectively, article authors reported on sixteen chronic illnesses, most commonly diabetes (N = 28) and cardiovascular disease (N = 20). Participants included men and women (mean age = 57, range 18-94) from 20 countries representing diverse races and ethnicities. We identified five categories of factors affecting self-management: Personal/Lifestyle Characteristics; Health Status; Resources; Environmental Characteristics; and Health Care System. Factors may interact to affect self-management and may exist on a continuum of positive (facilitator) to negative (barrier).

CONCLUSION

Understanding factors that influence self-management may improve assessment of self-management among adults with chronic illness and may inform interventions tailored to meet individuals' needs and improve health outcomes.

Taking it one day at a time: African American women aging with HIV and co-morbidities

Self-managing HIV/AIDS presents challenges for anyone infected. These challenges may be further complicated for older HIV-infected African American women who acquired the disease at younger ages and now have co-morbidities. Little is known regarding how women's age identity, social responsibilities, co-morbidities, and romantic relationship status influence their HIV self-management. Five focus groups were conducted in Washington DC, with HIV-positive African American women aged 52-65. Topics included HIV and co-morbidity self-management, social support needs, medication adherence, and future plans for old age. A constant comparison approach was applied during data analysis. Co-morbidities, including diabetes and hypertension, were perceived to be more difficult to self-manage than HIV. This difficulty was not attributed to aging but to daily struggles such as lack of income and/or health insurance, an inflexible work schedule, and loneliness. Social responsibilities, including caring for family, positively impacted participants' ability to self-manage HIV by serving as motivation to stay healthy in order to continue to help family members. In contrast, inflexible work schedules negatively impacted women's ability to sustain medication adherence. Overall, this study demonstrates that HIV and co-morbidity self-management are inextricably linked. We can no longer afford to view engagement in HIV care as a single-disease issue and hope to attain optimal health and well-being in our HIV-affected populations. Optimal HIV self-management must be framed within a larger context that simultaneously addresses HIV and co-morbidities, while considering how social and cultural factors uniquely intersect to influence older African American women's self-management strategies.

Health care among street-involved women: the perpetuation of health inequity

I present the findings from a study that explored the experiences and decision making of street-involved women navigating the health care system. Data were drawn from a larger qualitative study situated in a western Canadian inner-city neighborhood that examined the health-management strategies of street-involved women with a history of crack cocaine use. Data were collected over a 17-month period and included ethnographic methods of participant observation, group interviews (n = 57), and in-depth interviews (n = 10). Inductive thematic analysis derived two major themes: power and punishment, and organization and delivery of care. The themes illustrate how women's experiences and decision making were located within a nexus of power relations that operated across women's shared social location as downtown eastsiders. Implications of the findings are discussed in relation to supporting women's efforts and improving health outcomes.

What do we know about older adults and HIV? A review of social and behavioral literature

The fastest growing segment of the United States HIV population is people aged 50 and older. This heterogeneous group includes people with diverse pathways into HIV positive status in later life, including aging with the disease as well as later life-acquired infections. As people with HIV live into older ages, solving problems of successful secondary prevention and ongoing treatment requires more specific knowledge of the particular aging-related contextual sociocultural, psychosocial, and personal factors salient to the situations of persons living with HIV. Greater knowledge of these factors will help solve challenges to reducing psychological burden and promoting health maintenance for people with HIV. Yet, the current literature on aging and HIV remains nascent. To assess the state of knowledge of the sociocultural and behavioral factors associated with aging with HIV, we conducted a systematic critical content review of peer-reviewed social and behavioral research on aging and HIV to answer the question, "How have older age, and social, cultural, and behavioral aspects of the intersection of HIV and age been addressed in the literature?" We searched First Search, Proquest, Psych Info, Pub Med, Wilson Select Plus, and World Cat and identified 1549 articles. We then reviewed these to select peer-reviewed articles reporting results of research on the social and behavioral aspects of living with HIV at age 50 and older. Fifty-eight publications were identified that met study inclusion criteria. While few publications reported clear age-related differences, there were significant ethnic differences in living with HIV in later life and also differences among older people when groups were defined by mode of transmission. Findings are discussed in light of constructs from gerontology which may contribute to clarifying how later life, life course stage, and psychological development intersect with, influence, and are influenced by HIV disease and long-term anti-retroviral therapy use.

The experience of self-care: a systematic review

BACKGROUND

Self-care has been defined quite simply as "the set of activities in which one engages throughout life on a daily basis." Examining this 'set of activities' more closely, we see that a number of activities encompass "a person's attempts to promote optimal health, prevent illness, detect symptoms at an early date, and manage chronic illness." Hence, engaging in self-care activities may result in a range of different experiences depending on the set of activities that are performed and the reasons for their undertaking.

OBJECTIVES

To integrate and summarize the experience of engaging in self-care activities as reported by individuals and /or their families.

INCLUSION CRITERIA

Types of Studies - Qualitative studies included, but were not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.Types of Participants - Individuals and/or their families who engaged in self-care activities, or were assisted with their self-care activities, or provided support for self-care.Types of Interventions - Individual experiences of self-care in response to an intervention or where no intervention was introduced.Types of Outcomes - Individual experiences of self-care through self-report. Reports from family members who assisted or provided support for self-care were included.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies (e.g., theses). A three-step search strategy was used in each component of this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles were searched for additional studies. The databases searched included: CINAHL; MEDLINE; EMBASE; PsycINFO; AMED; Cochrane Library; Scirus; and Mednar METHODOLOGICAL QUALITY: Methodological quality of the studies was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument Critical Appraisal Checklist for Interpretive & Critical Research. Two appraisers independently reviewed each study.

DATA COLLECTION AND ANALYSIS

Qualitative data were extracted from included studies using an adaptation of the standardized JBI Data Extraction Tool for Qualitative Evidence.

DATA SYNTHESIS

The data were synthesized using narrative form.

RESULTS AND CONCLUSIONS

Engaging in self-care is a process involving being aware of self, acquiring knowledge and taking responsibility for meeting needs at whatever level they are presented. The performance of self-care behaviours can be influenced both positively and negatively by the attitudes of others. Throughout life, the purpose for performing self-care differs and individuals face challenges that interfere with their ability to master these self-care behaviours. Individuals who are able to find symbolic meaning in the disease/disability or reframe the implications positively are more capable of adapting and maintaining their focus on caring for themselves. Studies revealed that individuals may abandon self-care when overwhelmed by symptoms or disability and/or when they feel that they are not supported.

IMPLICATIONS FOR PRACTICE

It is valuable for health care professionals to understand the struggle that individuals experience when trying to engage in self-care. Furthermore, health care professionals need to be cognizant of how important their support is, in terms of encouraging individuals to adopt and maintain self-care behaviours.

IMPLICATIONS FOR RESEARCH

This review has provided an insight into the process of engaging in self-care through the different developmental stages of life, as well as the adoption of self-care behaviours to meet different requisites. Further research would be valuable to integrate the range of health care interventions provided to individuals across different disability or disease groupings who engage in self-care activities.

Self-care behaviors of African American women living with HIV: a qualitative perspective

Significant numbers of African American (AA) women have been diagnosed with HIV over the past decade. HIV may be viewed as a chronic condition that can be actively managed through the use of self-care behaviors, yet little is known about how these women define self-care (SC) for themselves, and still less is known about what facilitates and hinders SC behaviors among these women. This article highlights the results of a qualitative research study undertaken with AA women living with HIV in a metropolitan city in the southeastern United States. The objective of this study was to systematically collect data about the SC experiences of these women. Focus group methodology was used. Content analysis of the data was conducted. Two primary domains emerged: do what the doctor says and living healthy. SC activities included seeking social support, managing disclosure, engaging in pampering, taking part in religious customs, and maintaining recovery.

Systemic barriers to health care access for U.S. women with HIV: the role of cost and insurance

Lack of access to health care has particularly brutal consequences for low-income U.S. women with HIV who, without regular and consistent primary care, including treatment with highly active antiretroviral therapy (HAART), are less likely to live long and well with HIV. This article explores barriers to basic health care encountered by a sample of 55 HIV-infected women from urban and rural Wisconsin who participated in a longitudinal, qualitative study. In a series of 10 in-depth, story-eliciting interviews over a two-year period, each woman explained in detail what it was like for her to obtain health care since becoming infected. Conveying women's subjective experiences of trying to get the care they needed, their stories highlight serious institutional impediments to health care and provide a discomfiting glimpse of the systemic forces that limit access to health itself. Findings convey how the extraordinarily high cost of U.S. health care, the unpredictable and disjointed array of out-of-pocket costs, and the complex and obfuscated intricacies of health insurance impeded women's access. They lived a paradoxical reality: having an illness they feared, needing treatment for long-term survival, and being unable to meet its costs. Each woman's story reflects deep fissures in the U.S. health care system.

Coping with HIV: perspectives of mothers

This qualitative study explored how HIV-infected mothers cope with a diagnosis of HIV and their resulting life circumstances. The study was a secondary analysis of qualitative semistructured interviews with a subgroup of women (N = 35) who had participated in a larger quantitative and qualitative longitudinal study, Living with HIV/AIDS: Mother-Child Coping and Adjustment. The sample for the current study was primarily low-income HIV-infected mothers. Examination of the participants' narratives indicated that they relied on strategies that not only enabled them to cope with HIV but also helped them to develop better attitudes toward life and more positive behavior and to begin to live life differently than before the diagnosis. These results offset the stereotype that low-income women are less capable of coping with stressful life situations than other populations in that the coping strategies used by this population were very similar in form and function to those used by other more advantaged populations.

Pill taking from the perspective of HIV-Infected women who are vulnerable to antiretroviral treatment failure

We conducted this longitudinal qualitative study to gain in-depth understanding of HIV-infected women's experiences with antiretroviral (ARV) regimens, exploring from their perspective what medication taking was like for them and what it meant in the context of their everyday lives. We engaged 55 participants over a 2-year period in 10 narrative-eliciting interviews. From their medication stories, we were able to track a 2-year prospective pattern of self-reported adherence for each individual who was prescribed ARVs. In this article we focus on the medication experiences of a subsample of 14 women who persistently had difficulties taking ARVs as prescribed, detailing their descriptions and evaluations of pill taking. Results suggest that rather than judging themselves harshly for nonadherence, they perceived their at-odds pill taking to be personally meaningful and accomplished for good purpose. Their rationales provide insights for more nuanced, empowerment-based interventions for individuals who are vulnerable to ARV treatment failure.

Health concerns of mature women living with HIV in the midwestern United States

This study was performed to better understand the health concerns of mature Midwestern women living with HIV and to offer health care providers information about the spectrum of medical and psychosocial needs of this population. Individual interviews were conducted with 18 low-income women who were 41 to 68 years of age. Interviews showed multiple needs that encompassed both physical and emotional health: more frequent health screenings, the ability to differentiate symptoms of advancing HIV from those of aging, desire for knowledge about reasonable expectations for aging women with HIV, and attention to emotional health needs and social support. Interventions aimed at helping mature HIV-infected women cope as they age, education about the normal aging process, consumer information about appropriate timing of health care screenings, and mechanisms to facilitate the creation of social support networks to decrease isolation seem to be needed in this population.

Spirituality as a component of holistic self-care practices in human immunodeficiency virus-positive women with histories of abuse

The purpose of this article is to articulate the need for a holistic theory of self-care for women with human immunodeficiency virus that describes and interprets spirituality as a primary component. The authors propose that by conceptualizing spirituality as integral to self-care, nurses will support and educate women with human immunodeficiency virus utilizing a holistic perspective.