In the Interest of Time: Assessing the Role of Resilience Across an Intergenerational Sample of People Living with HIV

BACKGROUND

Biomedical advances have improved the quality of life of people living with HIV (PLWH); however, barriers to optimal well-being remain. A key feature in understanding the lived experiences of PLWH is resilience. The concept of resilience is quite complex in terms of its antecedents and expressions, suggesting the need for more nuanced understandings of how it could be harnessed to better support this population.

METHOD

The concept of resilience was explored in a qualitative study involving 22 PLWH, selectively sampled by era of diagnosis. Through interviews focused on context and experiences of living with HIV, the sample highlighted resilience processes corresponding to Positive reappraisal of life events, Positive reappraisal of self, and Community as resilience.

RESULTS

Participants who have lived with HIV longer more commonly described engaging in psychological processes of resilience, whereas those who were more recently diagnosed reported engaging in more social processes. However, these processes were not mutually exclusive and the ability to perform resilience through community seems to be key to optimizing outcomes, irrespective of era of diagnosis.

CONCLUSION

PLWH are a heterogeneous population where engagement in distinct processes of resilience may have important implications for optimal social and health outcomes. Better understanding of the distinct and diverse pathways through which PLWH engage in resilience may inform interventions promoting optimal well-being.

"It Comes in Steps and Stages": Experiences of People Living with HIV in Achieving Employment

People living with HIV who are seeking jobs experience unique barriers to obtaining employment at the individual, group, and community levels. Traditional employment assistance programs can provide support but may not be tailored to some people living with HIV who often experience barriers to work related to their social needs (such as housing instability) or their lack of consistent engagement in the workforce. To understand how people living with HIV return to work, in-depth interviews were conducted with 43 participants enrolled in interventions coordinating HIV care with housing and employment services at eight sites across the US. Four themes emerged on strategies to increase employment: (1) assessing and responding to employment needs that align with their socio-economic environment; (2) using social networks among family and friends for referrals and support; (3) engaging with navigators who are able to connect clients to skills building opportunities and job resources; and (4) addressing the system barriers such as helping with unmet basic needs (e.g. transportation), finding employers who can accommodate workers with income limits associated with public benefits, and helping immigrants, transgender individuals, and people experiencing homelessness secure legal documentsthat facilitate entry into employment by reducing stigmatized identities.

Smoking Predicts Food Insecurity Severity among Persons Living with HIV

Food insecurity is a key social and health issue among persons living with HIV (PLHIV). Food insecurity oftentimes co-occurs with substance use, but little is known about the relationship between tobacco use and food insecurity particularly among PLHIV. In this study, we prospectively examined the association of cigarette smoking with food insecurity in a cohort of 108 individuals seeking vocational rehabilitation services. Over the 12-month study period, smokers at baseline reported consistently higher levels of food insecurity compared to non-smokers. Smoking remained an independent risk factor for greater food insecurity, controlling for sociodemographic characteristics and known confounders (e.g., substance use, depression). Food insecurity is a key structural and socioeconomic barrier that may partially explain HIV-related health disparities observed among smokers. Further research is needed to characterize the bio-behavioral mechanisms linking smoking and food insecurity as well as test whether smoking cessation can reduce food insecurity in PLHIV who smoke.