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Nelson CL, Oswald AG, Jung HH, Fredriksen-Goldsen KI. Racial and Ethnic Variations in Resilience Factors Among Sexual and Gender Minority Midlife and Older Adults. THE GERONTOLOGIST 2024; 64:gnae100. [PMID: 39132715 PMCID: PMC11407853 DOI: 10.1093/geront/gnae100] [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] [Received: 03/19/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study explores resilience factors among sexual and gender minority (SGM) midlife and older adults, identifying historical/environmental, psychological, social, and behavioral predictors, and examining variations across racial/ethnic subgroups. By adopting a resilience-focused perspective, this research contributes to understanding strengths in the SGM community in the context of aging. RESEARCH DESIGN AND METHODS Using weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this research investigates distinct risk and protective factors associated with resilience among SGM midlife and older adults. Subgroup variations were assessed using regression models. Factors moderated by race/ethnicity were integrated into final interaction models. RESULTS Hispanic and Black individuals showed significantly higher resilience than non-Hispanic Whites. Lifetime victimization and day-to-day discrimination were negatively associated with resilience. Positive associations were found for higher income, identity affirmation, larger network size, greater social participation, increased physical activity, and sufficient food intake. Interaction models revealed nuanced patterns by subgroups; education negatively impacted resilience among Black individuals, while income positively influenced Hispanic individuals' resilience. The Other racial/ethnic group demonstrated unique associations between optimal sleep and resilience. DISCUSSION AND IMPLICATIONS This study shifts from a deficit-based to a resilience-focused approach among SGM midlife and older adults, revealing key strengths within diverse subgroups. Results underscore the significance of recognizing racial/ethnic differences in factors promoting resilience and posing risks for SGM midlife and older adults. Tailoring interventions to address the intersectional needs of SGM aging populations is essential for enhancing their abilities to bounce back from adverse events.
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Affiliation(s)
- Christi L Nelson
- Goldsen Institute, School of Social Work, University of Washington, Seattle, Washington, USA
| | - Austin G Oswald
- Goldsen Institute, School of Social Work, University of Washington, Seattle, Washington, USA
| | - Hailey H Jung
- Goldsen Institute, School of Social Work, University of Washington, Seattle, Washington, USA
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Pollak C, Cotton K, Winter J, Blumen H. Health Outcomes Associated with Loneliness and Social Isolation in Older Adults Living with HIV: A Systematic Review. AIDS Behav 2024:10.1007/s10461-024-04471-3. [PMID: 39231919 DOI: 10.1007/s10461-024-04471-3] [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] [Accepted: 08/16/2024] [Indexed: 09/06/2024]
Abstract
Self-management of HIV is crucial to reduce disease-related negative health outcomes. Loneliness and social isolation are associated with poor disease self-management (e.g., medication non-adherence and care disengagement) in younger people with HIV and negative health outcomes in the general older adult population. Older adults with HIV (OWH) are at increased risk for loneliness and social isolation, but the associated health outcomes remain unclear. A comprehensive review of Pubmed, Embase, PsycINFO, and Web of Science databases was conducted. Criteria for inclusion were original quantitative research, published in the English language, included adults with a mean age ≥ 50 years, and included a measure for loneliness or social isolation, and a health outcome measure. A total of 41 studies were analyzed and 19,282 participants contributed to this review. The main findings were that loneliness and social isolation were associated with negative health behavior, disease self-management, physiological, and psychological outcomes. Pooled prevalence of loneliness was 33.9% across 8 studies. Loneliness and social isolation are highly prevalent in OWH and are associated with negative outcomes in OWH, similarly to older adults in the general population. Older adults with HIV, however, are challenged by unique psychosocial circumstances that place them at greater risk for loneliness and social isolation and associated negative health outcomes. These findings should be verified in larger, diverse, and longitudinal samples to better understand interrelationships of psychosocial factors and clinical outcomes in OWH.
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Affiliation(s)
- Chava Pollak
- Department of Medicine (Geriatrics), Albert Einstein College of Medicine, 1225 Morris Park Ave, Bronx, NY, 10461, USA.
| | - Kelly Cotton
- Department of Neurology, Albert Einstein College of Medicine, 1225 Morris Park Ave, Bronx, NY, 10461, USA
| | - Jennifer Winter
- College of Health Professions, Pace University, 861 Bedford Rd, Pleasantville, NY, 10570, USA
| | - Helena Blumen
- Department of Medicine (Geriatrics), Albert Einstein College of Medicine, 1225 Morris Park Ave, Bronx, NY, 10461, USA
- Department of Neurology, Albert Einstein College of Medicine, 1225 Morris Park Ave, Bronx, NY, 10461, USA
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Handlovsky I, Amato AT, Ferlatte O, Kia H, Gagnon M, Worthington C. Examining the Influence of Pre-HAART Experiences on Older, Self-Identifying Gay Men's Contemporary Constructions of Quality of Life (QOL). JOURNAL OF HOMOSEXUALITY 2024; 71:1880-1899. [PMID: 37192266 DOI: 10.1080/00918369.2023.2212100] [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: 05/18/2023]
Abstract
Some older gay men (50+) experience diminished quality of life (QOL) due to historical and ongoing discrimination in addition to living through a collective trauma-the pre-HAART era of the HIV/AIDS epidemic-characterized by the absence of treatment and rampant discrimination targeting gay men. A growing body of literature, however, illustrates that older gay men demonstrate remarkable resilience but little is known about how QOL is conceptualized and how these conceptualizations are potentially shaped by pre-HAART experiences. The current study drew on constructivist grounded theory methods to examine how QOL is conceptualized in light of the sociohistorical relevance of pre-HAART. Twenty Canadian based gay men aged 50+ participated in semi-structured interviews via Zoom. Ultimately, QOL is understood as experiencing contentment, which is made possible by the development and implementation of three key processes: (1) developing and cultivating meaningful connections, (2) growing into and embracing identity, and (3) appreciating the capacity to do what brings joy. QOL for this group is greatly informed by a context of disadvantage, and the demonstrated resilience warrants further investigation to meaningfully support the overall well-being of older gay men.
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Affiliation(s)
- Ingrid Handlovsky
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony T Amato
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Olivier Ferlatte
- École de Santé Publique de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Hannah Kia
- UBC School of Social Work, Vancouver, British Columbia, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
- Canadian Institute for Substance Use Research, Victoria, British Columbia, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
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4
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Nelson CL. Exploring Resilience Among Midlife and Older Sexual Minority and Heterosexual Adults: A Multidimensional Analysis. J Appl Gerontol 2024:7334648241255496. [PMID: 38767117 DOI: 10.1177/07334648241255496] [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: 05/22/2024] Open
Abstract
Research on resilience in sexual minority midlife and older adults is limited. Using a multidimensional approach, this study examined trait resilience (optimism), resilience as a dynamic process (perceived control), and relational resilience (social support), analyzing their roles in physical and mental health among sexual minority adults. Analyzing data from MIDUS 2 and MIDUS Refresher, we examined a sample of 492 participants, comprising 164 sexual minority and 328 propensity-matched heterosexual individuals. Among sexual minority participants, perceived control was associated with fewer chronic conditions and optimism with lower depressed affect. Among heterosexual participants, perceived control was associated with both outcomes. Subgroup analyses found variations, particularly among lesbian and bisexual women. Resilience measures were not associated with the health outcomes for gay or bisexual men. This study highlighted the complex roles of trait resilience and dynamic resilience processes in association with health outcomes among sexual minority midlife and older adults across diverse subgroups.
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Affiliation(s)
- Christi L Nelson
- University of Washington, Seattle, WA, USA
- University of South Florida, Tampa, FL, USA
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Danielewicz M. Medical Issues Affecting Older Gay and Bisexual Men. Clin Geriatr Med 2024; 40:239-250. [PMID: 38521595 DOI: 10.1016/j.cger.2023.11.003] [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: 03/25/2024]
Abstract
Older gay and bisexual men constitute diverse, sizable, and potentially vulnerable populations. They have and continue to face discrimination and stigma in multiple settings, including health care. Older gay and bisexual men report worse health, higher rates of alcohol and tobacco use, and higher HIV rates compared with their heterosexual counterparts. They have unique needs and experiences in multiple realms of health care including mental health, sexual health, and cancer screenings. Geriatric medicine physicians and providers can educate themselves on these unique needs and risks and take steps to provide inclusive, affirming care.
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Affiliation(s)
- Michael Danielewicz
- Pride at the Jefferson Center for Healthy Aging, Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA 19147, USA.
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Almaradheef R, Alhalal E. Outcomes of adverse childhood experience during late adolescence: Evidence from college and community samples. Res Nurs Health 2024; 47:182-194. [PMID: 38217469 DOI: 10.1002/nur.22368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/31/2023] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
Scant studies have investigated adverse childhood experience (ACE) outcomes and mastery during adolescence in different cultural contexts. This cross-sectional study examines the impact of ACEs on subjective well-being, health complaints, and healthcare utilization during late adolescence, including the mediating role of the sense of mastery in the Saudi context. Adolescents (N = 396) aged 17-21 years were recruited via convenience sampling from colleges and local communities from two regions in Saudi Arabia. Data were collected using a paper-pencil anonymous survey and analyzed using path analysis. Of the sample, 85.5% experienced at least one ACE. ACEs had a direct effect on subjective well-being (p = 0.034), health complaints (p < 0.001), healthcare utilization (p < 0.001), and sense of mastery (p < 0.001). Sense of mastery had an effect on subjective well-being (p < 0.001) and health complaints (p < 0.001), but not on healthcare utilization (p = 0.436). Sense of mastery partially mediated the relationship between ACEs and subjective well-being (p = 0.034) and health complaints (p < 0.001), but not healthcare utilization (p = 0.438). ACEs have detrimental effects on adolescent health. Attention should be paid to primary prevention and early detection to avoid further harm, and interventions that address the role of the sense of mastery should be developed for adolescents.
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Affiliation(s)
| | - Eman Alhalal
- Community and Mental Health Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Abstract
BACKGROUND Sexual and gender minorities constitute a rapidly growing part of the older adult population in the United States and may face quality of life (QOL) challenges in older adulthood. Research on quality of life among lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults has increased dramatically since 2010. Common findings indicate that LGBTQ older adults face challenges related to personal experiences of discrimination, anticipated discrimination in health care settings, and lack of family support. Research designs were primarily nonprobability surveys, with a small number of qualitative designs and surveys using representative probability samples. AIM To identify and summarize research on QOL among LGBTQ older adults conducted in the United States between January 1, 2000 and December 31, 2020. METHOD Four scholarly databases were searched to identify studies addressing QOL in LGBTQ older adult populations. RESULTS The database search produced a total 568 unique results. Of these, 54 research articles were identified that met all inclusion criteria for the review. Appraisal of evidence was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. CONCLUSIONS Care for mental health of LGBTQ older adults should be sensitive to issues including lifetime history of discrimination, anxiety about anticipated discrimination from health care providers, and potential lack of family support. Focus can also be given to common areas of strength, including strengthening nonfamily social networks.
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Affiliation(s)
- Russell Preston
- Russell Preston, MS, RN, University of Rochester School of Nursing, Rochester, NY, USA
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Serrano VB, Pasipanodya EC, Montoya JL, Heaton RK, Jeste DV, Moore DJ. Reactivity of Health-Related Quality of Life to Perceived Stress: The Buffering Role of Psychosocial Resources in a Longitudinal Study of Adults with and Without HIV. J Clin Psychol Med Settings 2024; 31:174-185. [PMID: 37204645 PMCID: PMC10924706 DOI: 10.1007/s10880-023-09962-4] [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] [Accepted: 04/25/2023] [Indexed: 05/20/2023]
Abstract
People with HIV now have increased longevity; however, their health-related quality of life (HRQoL) still lags significantly compared to people without HIV. Perceived stress negatively impacts HRQoL, whereas psychosocial resources are linked to better HRQoL. This longitudinal analysis aims to explore the buffering role of psychosocial resources on the relationship between HRQoL and perceived stress. Participants (N = 240) included 142 persons with HIV (PwH) and 98 without HIV, M(SD) = 50.9(8.1) years. Multilevel models over four study years examined longitudinal relationships between HRQoL (outcome) and perceived stress (predictor) and potential moderation by psychosocial resources (personal mastery, social support, and resilience) by HIV serostatus. Among PwH only, personal mastery (p = 0.001), social support (p = 0.015), and resilience (p = 0.029) were associated with an attenuated effect of perceived stress (less negative slopes) for physical HRQoL over time. Bolstering personal mastery, social support, and resilience may have relevance for improving physical well-being among PwH.
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Affiliation(s)
- Vanessa B Serrano
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Elizabeth C Pasipanodya
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA
| | - Jessica L Montoya
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, San Diego, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, HIV Neurobehavioral Research Program, 220 Dickinson Street, Suite B (8231), San Diego, CA, 92103, USA.
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Handlovsky I, Wonsiak T, Amato AT. Older, self-identifying gay men's conceptualisations of psychological well-being (PWB): A Canadian perspective. Nurs Philos 2024; 25:e12466. [PMID: 37828850 DOI: 10.1111/nup.12466] [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] [Received: 07/13/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023]
Abstract
Many older gay men experience diminished psychological well-being (PWB) due to unique circumstances including discrimination, living with HIV, and aging through the HIV/AIDS crisis. However, there remains ambiguity as to how older gay men define and understand PWB. Our team interviewed and analyzed the accounts of 26 older (50+) self-identifying English-speaking men living in southwestern British Columbia, Canada. We drew on tenets of constructivist grounded theory and intersectionality to account for unique contextual considerations and power relations. Semi-structured Zoom interviews were conducted from August-October 2022. Interview transcripts were compared to generate high-order conceptual findings underpinned by processes understood as central to PWB. Three PWB temporal processes highlighted interlocking social and contextual circumstances intersecting with power and maturation: (1) being emotionally balanced, (2) living gratitude (3) and fully embracing self-acceptance. Being emotionally balanced supported the affective and sustainable state of contentment, living gratitude drew from the wisdom of accrued experiences to cultivate a positive affective state inclusive to recognising social location privileges, whilst fully embracing self-acceptance redressed the harms of anti-gay discourses that men endured throughout their lives. The knowledge is relevant to service and resource development to deliver tailored PWB supports to older gay men.
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Affiliation(s)
- Ingrid Handlovsky
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Tessa Wonsiak
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony T Amato
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
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10
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Haase SR, Billings R, Vance DE, Fazeli PL. The Association Between Intrapersonal Resilience Resources and Quality of Life Among Older Persons Living With HIV: A Systematic Review. J Assoc Nurses AIDS Care 2023; 34:502-526. [PMID: 37815846 PMCID: PMC10593503 DOI: 10.1097/jnc.0000000000000432] [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: 10/11/2023]
Abstract
ABSTRACT Despite positive improvements in health care, older persons living with HIV (PWH) still face psychosocial challenges and medical issues that affect their overall quality of life (QoL). Intrapersonal resilience resources may serve as a protective factor allowing PWH to better cope with adversity, thereby improving their well-being. In our systematic review, we examined intrapersonal resilience resources and their association with QoL outcomes among middle-aged and older PWH (≥40 years). Four databases (CINAHL, PubMed, PsycINFO, and Embase) were searched, and 1,400 articles were yielded. Following screening and full-text review, 19 studies met full criteria and were included. Based on our findings from these studies, trait resilience, spirituality, and self-efficacy were the most common resilience resources investigated. Resilience resources were positively associated with QoL outcomes and mediated the association between various psychosocial factors (e.g., stigma) and QoL. Future studies should explore resilience resources and QoL over time among diverse populations of PWH.
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Affiliation(s)
- Shakaye R. Haase
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L. Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Henderson ER, Haberlen SA, Coulter RW, Weinstein AM, Meanley S, Brennan-Ing M, Mimiaga MJ, Turan JM, Turan B, Teplin LA, Egan JE, Plankey MW, Friedman MR. The role of social support on cognitive function among midlife and older adult MSM. AIDS 2023; 37:803-811. [PMID: 36728912 PMCID: PMC10157348 DOI: 10.1097/qad.0000000000003464] [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: 02/03/2023]
Abstract
OBJECTIVE This study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV. DESIGN We analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study. METHODS We conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support. RESULTS Social support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support. CONCLUSION Social support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.
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Affiliation(s)
- Emmett R. Henderson
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert W.S. Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea M. Weinstein
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York City, New York
| | - Matthew J. Mimiaga
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Janet M. Turan
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Linda A. Teplin
- Departments of Psychiatry and Behavioral Sciences and Medicine, Infectious Diseases, Feinberg School of Medicine, Chicago, Illinois
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael W. Plankey
- Department of Medicine, Division of General Internal Medicine, George town University Medical Center, Washington, District of Columbia
| | - M. Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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A qualitative study of older people living with HIV Hong Kong: Resilience through downward comparison amidst limited social support. J Aging Stud 2023; 64:101079. [PMID: 36868626 DOI: 10.1016/j.jaging.2022.101079] [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: 04/25/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
Research on older people living with HIV (OPHIV) highlights social support as an important dimension of their resilience and coping resources. This study asks: in face of high perceived risk of HIV status disclosure, how do OPHIV cope when they have little social support from family and friends? METHODS This study broadens the study of OPHIV beyond North America and Europe and presents a case study of Hong Kong. In collaboration with the longest-running non-governmental organization working on HIV/AIDS issues in Hong Kong, 21 interviews with OPHIV were conducted. RESULTS It was found that a vast majority of them did not disclose their HIV status and many lacked social support from family and friends. The OPHIV in Hong Kong turned instead to coping through downward comparison, drawing on a comparison between their current lives with: (1) how they themselves experienced HIV in their earlier life; (2) how HIV was socially treated in the past; (3) how HIV was medically treated in the past; (4) growing up under harsh economic circumstances when industrialization and rapid economic development took place in Hong Kong; (5) Eastern religions, spiritual support and the associated philosophy of 'letting go' and acceptance. CONCLUSIONS This study has found that in face of high perceived risk of HIV status disclosure, where OPHIV have little social support from family and friends, they used the psychological mechanism of downward comparison to maintain positivity. The findings also contextualize the lives of OPHIV against the historical development of Hong Kong.
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Krause KD, Brennan-Ing M, Halkitis PN. Assessing the Factor Structure and Psychometric Properties of the HIV-Related Resilience Screener: The GOLD Studies. AIDS Behav 2022; 27:1703-1715. [PMID: 36369501 DOI: 10.1007/s10461-022-03902-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
People who are 50 and older constitute the majority of those living with HIV/AIDS (PLWHA) in the US. Aging PLWHA face myriad biopsychosocial health challenges related to HIV/AIDS and the aging process. Resilience may act as a buffer to the negative impact of these challenges however measuring it among PLWHA has been inconsistent, so the HIV-Related Resilience Screener (HIV-RRS) was developed. Data for the present study are drawn from 250 sociodemographically diverse HIV-positive gay men ages 50-69 in NYC. Tests of reliability and validity were conducted, and an Exploratory Factor Analysis indicated a three-factor model was the most parsimonious solution. Items were examined for their underlying relationships and labeled: adaptive coping, optimism, and effective coping. The total HIV-RRS yielded a Cronbach's α of 0.84. Convergent and face validity were established using psychosocial and physical outcomes. The HIV-RRS is a psychometrically sound instrument to assess resilience among older HIV-positive gay men.
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Jurček A, Keogh B, Sheaf G, Hafford-Letchfield T, Higgins A. Defining and researching the concept of resilience in LGBT+ later life: Findings from a mixed study systematic review. PLoS One 2022; 17:e0277384. [PMID: 36367883 PMCID: PMC9651550 DOI: 10.1371/journal.pone.0277384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Within the literature, resilience is described as either a trait, an outcome or a process and no universal definition exists. A growing body of research shows that older LGBT+ adults show signs of resilience despite facing multiple inequalities that negatively impact their health and social wellbeing. The aim of this review was to examine how resilience is defined in LGBT+ ageing research and how it is studied. A mixed-study systematic search of peer-reviewed research papers published before June 2022 was conducted using the electronic databases CINAHL, Embase, Medline, PsycInfo, Social Science Database and Web of Science. This resulted in the screening of 7101 papers 27 of which matched the inclusion criteria. A quality appraisal was conducted using the Mixed Methods Appraisal Tool. Findings show that papers often lack a clear definition of resilience and application of resilience theory within the studies, although many of the papers conceptualised resilience as either a trait, process or an outcome. However, resilience was rarely the primary focus of the studies and was researched using a variety of measurement instruments and conceptual frameworks. Given the socioeconomic disparities, diverse social relations, histories of discrimination and stigma, and acts of resistance that have shaped the lives of older LGBT+ populations, resilience is a topic of growing interest for researchers and practitioners. Clear definitions of resilience and application of resilience theory could help improve methods used to study the concept and lead to more robust findings and the development of effective interventions. Greater clarity on the concept of resilience could also broaden the focus of research that informs policies and practice, and support practitioner training in resilience and the particular experiences of older LGBT+ adults.
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Affiliation(s)
- Anže Jurček
- Faculty of Social Work, University of Ljubljana, Topniška ulica, Ljubljana, Slovenia
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin, Ireland
| | | | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Hopkins CN, Lee CA, Lambert CC, Vance DE, Haase SR, Delgadillo JD, Fazeli PL. Psychological resilience is an independent correlate of health-related quality of life in middle-aged and older adults with HIV in the Deep South. J Health Psychol 2022; 27:2909-2921. [PMID: 35086380 PMCID: PMC9329492 DOI: 10.1177/13591053211072430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Older people living with HIV (PLWH) are at risk for poorer health-related quality of life (HRQoL). Psychological resilience may protect HRQoL in this population. The sample included 174 predominately African American PLWH (age 40-73). Results indicated associations between resilience, socioeconomic status, cognitive performance, instrumental activities of daily living, personality, and depressive symptoms. HIV factors (e.g. viral load, duration of HIV) were not associated with resilience. Adjusting for confounders, resilience was associated with mental HRQoL. Understanding factors associated with resilience among older PLWH and the translation of resilience to HRQoL may inform interventions to improve well-being among individuals aging with HIV.
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16
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HIV-related challenges and women's self-response: A qualitative study with women living with HIV in Indonesia. PLoS One 2022; 17:e0275390. [PMID: 36215264 PMCID: PMC9550025 DOI: 10.1371/journal.pone.0275390] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2022] Open
Abstract
HIV infection is a major public health concern, with a range of negative impacts on People Living with HIV (PLHIV). A qualitative study in Yogyakarta, Indonesia, using in-depth interviews with 26 Women Living with HIV (WLHIV) was conducted to understand HIV risk factors and impact and their access to HIV care services. This paper describes the self-response of WLHIV towards negative HIV-related experiences facing them and adds to the existing literature which tends to focus on HIV impact only, as opposed to strategies that many WLHIV have used to empower and educate themselves and their family/community. Participants were recruited using the snowball sampling technique. Data analysis was guided by a qualitative data analysis framework. Our study highlighted that WLHIV experienced psychological challenges, stigma and discrimination. However, they demonstrated remarkable self-response and capacity in pursuing effective strategies and support to protect themselves, and educating themselves and others around them to rebuild trust and regain respect and acceptance. Our findings indicate that the needs of WLHIV should be addressed through policy and practice to help them cope with HIV-related psychological and social challenges effectively. Family and community members seem to play an important role in those negative challenges against WLHIV, thus there is also a need for HIV education programs for family and community members to enhance their HIV-health literacy and acceptance of PLHIV.
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17
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Davtyan M, Frederick T, Taylor J, Christensen C, Brown BJ, Nguyen AL. Determinants of COVID-19 vaccine acceptability among older adults living with HIV. Medicine (Baltimore) 2022; 101:e29907. [PMID: 35945741 PMCID: PMC9351509 DOI: 10.1097/md.0000000000029907] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Since the emergency approval of several therapeutic coronavirus disease 2019 (COVID-19) vaccines in the United States, >500 million doses have been administered. However, there have been disparities in vaccine acceptability and uptake. We examined demographic, human immunodeficiency virus (HIV) disease, and psychosocial factors associated with COVID-19 vaccine acceptability in older adults (≥50 years) living with HIV in the Coachella Valley, California. Participants completed a 1-time anonymous online questionnaire assessing their demographic (i.e., age, race, education, etc), HIV disease (i.e., viral suppression, years living with HIV, acquired immunodeficiency syndrome diagnosis), psychosocial (i.e., HIV-related stigma, personal mastery, depression, etc) characteristics, and COVID-19 vaccine acceptability. Respondents were offered an electronic $20 United States dollar (USD) gift card for survey completion. Descriptive, univariable, and multivariable tests were conducted to analyze the data. Between September 2020 and February 2021, 114 surveys were completed. Eighty-six (75%) agreed/strongly agreed with the COVID-19 vaccine acceptability statement that they saw no problem with receiving a COVID-19 vaccine if one became available. Among those who agreed/strongly agreed, the mean age was 62.2 years (standard deviation = 7.20); 86% self-identified as White; 95% male; 91% with more than high school education; and 31% with annual income <$20,000 USD. Among respondents who disagreed/strongly disagreed, the mean age was 59.9 years (standard deviation = 4.85); 50% self-identified as White; 50% male; 64% with more than high school education; and 4% with annual income <$20,000 USD. In the univariable analyses, those who disagreed/strongly disagreed with the COVID-19 vaccine acceptability statement were significantly more likely to be living with HIV for fewer years, experiencing higher levels of HIV-related stigma and depression, and with lower levels of personal mastery. In the multivariable logistic regression model, self-identification as female vs male and unemployed vs employed was significantly associated with decreased COVID-19 vaccine acceptability (odds ratio = 0.09, 95% confidence interval: 0.01-0.71 and odds ratio = 0.08, 95% confidence interval: 0.01-0.70 respectively), adjusting for ethnicity, marital status, education, disability, years living with HIV, HIV-related stigma, and depression. Additional studies are needed to understand vaccine-related decision-making among older adults living with HIV. Programmatic efforts may also be necessary to disseminate accurate information/resources about COVID-19 vaccines to those with more recent HIV diagnoses, experiencing HIV-related stigma and depression, with lower levels of personal mastery, and facing socioeconomic disparities.
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Affiliation(s)
- Mariam Davtyan
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Mariam Davtyan, Department of Pediatrics, University of Southern California, Keck School of Medicine, 1640 Marengo Street, Suite 300, Los Angeles, CA 90033 (e-mail: )
| | - Toinette Frederick
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jeff Taylor
- HIV+Aging Research Project Palm Springs (HARP-PS), Palm Springs, CA, United States
| | | | - Brandon J. Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California Riverside School of Medicine, Riverside, CA, United States
| | - Annie L. Nguyen
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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18
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Guo M, Wang Y, Liu J, Stensland M, Dong X. Coping repertoires and psychological well-being of Chinese older immigrants in the United States. Aging Ment Health 2022; 26:1385-1394. [PMID: 34233138 PMCID: PMC8738777 DOI: 10.1080/13607863.2021.1944979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study examines (1) the overall structures of multifaceted coping resources, that is, coping repertoires, among Chinese older immigrants in the United States, (2) the optimal coping repertoire that is associated with best psychological outcomes of these older immigrants, and (3) the most effective coping repertoire in different adversities. METHOD Using data from 2,923 Chinese older immigrants in Chicago, Latent Class Analysis (LCA) was performed to identify the overall coping repertoires of U.S. Chinese older adults. Negative binomial and logistic regressions were used to examine associations between coping repertoires and depression and Quality of Life (QoL), respectively. We further tested whether coping repertories moderate the relationships between adversities in health, economic, and social domains, and the two psychological outcomes. RESULTS LCA revealed four types of coping repertories: low-resource (43%), spouse-oriented (32%), community-oriented (15%), and multi-source coping (10%). Overall, Chinese older immigrants who had the multi-source coping repertoire reported the best psychological outcomes. The community-oriented and multi-source coping repertories had significantly stronger buffering effects on psychological well-being among individuals with IADL difficulties or low acculturation. However, spouse-oriented coping intensified the association between ADL difficulties and depression, and community-oriented coping intensified the association between poorer subjective health and lower quality of life. CONCLUSION This study revealed overall low coping repertories of Chinese older immigrants, suggesting the most optimal coping repertories should consist of both intrinsic and extrinsic coping sources. The findings further show that relying on limited sources might be harmful to older immigrants' mental health.
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Affiliation(s)
- Man Guo
- University of Iowa, School of Social Work, Iowa City, Iowa, USA
| | - Yi Wang
- University of Iowa, School of Social Work, Iowa City, Iowa, USA
| | - Jinyu Liu
- Columbia University, School of Social Work, New York City, New York, USA
| | - Meredith Stensland
- University of Texas Health Science Center at San Antonio, Department of Psychiatry and Behavioral Sciences, San Antonio, Texas, USA
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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19
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Berko J, Mazonson P, Loo T, Grant P, Zolopa A, Spinelli F, Short D. Factors Associated with Resilience Among Older People Living with HIV. AIDS Behav 2022; 26:1448-1455. [PMID: 34698952 DOI: 10.1007/s10461-021-03499-z] [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] [Accepted: 10/10/2021] [Indexed: 11/25/2022]
Abstract
Resilience, a measure of stress coping ability, may be important in helping older people (age 50+) living with HIV (PLWH) age successfully, but limited data exist regarding factors that contribute to resilience for this group. This study uses the Connor-Davidson Resilience Scale 2 (CD-RISC2) to assess resilience, based on a cross-sectional analysis of 1047 older PLWH. Bivariate linear regression models were used to identify predictor variables that had a relationship with resilience. Those variables were then included in a multivariable linear regression model, which was pared using backward selection. In the multivariable model, higher income and greater interpersonal support were associated with greater resilience, whereas depression and anxiety were associated with lower resilience. Relevant interventions that address these issues, such as increasing opportunities for social support and increasing screening for and treatment of depression and anxiety, are identified as potential pathways to increase resilience among older PLWH.
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Affiliation(s)
- Jeff Berko
- Mazonson & Santas, Inc., 15 Hillcrest Ave., Larkspur, CA, 94939, USA.
| | - Peter Mazonson
- Mazonson & Santas, Inc., 15 Hillcrest Ave., Larkspur, CA, 94939, USA
| | - Theoren Loo
- Mazonson & Santas, Inc., 15 Hillcrest Ave., Larkspur, CA, 94939, USA
| | | | - Andrew Zolopa
- Stanford University, Palo Alto, CA, USA
- ViiV Healthcare, Raleigh, NC, USA
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20
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Li X, Qiao S, Yang X, Harrison SE, Tam CC, Shen Z, Zhou Y. A Resilience-Based Intervention to Mitigate the Effect of HIV-Related Stigma: Protocol for a Stepped Wedge Cluster Randomized Trial. Front Public Health 2022; 10:857635. [PMID: 35425746 PMCID: PMC9001957 DOI: 10.3389/fpubh.2022.857635] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Despite decades of global efforts to tackle HIV-related stigma, previous interventions designed to reduce stigma have had limited effects that were typically in the small- to-moderate range. The knowledge gaps and challenges for combating HIV-related stigma are rooted both in the complexity of the stigma and in the limitations of current conceptualizations of stigma reduction efforts. Recent research has shown the promise of resilience-based approaches that focus on the development of strengths, competencies, resources, and capacities of people living with HIV (PLWH) and their key supporting systems (e.g., family members and healthcare providers) to prevent, reduce, and mitigate the negative effects of stigma. However, the resilience-based approach, while hypothesized, has rarely been empirically tested in large intervention trials, especially in resource-limited settings. Methods In this study, we propose to develop, implement, and evaluate a theory-guided, multilevel, multimodal resilience-based intervention via a stepped wedge cluster randomized trial among 800 PLWH and their biological or surrogate family members, as well as 320 healthcare providers in Guangxi, China with a longitudinal follow-up period of 36 months at 6-month intervals. The primary outcome will be viral suppression and the intermediate outcomes will include perceived stress and medication adherence of PLWH as well as resilience measures at the level of the individual, the family, and the healthcare system. Discussion The proposed study will be one of the first large scale efforts to examine whether resilience among PLWH can be fostered and sustained through a multilevel and multi-component HIV-related stigma intervention and whether a resilience-based intervention can improve clinical outcomes and quality of HIV care among PLWH in a low-resource setting. If efficacious, the intervention components could be tailored to other groups of PLWH and adapted for other low- and middle-income countries. Trial Registration This trial is registered at ClinicalTrials.gov, registration number NCT05174936, registered 13 December 2021. https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=3&cx=-jg9qo2.
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Affiliation(s)
- Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sayward E Harrison
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, United States
| | - Cheuk Chi Tam
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi, China
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi, China
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21
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Ruiz EL, Greene KY, Galea JT, Brown B. From surviving to thriving: the current status of the behavioral, social, and psychological issues of aging with HIV. Curr Opin HIV AIDS 2022; 17:55-64. [PMID: 35102052 DOI: 10.1097/coh.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite significant advances in knowledge regarding the biological and clinical issues related to aging with HIV, significantly less research has centered on related psychological, behavioral, and social issues, which are increasingly recognized as important for successfully aging with HIV. RECENT FINDINGS Barriers to successful aging include physical challenges from a sociobehavioral perspective, psychosocial challenges, and system-level challenges. In contrast, several resiliencies and interventions that help facilitate healthy aging with HIV are also emerging. Comprehensive interventions to address the physical, mental, and psychosocial needs of older people living with HIV (OPLWH) are necessary. CONCLUSION To promote healthy aging with HIV, we must utilize both clinical and biopsychosocial interventions. The lack of data on the needs of OPLWH is an important barrier to healthy aging in this population.
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Affiliation(s)
- Erik L Ruiz
- University of South Florida, College of Public Health
| | - Karah Y Greene
- University of South Florida, School of Social Work, Tampa, Florida
| | - Jerome T Galea
- University of South Florida, College of Public Health
- University of South Florida, School of Social Work, Tampa, Florida
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts
| | - Brandon Brown
- University of California, Riverside School of Medicine, Riverside, California, USA
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22
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Brown AL, Matthews DD, Meanley S, Brennan-Ing M, Haberlen S, D’Souza G, Ware D, Egan J, Shoptaw S, Teplin LA, Friedman M, Plankey M. The Effect of Discrimination and Resilience on Depressive Symptoms among Middle-Aged and Older Men who have Sex with Men. STIGMA AND HEALTH 2022; 7:113-121. [PMID: 35935592 PMCID: PMC9355118 DOI: 10.1037/sah0000327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigated if homophobic and racist discrimination increased depressive symptoms among 960 middle-aged and older men who have sex with men (MSM) and how resilience moderated these relationships. We used five waves of longitudinal data from the Healthy Aging sub-study of the Multicenter AIDS Cohort Study (MACS). We used linear regression analyses to model depressive symptoms as a function of discrimination. We used linear mixed analyses to model changes in mean resilience scores across visits. We used linear regression analyses to model depressive symptoms as a function of changes in resilience and to test the moderation effects of resilience on the relationship between discrimination and depressive symptoms. The models accounted for repeated measures of resilience. Men who experienced external and internal homophobia had greater depressive symptoms (β: 2.08; 95% Confidence Interval: 0.65, 3.51; β: 1.60; 95% Confidence Interval: 0.76, 2.44). Men experienced significant changes in mean resilience levels across visits (F = 2.84, p = 0.02). Men with a greater positive change in resilience had lower depressive symptoms (β: -0.95; 95% Confidence Interval: -1.47, -0.43). Men with higher average resilience levels had lower depressive symptoms (β: -5.08; 95% Confidence Interval: -5.68, -4.49). Men's resilience did not moderate the relationship between homophobia and depressive symptoms. Significant associations of external and internal homophobia with greater depressive symptoms present targets for future research and interventions among middle-aged and older MSM. Significant associations of average and positive changes in resilience with lower depressive symptoms provide aims for future research and interventions with this population.
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Affiliation(s)
- Andre L. Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | | | | | - Mark Brennan-Ing
- Roosevelt House Public Policy Institute at Hunter College, City University of New York
| | | | | | - Deanna Ware
- Department of Epidemiology, Georgetown University
| | - James Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh
| | - Steve Shoptaw
- Department of Family Medicine, University of California Los Angeles
| | - Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University
| | - Mackey Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh
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23
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Kia H, Grace D, Strike C, Ferlatte O, Knight R, Salway T, Ross LE. "They Haven't Made a Slot for Us Yet": Conceptualizing the Health Care and Social Service Needs of Older Gay Men Living with HIV in Canada. JOURNAL OF HOMOSEXUALITY 2022; 69:332-355. [PMID: 32946344 DOI: 10.1080/00918369.2020.1819712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this paper, we present the findings of a qualitative study aimed at conceptualizing the service needs of aging gay men living with HIV (GMLH). Our analysis is based on interview data from 16 gay-identified men living with HIV, ages 50 and over. Drawing on a framework of intersectionality, which theoretically accounts for interlocking expressions of marginalization in groups affected by multiple systems of oppression, we highlight the practical, social, and mental health needs of this population, as well as services that could be designed or adapted to address these concerns. We also emphasize the relevance of specialized training for caring professionals serving older GMLH, and articulate the need for initiatives that more fully engage gay men aging with HIV in the development and delivery of services intended for their use.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montreal, Canada
| | - Rod Knight
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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24
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Diaz-Martinez J, Tamargo JA, Delgado-Enciso I, Liu Q, Acuña L, Laverde E, Barbieri MA, Trepka MJ, Campa A, Siminski S, Gorbach PM, Baum MK. Resilience, Anxiety, Stress, and Substance Use Patterns During COVID-19 Pandemic in the Miami Adult Studies on HIV (MASH) Cohort. AIDS Behav 2021; 25:3658-3668. [PMID: 34009479 PMCID: PMC8132028 DOI: 10.1007/s10461-021-03292-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 01/11/2023]
Abstract
We evaluated mental health and substance use during the COVID-19 pandemic in 196 participants from the Miami Adult Studies on HIV (MASH) Cohort. A survey was administered between July-August of 2020, including validated measures of resilience and anxiety, a scale to measure COVID-19-related worry, and self-reported substance use. Compared to HIV-uninfected participants (n = 80), those living with HIV (n = 116) reported fewer anxiety symptoms, less COVID-19-related worry, and higher resilience. Those with more anxiety symptoms and lower resilience engaged in more frequent alcohol consumption, binge drinking, and cocaine use. Alcohol misuse was more common among HIV-uninfected participants. Cocaine use was reported by 21% fewer participants during the pandemic compared with 7.3 ± 1.5 months earlier. Possibly due to their experiences with HIV, PLWH responded with higher resilience and reduced worry and anxiety to the adversities brought by the COVID-19 pandemic.
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Affiliation(s)
- Janet Diaz-Martinez
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Javier A Tamargo
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | | | - Qingyun Liu
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Leonardo Acuña
- College of Arts, Sciences & Education, Florida International University, Miami, FL, USA
| | - Eduardo Laverde
- College of Arts, Sciences & Education, Florida International University, Miami, FL, USA
| | - Manuel A Barbieri
- College of Arts, Sciences & Education, Florida International University, Miami, FL, USA
| | - Mary Jo Trepka
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Adriana Campa
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | | | - Pamina M Gorbach
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Marianna K Baum
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
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25
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Penukonda V, Utz T, Perry NS, Ware D, Brennan-Ing M, Meanley S, Brown A, Haberlen S, Egan J, Shoptaw S, Teplin LA, Friedman MR, Plankey M. Viral suppression among middle-aged and aging MSM living with HIV: Partnership type and quality. PLoS One 2021; 16:e0258032. [PMID: 34597316 PMCID: PMC8486120 DOI: 10.1371/journal.pone.0258032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022] Open
Abstract
Functional support—the availability of material aid, emotional support, or companionship—promotes general well-being. For men who have sex with men (MSM) living with HIV, having a person who supports you associates with viral suppression. This study examines the association between supportive partnerships and HIV viral suppression among middle-aged and aging MSM living with HIV. A total of 423 middle-aged and aging MSM (mean age, 58.2 years) from the Multicenter AIDS Cohort Study provided self-reported data about their partnerships. Separate Poisson regression models assessed how partnership type, support, strain, and duration from April 2017 were associated with repeated viral load measurements up to April 2019. Of the follow-up visits (N = 1289), 90.0% of participants were virally suppressed. Most participants reported being non-Hispanic White (61.0%) and college-educated (83.4%). Participants were asked about their primary partnerships (i.e., “someone they are committed to above anyone else”) and secondary partnerships (i.e., those who can also be intimate or supportive but not necessarily romantic or sexual). The participants reported: no partnerships (45.2%), only primary partnerships (31.0%), only secondary partnerships (11.1%), or both primary and secondary partnerships (12.8%). Primary and secondary partnerships had mean (SD) durations of 15.9 (11.3) and 25.2 (16.5) years, respectively. Participants reporting both primary and secondary partnerships (compared with no partnership) showed significantly higher odds of being virally suppressed (adjusted prevalence ratio [aPR], 1.04; 95% CI, 1.00–1.08; p = 0.043). Albeit not statistically significant, primary-only (aPR, 1.01; 95% CI, 0.97–1.06; p = 0.547) or secondary-only (aPR, 1.03; 95% CI, 0.98–1.08; p = 0.224) partnership types were positively associated with viral suppression. Partner support and strain were not associated with viral suppression in any partnership group. Being older and non-Hispanic Black were positively and negatively associated with viral suppression, respectively. Encouraging partnerships should be considered one of clinicians’ many tools to help middle-aged and aging MSM achieve long-term viral suppression.
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Grants
- U01 HL146205 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146193 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- R01 MD010680 NIMHD NIH HHS
- U01 HL146245 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- P30 AI050410 NIAID NIH HHS
- National Institute on Minority Health and Health Disparities
- The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01-HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange and Elizabeth Golub), U01-HL146193; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240; Connie Wofsy Women’s HIV Study, Northern California CRS (Bradley Aouizerat, Phyllis Tien, and Jennifer Price), U01-HL146242; Los Angeles CRS (Roger Detels), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208; UAB-MS CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom, and Deborah Konkle-Parker), U01-HL146192; UNC CRS (Adaora Adimora), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), P30-AI-050409 (Atlanta CFAR), P30-AI-050410 (UNC CFAR), and P30-AI-027767 (UAB CFAR).
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Affiliation(s)
- Vaibhav Penukonda
- Georgetown University School of Medicine, Washington, District of Columbia, United States of America
- * E-mail:
| | - Timothy Utz
- Georgetown University School of Medicine, Washington, District of Columbia, United States of America
| | - Nicholas S. Perry
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, United States of America
- Center for Behavioral Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Deanna Ware
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, New York, United States of America
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Andre Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - James Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, California, United States of America
| | - Linda A. Teplin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, United States of America
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Liboro R, Despres J, Ranuschio B, Bell S, Barnes L. Forging Resilience to HIV/AIDS: Personal Strengths of Middle-aged and Older Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV/AIDS. Am J Mens Health 2021; 15:15579883211049016. [PMID: 34587823 PMCID: PMC8488414 DOI: 10.1177/15579883211049016] [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] [Indexed: 11/15/2022] Open
Abstract
HIV-positive gay, bisexual, two-spirit, and other men who have sex with men (MSM) have exhibited significant resilience to HIV/AIDS in Canada since the start of the epidemic. Since 2012, most of the research that has been conducted on resilience to HIV/AIDS has utilized quantitative methods and deficits-based approaches, with a preferential focus on the plight of young MSM. In order to address apparent gaps in research on HIV/AIDS resilience, we conducted a community-based participatory research qualitative study that utilized a strengths-based approach to examine the perspectives and lived experiences of HIV-positive, middle-aged and older MSM on their individual attributes that helped forge their HIV/AIDS resilience. We conducted 41 semistructured interviews with diverse, HIV-positive, middle-aged and older MSM from Central and Southwestern Ontario, Canada. From our thematic analysis of our interviews, we identified four themes, which represented personal strengths that fostered resilience to HIV/AIDS: (a) proactiveness, (b) perseverance, (c) having the right mindset, and (d) self-awareness with self-control. This article discusses the importance of these personal strengths to fostering HIV/AIDS resilience, and how community-based resources could potentially lessen the need to muster such personal strengths, or alternatively, cultivate them.
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Affiliation(s)
- R Liboro
- University of Nevada, Las Vegas, Las Vegas, NV, USA.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - J Despres
- University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - B Ranuschio
- University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - S Bell
- University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - L Barnes
- University of Nevada, Las Vegas, Las Vegas, NV, USA
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Egan JE, Haberlen SA, Meanley S, Ware D, Brown AL, Siconolfi D, Brennan-Ing M, Stall R, Plankey MW, Friedman MR. Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men: Protocol for an Observational Cohort Study. JMIR Res Protoc 2021; 10:e25750. [PMID: 34554100 PMCID: PMC8498890 DOI: 10.2196/25750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/23/2021] [Accepted: 05/25/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND With the graying of sexual and gender minority communities and the growing number of people aged ≥50 years living with HIV, it is increasingly important to understand resilience in the context of the psychosocial aspects of aging and aging well. OBJECTIVE This paper aims to describe the methods and sample for the Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men study. METHODS This observational cohort study was conducted within the Multisite AIDS Cohort Study (MACS) and was designed to explore resiliencies to explain patterns of health and illness among middle-aged and older sexual minority men. To be eligible, a participant had to be an active participant in the MACS, be at least 40 years of age as of April 1, 2016, and report any sex with another man since enrollment in the MACS. RESULTS Eligible participants (N=1318) completed six biannual surveys between April 2016 and April 2019. The mean age of the sample was 59.6 years (range 40-91 years). The sample was mostly White, educated, gay-identified, and included both HIV-positive (656/1318, 49.77%) and HIV-negative (662/1318, 50.23%) men. CONCLUSIONS Understanding resiliencies in aging is a critical springboard for the development of more holistic public health theories and interventions that support healthy aging among older sexual minority men. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/25750.
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Affiliation(s)
- James E Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Meanley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York, NY, United States
| | - Ron Stall
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC, United States
| | - M Reuel Friedman
- Center for LGBT Health Research, Graduate School for Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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Psychosocial Mechanisms of Self-rated Successful Aging with HIV: A Structural Equation Model. AIDS Behav 2021; 25:2875-2885. [PMID: 34115265 DOI: 10.1007/s10461-021-03340-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 02/06/2023]
Abstract
This study tested a conceptual psychosocial model of self-rated successful aging (SRSA) with HIV. Our sample (n = 356) included older women living with HIV (OWLH): average age 56.5 years, 73% Black. SRSA was assessed using a research-based 10-point scale (higher scores = better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables-protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and psychological distress (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ2(58) = 76, p = 0.06; RMSEA = 0.03; CFI = 0.99). Increased protective attributes were associated with improved SRSA both directly and mediated by improved coping with stress. While psychological distress did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes and via decreased coping with stress. Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors in OWLH.
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Clark JN. Resilience as a multi-directional movement process: A conceptual and empirical exploration. THE BRITISH JOURNAL OF SOCIOLOGY 2021; 72:1046-1061. [PMID: 33960397 DOI: 10.1111/1468-4446.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Movement is a recurrent thematic within extant resilience scholarship. Ecological theorizations of resilience emphasize systems that are in constant movement and flux. Terms such as "bouncing back" and "bouncing forward" are frequently used to describe how individuals recover and move on from adversity and trauma. However, integrated individual-systemic explanations of resilience movement dynamics are lacking. Seeking to address this gap, this interdisciplinary article expressly frames resilience as a multi-directional movement process. Individuals do not just move forward and backwards. Rather, they move in multiple and varied ways as they seek to navigate their way through adversity-and through systems and social-ecological traps that both shape how they move and require them to keep moving. Drawing on interview data with victims-/survivors of conflict-related sexual violence in Bosnia-Herzegovina (BiH), Colombia, and Uganda, the article empirically explores what "movement" looks like at the microlevel through a focus on everyday forms and expressions of movement, while also examining how wider systemic environments shape and influence these movements.
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Shepherd BF, Brochu PM, Stripling AM. Hidden grief is complicated: identity concealment as a minority stressor and relational-cultural barrier among bereaved sexual and gender minoritized elders. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1970618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Benjamin F. Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL
| | - Paula M. Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL
| | - Ashley M. Stripling
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL
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31
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Muñoz-Laboy M, Guidry JA, Kreisberg A. Internalised stigma as durable social determinant of HIV care for transnational patients of Puerto Rican ancestry. Glob Public Health 2021; 17:1232-1251. [PMID: 33945436 DOI: 10.1080/17441692.2021.1919173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intersectional stigmas have been contributing barriers to linkage and retention in HIV care for Latinx communities. Our analysis examines whether reductions in HIV-related and other stigmas were associated (or not) with progression on the HIV continuum of care for Puerto Ricans living with HIV, patients of the U.S. Special Projects of National Significance (SPNS) initiative: 'Culturally Appropriate Interventions of Outreach, Access and Retention among Latinx Populations from 2013 to 2018.' We conducted multivariate regression modelling to test our primary hypotheses. Internalised (HIV and racial/ethnic) stigma scores and age at baseline were predictors of ART adherence at six months assessment. Internalised stigma (HIV and racial/ethnic), depression, and resiliency scores were predictors of the likelihood of detectable HIV viral load at six months assessment. Our study confirms the importance of understanding internalised stigma on its own terms, as a durable construct that has implications for HIV treatment disparities for Puerto Ricans living with HIV.
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Affiliation(s)
| | | | - Alexa Kreisberg
- Analytics & Evaluation, Gay Men's Health Crisis (GMHC), New York, NY, USA
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Brennan-Ing M, Haberlen S, Ware D, Egan JE, Brown AL, Meanley S, Palella FJ, Bolan R, Cook JA, Okafor CN, Friedman MR, Plankey MW. Psychological Connection to the Gay Community and Negative Self-Appraisals in Middle-Aged and Older Men Who Have Sex With Men: The Mediating Effects of Fitness Engagement. J Gerontol B Psychol Sci Soc Sci 2021; 77:39-49. [PMID: 33945614 PMCID: PMC8755915 DOI: 10.1093/geronb/gbab076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Connections to the gay community may elicit negative self-appraisals among men who have sex with men (MSM), which may be exacerbated for people with HIV (PWH). Fitness engagement may mediate self-appraisals by maintaining or improving appearance and health. We hypothesized that gay community connections would be positively related to negative self-appraisal and explored whether this association would be mediated by fitness engagement and moderated by HIV status. METHOD Data were obtained from the Multicenter AIDS Cohort Healthy Aging study (N = 1,026; PWH n = 525; people without HIV [PWOH] n = 501). Structural equation modeling (SEM) examined associations between gay community connections, negative self-appraisal (body image dissatisfaction, self-perception of aging), and fitness engagement (physical activity, motivation to be fit). Multiple-group SEM tested the moderating effects of HIV serostatus. RESULTS The SEM fit the data well (root mean square error of approximation = 0.056; 90% CI: 0.046, 0.066). Connection to the gay community was inversely related to negative self-appraisals and positively related to fitness engagement. Fitness engagement mediated the association between community connections and negative self-appraisal and was inversely related to negative self-appraisals. Among PWH, the association between community connections and self-appraisal was weaker and the effect of fitness engagement on negative self-appraisal was stronger compared to PWOH. DISCUSSION Connection to the gay community may be a source of resilience for aging MSM by lessening negative self-appraisals and promoting strategies that address body image dissatisfaction and self-perceptions of aging. Interventions facilitating connections to the gay community may support healthy aging in this population.
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Affiliation(s)
- Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, USA,Address correspondence to: Mark Brennan-Ing, PhD, Brookdale Center for Healthy Aging, Hunter College, the City University of New York, 2180 Third Avenue, 8th Floor, New York, NY 10035, USA. E-mail:
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania, USA
| | - Andre L Brown
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Frank J Palella
- Feinberg School of Medicine, Northwestern Medicine, Northwestern University, Chicago, Illinois, USA
| | - Robert Bolan
- Department of Family Medicine, University of Southern California, Los Angeles, USA
| | - Judith A Cook
- Center on Mental Health Services Research and Policy, University of Illinois at Chicago, USA
| | - Chukwuemeka N Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pennsylvania, USA
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
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Vale MT, Bisconti TL. Age Differences in Sexual Minority Stress and the Importance of Friendship in Later Life. Clin Gerontol 2021; 44:235-248. [PMID: 33143546 DOI: 10.1080/07317115.2020.1836107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study examined whether younger and middle-aged and older sexual minorities (YSM, MAOSM) experience minority stress differently in relation to social support and depressive symptomatology. METHODS Cross-sectional data from 238 sexual minorities (18-80; M = 40.93) comprised the sample, who were strategically separated into cohorts. Group difference and regression methods were used to examine differences in minority stress between groups and the relationships between minority stress-social support-depressive symptomatology within groups. RESULTS MAOSM had greater outness and lower IH. Additionally, outness and IH were the best predictors for the MAOSM and YSM group, respectively. MAOSM indicated better adaption to minority stresses, highlighting the importance of friend support as a protective mechanism. CONCLUSIONS The minority stress-depressive symptomatology is mitigated by friend support in MAOSM. CLINICAL IMPLICATIONS OSM and YSM demonstrate different susceptibility of minority stress on depressive symptomatology, with outness being a stronger indicator in MAOSM and IH being a stronger predictor in YSM. Social support does not work uniformly in different cohorts; however, multiple sources (i.e., family, friends) should be discussed with clients. Clinicians should treat cohort as one of the defining features of a sexual minority's lifelong experience with minority stress.
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Affiliation(s)
- Michael T Vale
- Department of Psychology, University of Akron, Akron, Ohio, USA
| | - Toni L Bisconti
- Department of Psychology, University of Akron, Akron, Ohio, USA
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Marshall RA, Vargas EA, Mahalingam R. Minority stress and sexual minorities of colour: the mediating role of mastery. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1903535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Riley A. Marshall
- Department of Psychology, East Hall, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily A. Vargas
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ramaswami Mahalingam
- Department of Psychology, East Hall, University of Michigan, Ann Arbor, Michigan, USA
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35
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Statz M, Ware D, Perry N, Huebner D, Cox C, Brown A, Meanley S, Haberlen S, Egan J, Brennan M, Teplin LA, Bolan R, Friedman MR, Plankey M. Primary and secondary supportive partnerships among HIV-positive and HIV-negative middle-aged and older gay men. PLoS One 2021; 16:e0245863. [PMID: 33596240 PMCID: PMC7888601 DOI: 10.1371/journal.pone.0245863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
This study describes the primary and secondary partnerships of aging gay men participating in the Understanding Patterns of Healthy Aging Among Men Who Have Sex with Men substudy of the Multicenter AIDS Cohort Study and examines differences in the prevalence of these relationship structures by HIV status while adjusting for age, education, and race/ethnicity. Relationships were compared within the following structural categories: “only a primary partnership”, “only a secondary partnership”, “both a primary and secondary relationship”, or “neither a primary nor secondary relationship”. There were 1,054 participants (51.9% HIV negative/48.1% HIV positive) included in the study. Participants had a median age of 62.0 years (interquartile range: 56.0–67.0) and most reported being non-Hispanic white (74.6%) and college educated (88.0%). Of the 1,004 participants with available partnership status data, 384 (38.2%) reported no primary or secondary partnerships, 108 (10.8%) reported secondary-only partnership, 385 (38.3%) reported primary-only partnership, and 127 (12.6%) reported both primary and secondary partnerships. Of participants who reported primary partnerships only, the prevalence rates (PRs) were lower among those 62 years and older, HIV positive, black non-Hispanic and Hispanics. Of participants who reported only having a secondary partnership, the PRs were higher among those 62 years and older and HIV positive. Of participants who did not report having either a primary or secondary partnership, the PRs were higher among those 62 years and older, HIV positive, and black non-Hispanic compared with their respective referent groups. There was no significant difference in PRs of having both primary and secondary partnerships by age category, HIV status, race/ethnicity, and education. This study aimed to fill a knowledge gap in the literature regarding both primary and secondary supportive partnerships among aging HIV-positive and HIV-negative gay men.
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Affiliation(s)
- Matthew Statz
- Georgetown University School of Medicine, Washington, DC, United States of America
| | - Deanna Ware
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, United States of America
- * E-mail:
| | - Nicholas Perry
- Warren Alpert Medical School, Brown University, Providence, RI, United States of America
- Rhode Island Hospital, Providence, RI, United States of America
| | - David Huebner
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, DC, United States of America
| | - Christopher Cox
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Andre Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, United States of America
| | - Sabina Haberlen
- Warren Alpert Medical School, Brown University, Providence, RI, United States of America
| | - James Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Mark Brennan
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, United States of America
| | - Linda A. Teplin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Robert Bolan
- Los Angeles LGBT Center, Los Angeles, CA, United States of America
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, United States of America
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36
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Peless T, Chenneville T, Gabbidon K. Challenges to the conceptualization and measurement of resilience in HIV research. AIDS Care 2021; 33:1525-1533. [PMID: 33486975 DOI: 10.1080/09540121.2021.1871722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to evaluate the conceptualization and measurement of resilience in HIV research. Terms related to resilience and HIV were searched in three databases to identify peer-reviewed research articles. Of the 156 articles identified, 49 were included in the analyses. Applied thematic analysis was used to analyze the definitions and measurement of resilience. Articles were reviewed independently by two raters to establish inter-rater reliability. Six recurring themes were identified in the definitions of resilience: adaptation, positive mental health symptoms, the absence of negative mental health symptoms, hardiness, coping, and the ability to "bounce back". Among the articles examined, 14 measures were used to assess resilience, half of which were indirect. These findings help make sense of the available literature on resilience and highlight the importance of clearly operationalizing resilience and measuring it in a way that is congruent with its definition in future HIV research studies.
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Affiliation(s)
| | | | - Kemesha Gabbidon
- Department of Psychology, University of South Florida, St. Petersburg, USA
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37
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Vásquez E, Lee EE, Zhang W, Tu X, Moore DJ, Marquine MJ, Jeste DV. HIV and three dimensions of Wisdom: Association with cognitive function and physical and mental well-being: For: Psychiatry Research. Psychiatry Res 2020; 294:113510. [PMID: 33096437 PMCID: PMC7942181 DOI: 10.1016/j.psychres.2020.113510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/10/2020] [Indexed: 11/19/2022]
Abstract
Wisdom is a unique human personality trait with cognitive, affective or compassionate, and reflective dimensions. We evaluated relationships of three specific dimensions of wisdom with cognitive function and physical and mental well-being in people with HIV (PWH) and HIV-negative (HIV-) participants. Subjects included 138 adults (61 PWH, 77 HIV-) from the San Diego community. Validated measures were used to assess wisdom and well-being. Cognitive function was assessed via the Montreal Cognitive Assessment. We conducted multivariate linear regressions to evaluate the associations of wisdom dimensions with cognitive function and physical and mental well-being. Compared to the HIV- group, PWH had lower mean scores on cognitive function, and physical and mental well-being, and cognitive and reflective dimensions of wisdom, but similar scores on affective or compassionate wisdom. Among PWH, higher total wisdom scores were associated with older age, lower likelihood of substance dependence, greater mental well-being, better cognitive function, higher resilience, social support, and optimism scores, as well as lower levels of perceived stress and nadir CD4 count. Our findings of an association of different dimensions of wisdom with physical and/or mental well-being in PWH would point to a possibility that enhancing these dimensions of wisdom might improve health outcomes in PWH.
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Affiliation(s)
- Elizabeth Vásquez
- School of Public Health, University at Albany State University of New York, New York, NY, United States
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Weihui Zhang
- School of Public Health, University at Albany State University of New York, New York, NY, United States
| | - Xin Tu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Department of Neurosciences, University of California San Diego, La Jolla, CA, United States.
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Lyons A, Alba B, Waling A, Minichiello V, Hughes M, Fredriksen-Goldsen KI, Edmonds S, Blanchard M, Irlam C. Volunteering among Older Lesbian and Gay Adults: Associations with Mental, Physical and Social Well-Being. J Aging Health 2020; 33:3-13. [PMID: 32857633 DOI: 10.1177/0898264320952910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: Volunteering is associated with positive well-being among older people, providing opportunities to stay active and socially connected. This may be especially relevant for older lesbian and gay people, who are less likely than heterosexual people to have a partner, children or support from their family of origin. Methods: Patterns of volunteering and mental, physical and social well-being were examined in a sample of 754 lesbian and gay adults in Australia aged 60 years and older who completed a nationwide survey. Results: Volunteers reported greater positive mental health than non-volunteers. Among the gay men, volunteers additionally reported higher self-rated health and social support and lower psychological distress. Both the lesbian women and gay men who volunteered for lesbian, gay, bisexual, transgender or intersex (LGBTI) organisations also reported greater LGBTI community connectedness than volunteers for non-LGBTI organisations. Discussion: These findings provide further insight into potential factors associated with the well-being of older lesbian and gay adults.
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Affiliation(s)
- Anthony Lyons
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, 2080La Trobe University, Australia
| | - Beatrice Alba
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, 2080La Trobe University, Australia.,School of Psychology, 2104Deakin University, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, 2080La Trobe University, Australia
| | - Victor Minichiello
- Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health, 2080La Trobe University, Australia.,School of Justice, Faculty of Law, 1969Queensland University of Technology, Australia
| | - Mark Hughes
- School of Arts and Social Sciences, 4571Southern Cross University, Australia
| | | | | | - Michelle Blanchard
- 104504SANE Australia, Australia.,Anne Deveson Research Centre, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Australia
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39
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Tay PKC, Lim KK. Psychological Resilience as an Emergent Characteristic for Well-Being: A Pragmatic View. Gerontology 2020; 66:476-483. [PMID: 32784301 DOI: 10.1159/000509210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
Currently, there is no clear agreement on the definition and conceptualization for psychological resilience (PR) in old age. Adopting a pragmatic view, this article elucidates the definition and conceptualization of PR by (1) extracting existing PR concepts that are relevant to aging, and (2) elucidating the contributing and delimiting factors for developing and sustaining PR as guided by the biopsychosocial framework. In addition, a comprehensive review of the tools used to measure PR was conducted to examine how scholars have conceptualized PR. Consequently, the renewed understanding defines PR as an emergent construct which is malleable, enduring, and can be developed and sustained by a dynamic interplay of biological, psychological, spiritual, and social factors. Correlates in terms of physical and mental well-being in the context of aging are identified.
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Affiliation(s)
- Peter Kay Chai Tay
- Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore, .,Centre for Ageing Research and Education, Duke-NUS, Singapore, Singapore,
| | - Ka Keat Lim
- Health Services and Systems Research, Duke-NUS, Singapore, Singapore.,Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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40
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Emlet CA, Fredriksen-Goldsen KI, Kim HJ, Jung H. Accounting for HIV Health Disparities: Risk and Protective Factors Among Older Gay and Bisexual Men. J Aging Health 2020; 32:677-687. [PMID: 31079525 PMCID: PMC6851439 DOI: 10.1177/0898264319848570] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: This study examines whether disparities exist in poor health and depressive symptomatology among older gay/bisexual men (50+) with (n = 371) and without (n = 973) HIV. If so, what risk/promoting factors account for those disparities? Method: These cross-sectional analyses used 2014 data from the Aging With Pride: National Health, Aging, and Sexuality/Gender Study. Results: Those with HIV reported poorer health and more depressive symptomatology accounted for by lower income, resilience and social support, and more lifetime victimization. Poorer health among those with HIV was associated with more chronic conditions. Higher depressive symptomatology was associated with diagnosed anxiety and drug addiction. Community engagement reduced disparities in poor health and depression. Implications: Older gay/bisexual men living with HIV infection are at greater risk for physical and mental health issues. Assessments should be conducted with attention to these risk factors. Interventions for improving social support, resilience, and community engagement are warranted.
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41
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Nguyen AL, Sundermann E, Rubtsova AA, Sabbag S, Umlauf A, Heaton R, Letendre S, Jeste DV, Marquine MJ. Emotional health outcomes are influenced by sexual minority identity and HIV serostatus. AIDS Care 2020; 33:1127-1132. [PMID: 32590909 DOI: 10.1080/09540121.2020.1785998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
For people living with HIV (PLWH) and sexual minorities (SM), the intersection of identities can compound experiences like stigma and discrimination resulting in poor emotional health. We investigated the separate and interactive associations of HIV serostatus and sexual identity with emotional health. Our dataset included 371 participants. Emotional health was assessed by the NIH Toolbox emotion battery which yields negative affect, social satisfaction, and psychological well-being. Regressions were conducted for each composite, with HIV serostatus, sexual identity, and their interaction as independent variables along with covariates. The HIV serostatus x SM identity interaction was statistically significant in the regression of Negative Affect (p = .01): heterosexuals living with HIV had worse Negative Affect compared to heterosexual HIV-persons (p = .01). The interaction terms were for social satisfaction and psychological well-being were not significant. However, among PLWH, sexual minorities reported better Social Satisfaction (p = .03) and marginally better psychological well-being (p = .07) compared to heterosexuals.
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Affiliation(s)
- Annie L Nguyen
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Anna A Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Samir Sabbag
- Department of Psychiatry, University of Miami, Miami, FL, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Robert Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Scott Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Neuroscience, University of California San Diego, San Diego, CA, USA.,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, CA, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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42
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Lewis C, Lartey M, Operario D. Resilience and pathways to wellness among HIV-positive patients in Ghana: a qualitative study. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:69-79. [PMID: 32200724 DOI: 10.2989/16085906.2019.1686034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Few African studies have focused on resilience factors related to engagement in HIV-related care among people living with HIV; instead, many studies have identified health risk factors and barriers within this population. Informed by the Disability-Stress-Coping Model of Adjustment, a qualitative study was conducted to develop a better understanding of psychosocial factors that can promote positive behaviours and subjective wellness for people living with HIV in Accra, Ghana. Thirty patients from the two largest HIV clinics in Accra participated in in-depth individual interviews. Using a thematic analysis approach, three individual-level factors related to resilience and subjective wellness were identified: (1) holding positive attitudes towards the pathway from HIV testing and diagnosis to healthy living with HIV; (2) placing appropriate (but not absolute) levels of trust in the clinical care environment; and (3) judicious disclosure of their HIV status to key individuals. Findings support a resilience framework that focuses on individual strengths and positive adaptations to HIV diagnosis in order to enhance understanding and promote the HIV care continuum for people living with HIV in this context. Development of resilience-focused approaches to public health intervention is particularly important in low-resource settings such as Ghana where research tends to focus on deficiencies and healthcare inadequacies for people living with HIV.
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Affiliation(s)
- Chantal Lewis
- Brown University Schools of Public Health, Providence, Rhode Island, USA
| | - Margaret Lartey
- University of Ghana School of Medicine & Dentistry, College of Health Sciences, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Don Operario
- Brown University Schools of Public Health, Providence, Rhode Island, USA
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O’Brien KK, Ibáñez-Carrasco F, Solomon P, Harding R, Brown D, Ahluwalia P, Chan Carusone S, Baxter L, Emlet C, Restall G, Casey A, Ahluwalia A, Quigley A, Terpstra AR, Ononiwu N. Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC). AIDS Res Ther 2020; 17:21. [PMID: 32429973 PMCID: PMC7236512 DOI: 10.1186/s12981-020-00280-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND People living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC's aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders. METHODS We conducted a multi-stakeholder multi-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities. RESULTS Sixty-nine stakeholders from countries including Canada (n = 62; 90%), the United Kingdom (n = 5; 7%), United States (n = 1; 1%) and Australia (n = 1; 1%) attended the International Forum on HIV, Aging and Rehabilitation Research. Stakeholders represented community-based organizations (n = 20; 29%), academic institutions (n = 18; 26%), community or institutional healthcare organizations (n = 11; 16%), research or knowledge production organizations (n = 10; 14%), and organizations representing government or industry (n = 10; 14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: (1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; (2) prevalence, severity and impact of frailty; (3) community and social participation aging with HIV; (4) strategies for chronic disease management and healthy aging with HIV; (5) facilitators and barriers to access and engagement in, rehabilitation; (6) effectiveness of rehabilitation interventions for healthy aging with HIV; and (7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy. CONCLUSIONS These priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation (IHPME), 155 College Street, 4th Floor, Toronto, ON Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
| | | | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON Canada
| | - Richard Harding
- Cicely Saunders Institute, King’s College London, Bessemer Road, London, UK
| | - Darren Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Charles Emlet
- University of Washington, Tacoma, Social Work, 1900 Commerce Street, Tacoma, WA USA
| | - Gayle Restall
- College of Rehabilitation Sciences, University of Manitoba, R127 Rehab Building, Winnipeg, MB Canada
| | - Alan Casey
- Department of Physical Medicine and Rehabilitation, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB Canada
| | | | - Adria Quigley
- Faculty of Health, Dalhousie University, 5968 College Street, Room 316, Halifax, NS Canada
| | - Alex R. Terpstra
- Department of Psychology, 2136 West Mall, Room 2405, Vancouver, BC Canada
| | - Nkem Ononiwu
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
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44
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Dale SK, Sanders J, Safren SA, Ironson G, O’Cleirigh C. Correlates of resilience after childhood sexual abuse among men who have sex with men. J Trauma Dissociation 2020; 21:365-375. [PMID: 31986997 PMCID: PMC7199796 DOI: 10.1080/15299732.2020.1719263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
Men who have sex with men (MSM) are at high risk for physical and mental health conditions and are often discussed in the health literature as "at risk" versus "at promise". However, there is an ongoing need to examine factors that place MSM "at promise" for optimal well-being. This manuscript examines correlates of resilience, the ability to "bounce back" and function adaptively after adversities, among MSM. One hundred and five MSM with a history of childhood sexual abuse, who were enrolled in a randomized control trial were recruited for a supplemental study assessing resilience and other psychosocial factors. Participants completed measures assessing resilient trait and coping (i.e. "I am able to adapt" and "I tend to bounce back"), symptoms of trauma, trauma-related thoughts, and distress tolerance (ability to regulate unpleasant feelings). Findings from multivariable linear regressions controlling for covariates (age, education, race/ethnicity, and income) indicated that higher resilience was associated with (a) lower trauma scores on reexperiencing severity (b = -1.41, SE = .53, p = .01) and avoidance severity (b = -1.61, SE= .67, p = .02), (b) lower post-traumatic cognitions (b = -11.39, SE = 5.08, p = .03) especially negative cognitions about the self (b = -.44, SE = .16, p = .007), and (c) higher distress tolerance (b = .26, SE = .10, p = .01). Our preliminary findings suggest that resilient coping/traits are important to research after childhood sexual abuse among MSM, potentially assess in clinical settings, and address in interventions.
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45
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Ogletree AM, Brennan-Ing M, Blieszner R, Karpiak SE, Sands LP. Health Burden, Support Adequacy, and Depressive Symptoms in Older Men With HIV. THE GERONTOLOGIST 2020; 59:1131-1140. [PMID: 30541078 DOI: 10.1093/geront/gny169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults with HIV face greater health burden than HIV-uninfected counterparts. Little is known about resources that might mediate the influence of physiological health burden on psychological well-being. Informed by the stress process model, we assessed the influence of multifaceted health burden indicators on depressive symptoms and evaluated the mediating effects of social support adequacy. RESEARCH DESIGN AND METHODS This cross-sectional study used structural equation modeling with data from 640 older men who participated in the Research on Older Adults with HIV study in the United States. Health burden assessment included number of age-related chronic conditions, multiple HIV-related chronic conditions, and self-rated health. Perceptions of instrumental and emotional support adequacy measured support as a coping resource. Depressed mood as assessed by the 10-item Center for Epidemiologic Studies Depression Scale was the indicator of psychological well-being. RESULTS Higher incidence of age-related conditions and worse self-rated health was significantly associated with more depressed mood. Self-rated health and HIV-related conditions showed a significant indirect effect on depressed mood via emotional support adequacy. DISCUSSION AND IMPLICATIONS Each dimension of health burden demonstrated a distinct pathway to psychological well-being for men with HIV, which should be considered when prioritizing care plans. Complementing research on medical interventions for people with HIV, these findings suggest that nonpharmacological interventions may be important for improving overall well-being.
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Affiliation(s)
- Aaron M Ogletree
- American Institutes for Research, Washington, District of Columbia
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York
| | - Rosemary Blieszner
- Center for Gerontology, Blacksburg, VA.,Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA
| | - Stephen E Karpiak
- ACRIA Center for HIV and Aging at GMHC, New York, New York.,Rory Meyers College of Nursing, New York University
| | - Laura P Sands
- Center for Gerontology, Blacksburg, VA.,Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA
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46
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Nelson CL, Andel R. Does Sexual Orientation Relate to Health and Well-Being? Analysis of Adults 50+ Years of Age. THE GERONTOLOGIST 2020; 60:1282-1290. [DOI: 10.1093/geront/gnz187] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 01/14/2023] Open
Abstract
Abstract
Background and Objectives
Based on the Minority Stress Theory, this article examines the associations between sexual orientation and self-reported measures of physical, mental, and cognitive health, as well as health risk behaviors.
Research Design and Methods
The analytical sample included members of the 2016 wave of the Health and Retirement Study aged 50+ years. Binary and ordered logistic regressions were conducted to assess whether being a sexual minority was associated with poorer self-rated physical, mental, and cognitive health, as well as being more likely to engage in health risk behaviors.
Results
In analyses using overall and propensity-matched samples, lesbian, gay, and bisexual (LGB) participants were about twice as likely to report ever having depression as their heterosexual counterparts but were also more likely to report better self-rated health. The LGB group was more likely to report ever having smoked but were not significantly different in any of the other health risk behaviors.
Discussion and Implications
LGB individuals appear to be at greater risk of ever experiencing depression than heterosexual individuals but, at the same time, report better physical health. This may suggest a tendency for resilience. Differences in health risk behavior may also exist. Mental health and other medical professionals should receive special training to better understand the unique problems of LGB individuals.
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Affiliation(s)
| | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
- Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
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47
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Jaiswal J, Singer S, Lekas HK. Resilience and Beliefs in the Effectiveness of Current Antiretroviral Therapies Among Recently Disengaged Low-Income People of Color Living with HIV. Behav Med 2020; 46:75-85. [PMID: 30908162 PMCID: PMC7549317 DOI: 10.1080/08964289.2019.1570070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Consistent antiretroviral adherence is key to viral suppression, but many low-income people of color living with HIV are not optimally adherent due to a wide variety of interrelated social and structural factors. Previous studies have found that HIV medication beliefs are an important facet of adherence. In contrast to the AZT era , currently available antiretroviral therapies are significantly safer and more effective, but research suggests that negative beliefs may persist among racial and ethnic minority people. Twenty-seven semi-structured interviews were conducted with low-income Black and Latinx people living with HIV in New York City that were currently, or had been recently, disengaged from outpatient HIV medical care. This research suggests that socially and economically marginalized people living with HIV, many long-term survivors who lived through the AZT era, recognized that current treatments are very effective in making HIV a chronic, manageable illness and a significant improvement compared to the therapies early in the epidemic. Most importantly, the data suggests that people demonstrate great resilience despite their experiences of social and economic exclusion. Both clinical practice and public health interventions can benefit from these findings. HIV care providers should speak with patients about their beliefs related to HIV medication, and public health interventions should specifically address HIV medication-related beliefs in order to enhance adherence. In order to avoid reifying people's marginalization, public health should endeavor to recognize and support people's resilience.
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Affiliation(s)
- J. Jaiswal
- Center for Health, Identity, Behavior and Prevention Studies, New York University,Department of Social and Behavioral Sciences, College of Global Public Health, New York University,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health
| | - S.N. Singer
- Center for Health, Identity, Behavior and Prevention Studies, New York University,Graduate School of Applied and Professional Psychology, Rutgers University
| | - H-K Lekas
- Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, State of New York Office of Mental Health,Department of Psychiatry, School of Medicine, New York University
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48
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Khumsaen N, Stephenson R. Feasibility and Acceptability of an HIV/AIDS Self-Management Education Program for HIV-Positive Men Who Have Sex With Men in Thailand. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:553-566. [PMID: 31815528 PMCID: PMC7075033 DOI: 10.1521/aeap.2019.31.6.553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This pilot study examined the feasibility and acceptability of the HIV/AIDS self-management education program-Thai (HASMEP-T) for HIV-positive Thai men who have sex with men (MSM). HASMEP-T is a group-based adaptation of the evidence-based intervention, HASMEP. Participants were 40 Thai MSM living with HIV aged 18 years or older, recruited from an HIV clinic housed in a hospital in Thailand. Results support the feasibility of recruitment, screening, eligibility, and retention methods. The majority of the participants reported that the intervention was acceptable and met their initial expectations. Furthermore, all recruited participants in the intervention group (n = 20) completed HASMEP-T. Overall, intervention group participants demonstrated significant increases in all aspects of HIV self-management (p < .05), as well as improvement in quality of life in the psychological domain (p < .05). Our findings provide preliminary support for the large-scale, randomized-controlled trial of the efficacy of HASMEPT to promote self-management behaviors among HIV-positive Thai MSM.
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Affiliation(s)
- Natawan Khumsaen
- Boromarajonani College of Nursing, Suphanburi, Praboromarajchanok Institute of Health Workforce Development, Thailand
- Corresponding author’s
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48104, USA
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI 48104, USA
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49
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Gonzalez CE, Okunbor JI, Parker R, Owens MA, White DM, Merlin JS, Goodin BR. Pain-Specific Resilience in People Living With HIV and Chronic Pain: Beneficial Associations With Coping Strategies and Catastrophizing. Front Psychol 2019; 10:2046. [PMID: 31555190 PMCID: PMC6742745 DOI: 10.3389/fpsyg.2019.02046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/18/2022] Open
Abstract
Objective Chronic pain is increasingly recognized as a common and disabling problem for people living with HIV (PLWH). In a recent systematic review of psychosocial factors associated with chronic pain in PLWH, it was reported that very few studies to date have examined protective psychological factors that might help mitigate chronic pain for PLWH. The current study examined pain-specific resilience in relation to clinical and experimental pain, as well as pain coping in PLWH and chronic pain. Pain-specific resilience specifically refers to the ability to maintain relatively stable, healthy levels of psychological and physical functioning in the face of ongoing and persistent pain. Methods A total of 85 PLWH (mean CD4 = 643; 13% detectable viral load ≥200; 99% on antiretroviral therapy) who met criteria for chronic pain (>3 consecutive month’s duration) were enrolled. Medical records were reviewed to confirm clinical data. All participants provided sociodemographic information prior to completing the following validated measures: Pain Resilience Scale (PRS), Coping Strategies Questionnaire-Revised (CSQ-R), Center for Epidemiologic Studies – Depression Scale (CES-D), and the Brief Pain Inventory – Short Form (BPI-SF). They then completed a quantitative sensory testing battery designed to assess tolerance for painful heat and cold stimuli. Results In adjusted multiple regression models controlling for covariates, greater pain-specific resilience was significantly associated with less pain interference (p = 0.022) on the BPI-SF, less pain catastrophizing (p = 0.002), greater use of distraction (p = 0.027) and coping self-statements (p = 0.039) on the CSQ-R, as well as significantly greater heat pain tolerance (p = 0.009). Finally, results of a parallel multiple mediation model demonstrated that the effect of pain-specific resilience on heat pain tolerance was indirectly transmitted through less pain catastrophizing (95% confidence interval:0.0042 to 0.0354), but not use of distraction (95% confidence interval: −0.0140 to 0.0137) or coping self-statements (95% confidence interval: −0.0075 to 0.0255). Conclusion The findings suggest that pain-specific resilience may promote adaptation and positive coping in PLWH and chronic pain.
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Affiliation(s)
- Cesar E Gonzalez
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer I Okunbor
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Romy Parker
- Department of Anesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael A Owens
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dyan M White
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jessica S Merlin
- Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, United States
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
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50
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Solomon P, O'Brien KK, McGuff R, Sankey M. Living strategies for disability in men ageing with HIV in Ontario, Canada: a longitudinal qualitative study. BMJ Open 2019; 9:e031262. [PMID: 31481379 PMCID: PMC6731853 DOI: 10.1136/bmjopen-2019-031262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine the living strategies used by older men living with HIV to deal with the episodic nature of disability and associated uncertainty, over time. DESIGN Qualitative longitudinal study in which men living with HIV were interviewed on four occasions over 20 months. SETTING Men were recruited from HIV community organisations in Canada. PARTICIPANTS 14 men with a median age of 57.5 years and median time since diagnosis of 21.5 years. RESULTS Five themes depict the living strategies used to deal with the episodic nature of disability and uncertainty over time. Actively engaging in problem-solving by prioritising and modifying activities and avoiding stress, advocating for support, being positive and future oriented, engaging in healthy pursuits and providing social support to others helped men to mitigate their disability. By following participants over time, we were able to gather insights into triggers of episodes of disability, and perceptions of the success of implementing their living strategies and avoiding uncertainty. CONCLUSIONS Participants used living strategies to deal with uncertainty and mitigate episodes of disability over time. This study supports the importance of programmes that promote self-management for older men living with HIV through helping them identify triggers of disability, set realistic goals and problem-solve. These may help build self-efficacy, increase sense of control, and decrease feelings of uncertainty and episodes of disability.
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Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Rebecca McGuff
- School of Rehabilitation Science, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Michelle Sankey
- School of Rehabilitation Science, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
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