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Jaiswal J, Francis MD, Singer SN, Dunlap KB, Cox AB, Greene R. "Worn out": Coping strategies for managing antiretroviral treatment fatigue among urban people of color living with HIV who were recently disengaged from outpatient HIV care. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2020; 19:173-187. [PMID: 35431666 PMCID: PMC9009737 DOI: 10.1080/15381501.2020.1767749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 06/14/2023]
Abstract
Antiretroviral-related treatment fatigue is inconsistently defined in the literature on barriers to ART adherence. Research suggests that treatment fatigue is a salient challenge for people struggling with antiretroviral therapy adherence, but little is known about how people living with HIV attempt to manage this fatigue. Twenty-seven semi-structured interviews were conducted with low-income people of color living with HIV in NYC that were currently, or recently, disengaged from HIV care. The findings from this exploratory study suggest that treatment fatigue was common and that participants devised personal strategies to overcome it. These strategies included using reminder programs, requesting weekly rather than monthly pill quantities, and taking "pill holidays". The varied nature- and varying levels of effectiveness- of these strategies highlight the need for specific programming to provide tailored support. Future research should examine treatment fatigue as a specific subtype of adherence challenge, and aim to define pill fatigue clearly.
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Affiliation(s)
- J Jaiswal
- Department of Health Science, University of Alabama, Tuscaloosa, AL 35401
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health
| | - M D Francis
- Teachers College, Columbia University
- Rory Meyers College of Nursing, New York University
| | - S N Singer
- Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ 08854, USA
| | - K B Dunlap
- Department of Health Science, University of Alabama, Tuscaloosa, AL 35401
| | - A B Cox
- Department of Health Science, University of Alabama, Tuscaloosa, AL 35401
| | - R Greene
- Department of Medicine, New York University
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202
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Williams R, Cook R, Brumback B, Cook C, Ezenwa M, Spencer E, Lucero R. The relationship between individual characteristics and HIV-related stigma in adults living with HIV: medical monitoring project, Florida, 2015-2016. BMC Public Health 2020; 20:723. [PMID: 32429947 PMCID: PMC7236917 DOI: 10.1186/s12889-020-08891-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) disproportionately affects the Southern United States, accounting for approximately 46% of people living with HIV. HIV-related stigma is recognized as a barrier to testing, treatment, and prevention efforts. However, little is known about HIV-related stigma experiences in Florida. Using data collected from the Florida Medical Monitoring Project, we sought to examine individual characteristics associated with HIV-related stigma. METHODS We analyzed secondary data from the 2015-2016 Medical Monitoring Project in Florida (n = 603). Stigma was measured using the 10-item HIV Stigma Scale. Exploratory factor analysis of the HIV Stigma Scale revealed three subscales: negative self-image, anticipated, and personalized stigma. Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV Stigma Scale. RESULTS Multivariate analysis indicated that people with severe depression scores (OR: 3.13; CI: 1.38-7.13) and persons with disability (OR: 1.64; CI: 1.03-2.61) had significantly increased odds of higher overall stigma. In the subscale analyses, negative self-image was significantly associated with alcohol misuse (OR: 2.02; CI: 1.15-3.56) depression (OR: 2.81; CI: 1.38-5.72) and/or those who identify as homosexual (OR: 0.54; CI: 0.31-0.93). Anticipated stigma was significantly associated with people who had mild-moderate depression (OR: 3.03; CI: 1.20-7.65), severe depression (OR: 2.87; CI: 1.38-5.98), identified as Black (OR: 0.60; CI: 0.37-0.98), non-injection drug use (OR: 0.55; CI: 0.33-0.91), and/or people aged 50 years and older (OR: 0.28; CI: 0.09-0.82). Personalized stigma was not associated with any of the variables examined. CONCLUSIONS The implications of these findings reveal that certain individuals are more vulnerable to stigma. Researchers could consider distinct stigma interventions strategies based on the characteristics of specific individuals (i.e., targeting depression, disability, sexual orientation, avoidant coping, racial/ethnic groups, and youth) in Florida.
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Affiliation(s)
| | - Robert Cook
- Department of Epidemiology, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, FL, USA
| | - Christa Cook
- Department of Nursing Systems, College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Miriam Ezenwa
- Department of Biobehavioural Nursing, University of Florida College of Nursing, Gainesville, FL, USA
| | - Emma Spencer
- HIV/AIDS Surveillance Program, Florida Department of Health, Tallahassee, FL, USA
| | - Robert Lucero
- Center for Latin American Studies, Department of Family, Community and Health Systems Science, University of Florida College of Nursing, Gainesville, FL, USA
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203
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Dorward J, Msimango L, Gibbs A, Shozi H, Tonkin-Crine S, Hayward G, Butler CC, Ngobese H, Drain PK, Garrett N. Understanding how community antiretroviral delivery influences engagement in HIV care: a qualitative assessment of the Centralised Chronic Medication Dispensing and Distribution programme in South Africa. BMJ Open 2020; 10:e035412. [PMID: 32414827 PMCID: PMC7245406 DOI: 10.1136/bmjopen-2019-035412] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Providing antiretroviral therapy (ART) for millions of people living with HIV requires efficient, client-centred models of differentiated ART delivery. In South Africa, the Centralised Chronic Medication Dispensing and Distribution (CCMDD) programme allows over 1 million people to collect chronic medication, including ART, from community pick-up points. We aimed to explore how CCMDD influences engagement in HIV care. METHODS We performed in-depth interviews and focus group discussions with clients receiving ART and healthcare workers in Durban, South Africa. We analysed transcripts using deductive thematic analysis, with a framework informed by 'theories of practice', which highlights the materialities, competencies, meanings and other life practices that underpin clients' engagement in HIV care. RESULTS Between March 2018 to August 2018 we undertook 25 interviews and four focus groups with a total of 55 clients, and interviewed eight healthcare workers. The material challenges of standard clinic-based ART provision included long waiting times, poor confidentiality and restricted opening hours, which discouraged clients from engagement. In contrast, CCMDD allowed quicker and more convenient ART collection in the community. This required the development of new competencies around accessing care, and helped change the meanings associated with HIV, by normalising treatment collection. CCMDD was seen as a reward by clients for taking ART well, and helped reduce disruption to other life practices such as employment. At private pharmacies, some clients reported receiving inferior care compared with paying customers, and some worried about inadvertently revealing their HIV status. Clients and healthcare workers had to negotiate problems with CCMDD implementation, including some pharmacies reaching capacity or only allowing ART collection at restricted times. CONCLUSIONS In South Africa, CCMDD overcame material barriers to attending clinics, changed the meanings associated with collecting ART and was less disruptive to other social practices in clients' lives. Expansion of community-based ART delivery programmes may help to facilitate engagement in HIV care. TRIAL REGISTRATION NUMBER STREAM study clinical trial registration: NCT03066128, registered February 2017.
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Affiliation(s)
- Jienchi Dorward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Lindani Msimango
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Hlengiwe Shozi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hope Ngobese
- eThekwini Municipality Health Unit, Durban, South Africa
| | - Paul K Drain
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, United States
- Department of Medicine, School of Medicine, University of Washington, Seattle, United States
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, United States
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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204
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Penrose K, Robertson M, Nash D, Harriman G, Irvine M. Social Vulnerabilities and Reported Discrimination in Health Care Among HIV-Positive Medical Case Management Clients in New York City. STIGMA AND HEALTH 2020; 5:179-187. [PMID: 32432165 PMCID: PMC7236577 DOI: 10.1037/sah0000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2024]
Abstract
We aimed to investigate the extent to which social vulnerabilities correlated with lifetime experience of discrimination in healthcare among people with HIV (PWH) receiving services to improve treatment adherence and viral suppression. Individuals (N=687) enrolled in a Ryan White Part A medical case management program were surveyed about discrimination experienced in healthcare settings, reasons for any discrimination faced, and self-reported health. We merged data from the survey with data from the New York City HIV Surveillance Registry and a programmatic database to obtain client sociodemographic and clinical characteristics and reported history of social vulnerabilities. Thirty-nine percent of participants reported lifetime experience of discrimination in healthcare settings; individuals with a history of at least three social vulnerabilities (mental health diagnosis, incarceration, substance use, and/or housing instability) had more than twice the odds of reporting discrimination than individuals who did not report any of these social vulnerabilities (aOR, 2.33 [95% CI, 1.43 - 3.83]). Among individuals who reported discrimination in healthcare, those who cited HIV status or substance use as reasons for discrimination were significantly more likely to report a higher number of social vulnerabilities (p=0.04 and p=0.009, respectively), with discrimination due to HIV status most strongly associated with a mental health diagnosis. These findings underscore the importance of acknowledging life experience and psychosocial barriers in provider interactions with PWH. They also highlight a need for monitoring provider attitudes and behaviors regarding intersectional stigmas related not only to factors such as race and sexual orientation, but also to social vulnerabilities.
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Affiliation(s)
- Katherine Penrose
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Graham Harriman
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY
| | - Mary Irvine
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY
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205
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Testing Mindful Awareness as a Moderator in the Association Between HIV-Related Stress and Drug and Alcohol Use Problems Among People Living with HIV. Mindfulness (N Y) 2020; 11:1159-1169. [PMID: 34306246 DOI: 10.1007/s12671-020-01315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives People living with HIV (PLWH) are disproportionately affected by stressful life events. HIV-related stress adds to general life stressors to increase health risks among this population. Stress has not only been associated with HIV progression but it is also linked to HIV transmission risk behavior (e.g., substance use). Older adults living with HIV (OALWH) experience additional age-related stress and are at increased risk for substance use. Mindfulness buffers against stress for PLWH; however, research has yet to examine mindfulness as a buffer between HIV-related stress and substance use for OALWH. Methods Participants were 130 OALWH (M age = 54.65, SD = 4.20) and 74.6% were Black. The majority were male (69.2%), and nearly half identified as heterosexual (48.5%). A hierarchical linear regression examined the main and interactive effects of mindful awareness and two types of HIV-related stress (e.g., stigma and rumination) on alcohol and drug use problems. Results In step one of the model, we examined HIV stigma (β = .231, p = .015) and found no significant interaction with mindful awareness. In step two, HIV rumination (β = .288, p = .001) was added. We found a significant interaction (β = .196, p = .020), indicating those with low mindful awareness and high rumination reported the greatest substance use problems. Exploratory analyses revealed an indirect effect of HIV stigma on substance use through HIV rumination as well as a significant effect for second-stage moderated mediation. Conclusions These findings support mindful awareness as a buffer against HIV rumination for OALWH. Further, our results have important implications for the utility of mindfulness-based interventions (MBIs) with OALWH and comorbid substance use disorders.
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206
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Stockton MA, Pence BW, Mbote D, Oga EA, Kraemer J, Kimani J, Njuguna S, Maselko J, Nyblade L. Associations among experienced and internalized stigma, social support, and depression among male and female sex workers in Kenya. Int J Public Health 2020; 65:791-799. [PMID: 32347313 DOI: 10.1007/s00038-020-01370-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES This study (1) estimated the association between experienced sex work-related stigma and moderate-to-severe depressive symptoms (hereafter depression), (2) examined independent associations between internalized stigma, experienced stigma, and depression among sex workers, and (3) investigated the potential modifying role of social support. METHODS A cross-sectional survey was conducted among 729 male and female sex workers in Kenya. RESULTS The prevalence of depression was 33.9%, and nearly all participants reported at least one of the experienced and internalized stigma items. Increasing levels of experienced stigma was associated with an increased predicted prevalence of depression [aPD 0.15 (95% CI 0.11-0.18)]. Increasing internalized stigma was independently associated with higher experienced stigma and depression and appeared to account for 25.5% of the shared variance between experienced stigma and depression after adjustment for confounders. Social support from same-sex sex workers did not appear to modify the association between experienced stigma and depression. CONCLUSIONS Addressing the high levels of stigma that sex workers face and their mental health needs should be a public health and human rights imperative.
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Affiliation(s)
- Melissa A Stockton
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
| | - Brian W Pence
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - David Mbote
- Kuria Foundation for Social Enterprise, Nairobi, Kenya
| | - Emmanuel A Oga
- Center for Applied Public Health Research, RTI International, 6110 Executive Boulevard, Rockville, MD, 20852, USA
| | - John Kraemer
- Global Health Division, International Development Group, RTI International, Washington, DC, USA.,Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Joshua Kimani
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | | | - Joanna Maselko
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Laura Nyblade
- Global Health Division, International Development Group, RTI International, Washington, DC, USA
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207
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Marg LZ, Ruiz G, Chagolla F, Cabral A, Taylor J, Christensen C, Martin M, Picou B, Brown B. "We are becoming older women and then we have two stigmas": voicing women's biopsychosocial health issues as they age with HIV. J Women Aging 2020; 32:365-388. [PMID: 32310730 DOI: 10.1080/08952841.2020.1751566] [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: 02/06/2023]
Abstract
In April 2019, nine older women (age 50+) living with HIV in Palm Springs, California, participated in a 90-minute focus group to identify their major health issues, strengths, and HIV and aging-related health priorities. Using the rigorous and accelerated data reduction (RADaR) technique, we identified four major themes: (1) mental health, (2) HIV comorbidities, (3) social determinants of health, and (4) resiliencies. These results reinforce the need to conduct additional research focused on women aging with HIV, an understudied population that requires more effective, tailored interventions to promote better quality of life and healthy aging.
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Affiliation(s)
- Logan Z Marg
- Department of Sociology, University of California, Riverside , Riverside, California, USA
| | - Griselda Ruiz
- Department of Public Health, University of California, San Diego , San Diego, California, USA
| | - Fidel Chagolla
- Department of Sociology, University of California, Riverside , Riverside, California, USA
| | - Alejandra Cabral
- Department of Community Health Sciences, UCLA Fielding School of Public Health , Los Angeles, California, USA
| | - Jeff Taylor
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA
| | - Chris Christensen
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA
| | - Marjorie Martin
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA
| | - Bridgette Picou
- HIV and Aging Research Project-Palm Springs , Palm Springs, California, USA.,Desert AIDS Project , Palm Springs, California, USA
| | - Brandon Brown
- Center for Healthy Communities, School of Medicine, University of California, Riverside , Riverside, California, USA
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208
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Internalized HIV Stigma Is Associated With Concurrent Viremia and Poor Retention in a Cohort of US Patients in HIV Care. J Acquir Immune Defic Syndr 2020; 82:116-123. [PMID: 31513551 DOI: 10.1097/qai.0000000000002117] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The relationship of internalized HIV stigma to key care cascade metrics in the United States is not well established using large-scale, geographically diverse data. SETTING Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort study. METHODS Beginning in February 2016, we administered a yearly, validated 4-item internalized HIV stigma scale (response scale 1 = strongly disagree to 5 = strongly agree, Cronbach's alpha 0.91) at 7 CNICS sites and obtained cohort data through November 2017. We compared mean stigma levels by sociodemographic characteristics and used multivariable logistic regression, controlling for the same sociodemographic covariates, to evaluate the association between mean stigma and (1) concurrent viremia; (2) missed visits; and (3) poor visit constancy. We used inverse probability weighting (IPW) to account for differences between patients who did and did not undergo stigma assessment. RESULTS Of 13,183 CNICS patients, 6448 (49%) underwent stigma assessment. Mean stigma was 1.99 (SD 1.07), and 28.6% agreed/strongly agreed with at least 1 stigma question. Patients younger than 50 years, racial/ethnic minorities, cis-women, and heterosexuals had higher mean stigma. Mean stigma score was associated with concurrent viremia [adjusted odds ratio (AOR) 1.13, 95% confidence interval (CI): 1.02 to 1.25, P 0.02], missed visits (AOR 1.10, 95% CI: 1.02 to 1.19, P 0.01), and poor visit constancy, although the effect on visit constancy was attenuated in the IPW model (AOR 1.05, 95% CI: 0.98 to 1.13, P 0.17). CONCLUSIONS Higher internalized HIV stigma had a modest but statistically significant association with concurrent viremia and poor retention in care. Further inquiry with prospective analyses is warranted.
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209
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Etowa J, Hannan J, Babatunde S, Etowa EB, Mkandawire P, Phillips JC. HIV-Related Stigma Among Black Mothers in Two North American and One African Cities. J Racial Ethn Health Disparities 2020; 7:1130-1139. [PMID: 32198696 DOI: 10.1007/s40615-020-00736-4] [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] [Received: 09/19/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 01/29/2023]
Abstract
HIV-related stigma is a negative attitude or behaviour towards persons living with HIV, and is detrimental to effective care, management, and treatment of HIV. Using a revised 10-item stigma scale, we compared levels of HIV-related stigma and its correlates among Black women living with HIV in Ottawa, Canada, and Miami, FL, USA, with those in Port Harcourt, Nigeria. HIV-related stigma scores were calculated, with a maximum score of 10 and averaged 4.71 in Ottawa, 5.06 in Miami, and 3.78 in Port Harcourt. No significant difference in HIV-related stigma scores between Ottawa and Miami. HIV-related stigma was significantly (p < 0.05) higher among women in the North American cities compared with women in the African city. Hierarchical linear modelling shows that psychosocial variables contributed to variations in HIV-related stigma in Ottawa (22.3%), Miami (36.3%), and Port Harcourt (14.1%). At p < 0.05, discrimination was a significant predictor of increased HIV-related stigma in Ottawa (β = 0.077), Miami (β = 0.092), and Port Harcourt (β = 0.068). Functional social support had a significant diminishing effect on HIV-related stigma in Miami (β = - 0.108) and Port Harcourt (β = - 0.035). Tackling HIV-related sigma requires sociocultural considerations within specific regional and national contexts.
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Affiliation(s)
- Josephine Etowa
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Seye Babatunde
- Centre for Health and Development, University of Port Harcourt, Port Harcourt, Nigeria
| | - Egbe B Etowa
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Paul Mkandawire
- Institute of Interdisciplinary Studies, Carleton University Ottawa, Ottawa, Canada
| | - J Craig Phillips
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
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210
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Power J, Dowsett GW, Westle A, Tucker JD, Hill S, Sugarman J, Lewin SR, Brown G, Lucke J. The significance and expectations of HIV cure research among people living with HIV in Australia. PLoS One 2020; 15:e0229733. [PMID: 32130262 PMCID: PMC7055878 DOI: 10.1371/journal.pone.0229733] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/12/2020] [Indexed: 01/20/2023] Open
Abstract
Most people living with HIV (PLHIV) with reliable access to antiretroviral treatment (ART) have a life expectancy similar to uninfected populations. Despite this, HIV can negatively affect their social and psychological wellbeing. This study aimed to enhance understanding of the expectations PLHIV hold for HIV cure research and the implications this has for HIV cure research trials. We interviewed 20 Australian PLHIV about their expectations for HIV cure research outcomes and the impact a potential cure for HIV may have on their everyday lives. Data were analysed thematically, using both inductive and deductive approaches. The significance of a cure for HIV was expressed by participants as something that would offer relief from their sense of vigilance or uncertainty about their health into the future. A cure was also defined in social terms, as alleviation from worry about potential for onward HIV transmission, concerns for friends and family, and the negative impact of HIV-related stigma. Participants did not consider sustained medication-free viral suppression (or remission) as a cure for HIV because this did not offer certainty in remaining virus free in a way that would alleviate these fears and concerns. A cure was seen as complete elimination of HIV from the body. There is an ethical need to consider the expectations of PLHIV in design of, and recruitment for, HIV cure-related research. The language used to describe HIV cure research should differentiate the long-term aspiration of achieving complete elimination of HIV from the body and possible shorter-term therapeutic advances, such as achieving medication free viral suppression.
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Affiliation(s)
- Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Gary W. Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Andrew Westle
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Joseph D. Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sharon R. Lewin
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - Graham Brown
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
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211
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El Ayadi AM, Barageine JK, Miller S, Byamugisha J, Nalubwama H, Obore S, Korn A, Sukumar S, Kakaire O, Mwanje H, Lester F, Turan JM. Women's experiences of fistula-related stigma in Uganda: a conceptual framework to inform stigma-reduction interventions. CULTURE, HEALTH & SEXUALITY 2020; 22:352-367. [PMID: 31035913 PMCID: PMC6821552 DOI: 10.1080/13691058.2019.1600721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/25/2019] [Indexed: 05/26/2023]
Abstract
Fistula-related stigma is common. The absence of a unifying conceptual framework prevents a nuanced understanding of the nature of fistula-related stigma, comparison across contexts and the ability to contrast with other stigmas. It also hinders intervention development. We conducted in-depth interviews or focus groups with 60 women who had undergone fistula surgery 6-24 months prior at Mulago Hospital in Kampala, Uganda in 2014. Transcripts were analysed for experiences and consequences of enacted, anticipated and internalised stigma. Narratives revealed experiences with enacted stigma, including gossip, verbal abuse and social exclusion. Women also anticipated and feared stigma in the future. Internalised stigma reports revealed shame and low self-esteem: self-worth reduction, feeling disgraced and envisioning no future. Consequences included social isolation, changes to normal activities, non-disclosure and poor mental health. Refining stigma theory to specific conditions has resulted in a more nuanced understanding of stigma dimensions, manifestations, mechanisms and consequences, permitting comparison across contexts and populations and the development of stigma-reduction interventions. These lessons should be applied to fistula, acknowledging unique features: concealability, the potential for treatment, lack of community awareness and the social consequences of stillbirth. Reducing fistula-related stigma requires timely surgery and supportive care, stigma-reduction interventions and addressing the complex societal structures that perpetuate fistula.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
- Urogynaecology Division, Mulago National Teaching and Referral Hospital, Kampala, Uganda
- Save the Mothers, Uganda Christian University, Mukono, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Obore
- Urogynaecology Division, Mulago National Teaching and Referral Hospital, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Smrithi Sukumar
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Mwanje
- Urogynaecology Division, Mulago National Teaching and Referral Hospital, Kampala, Uganda
| | - Felicia Lester
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Alabama, AL, USA
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212
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Nwangwu‐Ike N, Saduvala N, Watson M, Panneer N, Oster AM. HIV Diagnoses and Viral Suppression Among US Women in Rural and Nonrural Areas, 2010–2017. J Rural Health 2020; 36:217-223. [DOI: 10.1111/jrh.12384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/11/2019] [Accepted: 05/30/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Ndidi Nwangwu‐Ike
- Division of HIV AIDS and PreventionCenters for Disease Control and Prevention Atlanta Georgia
| | | | - Meg Watson
- Division of HIV AIDS and PreventionCenters for Disease Control and Prevention Atlanta Georgia
| | - Nivedha Panneer
- Division of HIV AIDS and PreventionCenters for Disease Control and Prevention Atlanta Georgia
| | - Alexandra M. Oster
- Division of HIV AIDS and PreventionCenters for Disease Control and Prevention Atlanta Georgia
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213
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Discrimination, Medical Distrust, Stigma, Depressive Symptoms, Antiretroviral Medication Adherence, Engagement in Care, and Quality of Life Among Women Living With HIV in North Carolina: A Mediated Structural Equation Model. J Acquir Immune Defic Syndr 2020; 81:328-335. [PMID: 30893124 DOI: 10.1097/qai.0000000000002033] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women represent 23% of all Americans living with HIV. By 2020, more than 70% of Americans living with HIV are expected to be 50 years and older. SETTING This study was conducted in the Southern United States-a geographic region with the highest number of new HIV infections and deaths. OBJECTIVE To explore the moderating effect of age on everyday discrimination (EVD); group-based medical (GBM) distrust; enacted, anticipated, internalized HIV stigma; depressive symptoms; HIV disclosure; engagement in care; antiretroviral medication adherence; and quality of life (QOL) among women living with HIV. METHODS We used multigroup structural equation modeling to analyze baseline data from 123 participants enrolled at the University of North Carolina at Chapel Hill site of the Women's Interagency HIV Study during October 2013-May 2015. RESULTS Although age did not moderate the pathways hypothesized, age had a direct effect on internalized stigma and QOL. EVD had a direct effect on anticipated stigma and depressive symptoms. GBM distrust had a direct effect on depressive symptoms and a mediated effect through internalized stigma. Internalized stigma was the only form of stigma directly related to disclosure. Depressive symptoms were a significant mediator between GBM, EVD, and internalized stigma reducing antiretroviral therapy medication adherence, engagement in care, and QOL. CONCLUSIONS EVD, GBM, and internalized stigma adversely affect depressive symptoms, antiretroviral therapy medication adherence, and engagement in care, which collectively influence the QOL of women living with HIV.
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214
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Lyons CE, Schwartz SR, Murray SM, Shannon K, Diouf D, Mothopeng T, Kouanda S, Simplice A, Kouame A, Mnisi Z, Tamoufe U, Phaswana-Mafuya N, Cham B, Drame FM, Aliu Djaló M, Baral S. The role of sex work laws and stigmas in increasing HIV risks among sex workers. Nat Commun 2020; 11:773. [PMID: 32071298 PMCID: PMC7028952 DOI: 10.1038/s41467-020-14593-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/18/2020] [Indexed: 12/19/2022] Open
Abstract
Globally HIV incidence is slowing, however HIV epidemics among sex workers are stable or increasing in many settings. While laws governing sex work are considered structural determinants of HIV, individual-level data assessing this relationship are limited. In this study, individual-level data are used to assess the relationships of sex work laws and stigmas in increasing HIV risk among female sex workers, and examine the mechanisms by which stigma affects HIV across diverse legal contexts in countries across sub-Saharan Africa. Interviewer-administered socio-behavioral questionnaires and biological testing were conducted with 7259 female sex workers between 2011-2018 across 10 sub-Saharan African countries. These data suggest that increasingly punitive and non-protective laws are associated with prevalent HIV infection and that stigmas and sex work laws may synergistically increase HIV risks. Taken together, these data highlight the fundamental role of evidence-based and human-rights affirming policies towards sex work as part of an effective HIV response.
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Affiliation(s)
- Carrie E Lyons
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
| | - Sheree R Schwartz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins School of Public Health, Hampton House 624 N. Broadway 8th Floor, Baltimore, MD, 21205, USA
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada
| | - Daouda Diouf
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
| | | | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso, Institut Africain de Santé Publique, 12 BP 199, Ouagadougou, Burkina Faso
| | | | - Abo Kouame
- Ministère de la Sante et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Zandile Mnisi
- Health Research Department, Strategic Information Division, Ministry of Health, Cooper Centre Office 106, Mbabane, Eswatini
| | - Ubald Tamoufe
- Metabiota. Avenue Mvog-Fouda Ada, Av 1.085, Carrefour Intendance BP, 15939, Yaoundé, Cameroon
| | - Nancy Phaswana-Mafuya
- DVC Research and Innovation Office, North-West University, Potchefstroom Campus, Private Bag X6001 Potchefstroom, 2520, Potchefstroom, South Africa
| | - Bai Cham
- Actionaid, Banjul The Gambia, MDI Road, Kanifing South PMB 450, Serrekunda PO Box 725, Banjul, The Gambia
| | - Fatou M Drame
- Enda Santé, Senegal, 56 Cité Comico VDN, B.P, 3370, Dakar, Senegal
- Gaston Berger University, Department of Geography, School of Social Sciences. BP: 234 - Saint-Louis, Nationale 2, route de Ngallèle, St. Louis, Senegal
| | - Mamadú Aliu Djaló
- Enda Santé, Guiné-Bissau. Bairro Santa Luzia, Rua s/n, CP 1041, Bissau, Guinea-Bissau
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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215
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Fabian K, Molina Y, Kemp CG, Nevin PE, McCoy K, Simoni JM, Andrasik M, Cohn SE, Micci S, Rao D. Internalized HIV-Related Stigma and Breast Health Beliefs Among African-American Women Receiving Care for HIV in the USA. J Racial Ethn Health Disparities 2020; 7:45-51. [PMID: 31452148 PMCID: PMC6980483 DOI: 10.1007/s40615-019-00632-6] [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: 04/27/2019] [Revised: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES African-American women suffer disproportionately from HIV, breast cancer, and other illnesses. Little is known about the relationship between internalized HIV-related stigma and health beliefs related to other illnesses, including breast cancer. Our study examined (1) the relationship between internalized HIV-related stigma and breast health beliefs over time and (2) the moderating effects of participating in a stigma reduction intervention and/or social support. METHODS Data from 239 African-American women receiving care for HIV in Chicago, IL, or Birmingham, AL, enrolled in the Unity randomized controlled trial, were used in this secondary analysis. Threat of breast cancer was measured in terms of perceived susceptibility, fear, and adverse consequences as well as an overall perceived threat of breast cancer. We used multivariate models with generalized estimating equations to examine the relationship between internalized HIV-related stigma and breast health beliefs across three time points (baseline, immediately post-workshop, and at 12-month follow-up) and to examine if the study arm (HIV stigma reduction vs. breast cancer education) or social support moderated the relationship. RESULTS Internalized HIV-related stigma was associated with greater overall perceived threat (p < 0.001), susceptibility (p = 0.03), fear (p < 0.001), and perceived adverse consequences (p < 0.001) of breast cancer. These associations remained consistent across study arms and across all levels of social support. CONCLUSIONS Future studies that examine co-morbid health conditions among African-American women living with HIV should consider the impact of HIV-related stigma on attitudes and beliefs related to co-morbid conditions.
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Affiliation(s)
- Katrin Fabian
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Yamilé Molina
- Community Health Sciences Division, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL, 60612, USA.
| | | | - Paul E Nevin
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Katryna McCoy
- School of Nursing & Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - Jane M Simoni
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Susan E Cohn
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Sandy Micci
- CORE Center/Division of Infectious Diseases, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry, University of Washington, Seattle, WA, USA
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216
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Relevance of students' demographic characteristics, sources of information and personal attitudes towards HIV testing for HIV knowledge: evidence from a post-conflict setting. J Biosoc Sci 2020; 53:1-19. [PMID: 31987058 DOI: 10.1017/s0021932019000877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although studies on HIV knowledge have previously been conducted in central Serbia and southern Kosovo, none has included the Serbian population residing in the northern part of the Kosovo province. The aim of this study was to assess HIV-related knowledge and to estimate factors contributing to a higher HIV-related knowledge level among Serbian university students in the Kosovo province. A cross-sectional study including 1017 first- and fourth-year students enrolled at the University of Pristina temporarily seated in Kosovska Mitrovica was carried out during the academic year 2013-2014. The students completed a 31-item questionnaire comprising demographic data, HIV transmission knowledge and attitude towards HIV testing. Data were statistically analysed. Students demonstrated good knowledge of HIV (average 32.8 ± 3.3 out of a maximum 42). Only 5% of the students reported having been tested for HIV. Factors associated with being more knowledgeable about HIV were studying health-related disciplines (β = -0.09; 95% confidence interval [CI] -0.13, 0.00), using the internet as a source of information about HIV (β = -1.09; 95% CI -1.65, -0.52), having a positive attitude towards HIV testing (β = -0.43; 95% CI -0.59, -0.26), having a low self-perceived risk for HIV infection (β = 0.41; 95% CI 0.23, 0.56) and the position that one would keep the same level of contact with an HIV-positive person after learning their HIV status (β = 0.38; 95% CI 0.21, 0.55). Setting up specialized classes on this topic at high schools and universities could help to increase the awareness of HIV infection and promote HIV testing and a positive attitude towards HIV-positive persons.
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217
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Philbin MM, Feaster DJ, Gooden L, Duan R, Das M, Jacobs P, Lucas GM, Batey DS, Nijhawan A, Jacobson JM, Mandler R, Daar E, McMahon DK, Armstrong WS, Del Rio C, Metsch LR. The North-South Divide: Substance Use Risk, Care Engagement, and Viral Suppression Among Hospitalized Human Immunodeficiency Virus-Infected Patients in 11 US Cities. Clin Infect Dis 2020; 68:146-149. [PMID: 29920584 DOI: 10.1093/cid/ciy506] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022] Open
Abstract
Regional variability in human immunodeficiency virus (HIV) care engagement remains underexplored. Multiple logistic models compared HIV outcomes for participants from 5 Southern (n = 557) and 6 non-Southern (n = 670) sites. Southern participants were less likely to experience viral suppression (adjusted odds ratio [aOR], 0.52; 95% confidence interval [CI], .37-.72) and had a higher likelihood of a CD4+ count <200 cells/µL (aOR, 1.53; 95% CI, 1.17-2.00). HIV intervention and social safety net programs should be expanded. Clinical Trials Registration NCT01612169.
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Affiliation(s)
- Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida
| | - Lauren Gooden
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Florida
| | | | | | - Gregory M Lucas
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - D Scott Batey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham
| | - Ank Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas
| | - Jeffrey M Jacobson
- Departments of Medicine and Neuroscience, Center for Translational AIDS Research, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - Eric Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | | | | | - Carlos Del Rio
- Department of Medicine, Emory University School of Medicine.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
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218
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Taylor TN, DeHovitz J, Hirshfield S. Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean. Front Public Health 2020; 7:373. [PMID: 31998675 PMCID: PMC6965168 DOI: 10.3389/fpubh.2019.00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
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Affiliation(s)
- Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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219
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Deering KN, Braschel M, Logie C, Ranville F, Krüsi A, Duff P, Shannon K. Exploring pathways from violence and HIV disclosure without consent to depression, social support, and HIV medication self-efficacy among women living with HIV in Metro Vancouver, Canada. Health Psychol Open 2020; 7:2055102919897384. [PMID: 32010448 PMCID: PMC6971967 DOI: 10.1177/2055102919897384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We used path analysis to investigate complex pathways from HIV status disclosure without consent, physical/verbal violence and depression, social support, and HIV medication self-efficacy through mediators of HIV stigma among women living with HIV in Canada. In the final model, internalized stigma fully mediated the relationship between physical/verbal violence and reduced medication self-efficacy. Enacted stigma fully mediated the relationship between HIV status disclosure without consent and depression. Internalized stigma (β = 0.252; p < 0.001) had a significant negative direct effect on medication self-efficacy. Enacted stigma had a significant direct effect on depression (β = 0.162; p = 0.037). Findings will help improve services and interventions to promote quality of life and well-being of women living with HIV.
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Affiliation(s)
- Kathleen N Deering
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| | | | | | - Flo Ranville
- Centre for Gender & Sexual Health Equity, Canada
| | - Andrea Krüsi
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| | - Putu Duff
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
| | - Kate Shannon
- Centre for Gender & Sexual Health Equity, Canada
- The University of British Columbia, Canada
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220
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Hogben M, Leichliter J, Aral SO. An Overview of Social and Behavioral Determinants of STI. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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221
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Whittle HJ, Leddy AM, Shieh J, Tien PC, Ofotokun I, Adimora AA, Turan JM, Frongillo EA, Turan B, Weiser SD. Precarity and health: Theorizing the intersection of multiple material-need insecurities, stigma, and illness among women in the United States. Soc Sci Med 2020; 245:112683. [PMID: 31760320 PMCID: PMC7111434 DOI: 10.1016/j.socscimed.2019.112683] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022]
Abstract
Material-need insecurities (including insecurities in basic resources such as income, food, housing, and healthcare) are widespread in the United States (US) and may be important predictors of poor health outcomes. How material-need insecurities besides food insecurity are experienced, however, remains under-researched, including how multiple material-need insecurities might intersect and converge on the individual. Here we used qualitative methods to investigate experiences with multiple material-need insecurities among 38 food-insecure women aged over 50 years living with or at risk for HIV in the US. Our aims were: (1) to understand the co-experience of material-need insecurities beyond food insecurity; (2) to elucidate how multiple material-need insecurities might intersect; and (3) to discover how this intersection might be detrimental to health. During November 2017-July 2018, we conducted semi-structured interviews at three sites across the US (Northern California, Georgia, North Carolina) and analyzed the data using an inductive-deductive approach. We identified a common and complex picture of multiple material-need insecurities, stigma, and illness among participants across all three sites. There were five primary themes: (1) insecure income arising from a combination of precarious wage labor and federal disability benefits; (2) resultant experiences of uncertainty, compromised quality, insufficiency, and having to use socially unacceptable coping strategies across finances, food, housing, and healthcare; (3) participants' disempowerment arising from their engagement with social safety net institutions; (4) closely related experiences of intersectional stigma and discrimination; and (5) negative implications for health across a wide range of illnesses. By employing the sociological concept of precarity-a term denoting the contemporary convergence of insecure wage labor and retraction of the welfare state-we combine these themes into a unifying framework of precarity and health. This framework may prove useful for testing how the widespread intersection of multiple material-need insecurities interacts with stigma and discrimination to negatively impact physical and mental health.
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Affiliation(s)
- Henry J Whittle
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Jacqueline Shieh
- Institute for Global Health Sciences, UCSF, San Francisco, CA, USA
| | - Phyllis C Tien
- Department of Medicine, UCSF and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, USA
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University and Grady Healthcare System, Atlanta, GA, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bulent Turan
- Department of Psychology, UAB, Birmingham, AL, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, UCSF, San Francisco, CA, USA
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222
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Ray A, Sharma S, Sadasivam B. Exploring an unsung stigma factor in COVID-19. J Family Med Prim Care 2020; 9:5400-5401. [PMID: 33409231 PMCID: PMC7773111 DOI: 10.4103/jfmpc.jfmpc_1497_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 12/02/2022] Open
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223
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Yator O, Mathai M, Albert T, Kumar M. Burden of HIV-Related Stigma and Post-Partum Depression: A Cross-Sectional Study of Patients Attending Prevention of Mother-to-Child Transmission Clinic at Kenyatta National Hospital in Nairobi. Front Psychiatry 2020; 11:532557. [PMID: 33716799 PMCID: PMC7947326 DOI: 10.3389/fpsyt.2020.532557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 12/21/2020] [Indexed: 12/04/2022] Open
Abstract
Background: We look at how various HIV-related stigma subtypes, especially internalizing types, interact with postpartum depression (PPD) among women living with HIV. Additionally, we identify key psychosocial risk factors that influence stigma and PPD among women attending Prevention of Mother-to-Child Transmission (PMTCT) clinics. Methods: In this cross-sectional design, 123 women living with HIV were recruited. Participants ages between 18 and 50, who were at least 8 weeks postpartum seeking PMTCT services at Kenyatta National Hospital (KNH), between June and September 2014 participated in the study. HIV/AIDS Stigma Instrument-PLWHA (HASI-P) was used to assesses stigma and Postpartum depression was assessed by Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV-related stigma Scale. Post survey a few in-depth-interviews were conducted to explore individuals' stigma and depression experiences. Results: The mean age was 31.2 years (SD = 5.2). Fifty-nine (48%) women screened positive for significant depressive symptoms. Post-partum depression was a significant predictor of internalized stigma, enacted, and total stigma (P < 0.05). Older age was associated with less internalized stigma. Living with a partner was associated with more internalized stigma. Having an income above 100 USD per month was protective against stigma. Having good family social support was protective against internalized stigma. A higher educational level was protective against enacted stigma. Being treated for STIs was a risk factor for both enacted and overall stigma. Conclusions: HIV-related stigma needs to be addressed through integrated mental health care programs in PMTCT. Postpartum depression requires comprehensive management to improve short- and long-term outcomes of women living with HIV.
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Affiliation(s)
- Obadia Yator
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Muthoni Mathai
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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224
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Watt MH, Knippler ET, Minja L, Kisigo G, Knettel BA, Ngocho JS, Renju J, Osaki H, Mwamba R, Rogathi JJ, Mmbaga BT. A counseling intervention to address HIV stigma at entry into antenatal care in Tanzania (Maisha): study protocol for a pilot randomized controlled trial. Trials 2019; 20:807. [PMID: 31888700 PMCID: PMC6937735 DOI: 10.1186/s13063-019-3933-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/24/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND HIV-related stigma significantly impacts HIV care engagement, including in prevention of mother-to-child transmission of HIV (PMTCT) programs. Maisha is a stigma-based counseling intervention delivered during the first antenatal care (ANC) visit, complementing routine HIV counseling and testing. The goal of Maisha is to promote readiness to initiate and sustain treatment among those who are HIV-positive, and to reduce HIV stigmatizing attitudes among those who test negative. METHODS A pilot randomized control trial will assess the feasibility and acceptability of delivering Maisha in a clinical setting, and the potential efficacy of the intervention on HIV care engagement outcomes (for HIV-positive participants) and HIV stigma constructs (for all participants). A total of 1000 women and approximately 700 male partners will be recruited from two study clinics in the Moshi municipality of Tanzania. Participants will be enrolled at their first ANC visit, prior to HIV testing. It is estimated that 50 women (5%) will be identified as HIV-positive. Following consent and a baseline survey, participants will be randomly assigned to either the control (standard of care) or the Maisha intervention. The Maisha intervention includes a video and counseling session prior to HIV testing, and two additional counseling sessions if the participant tests positive for HIV or has an established HIV diagnosis. A subset of approximately 500 enrolled participants (all HIV-positive participants, and a random selection of HIV-negative participants who have elevated stigma attitude scores) will complete a follow-up assessment at 3 months. Measures will include health outcomes (care engagement, antiretroviral adherence, depression) and HIV stigma outcomes. Quality assurance data will be collected and the feasibility and acceptability of the intervention will be described. Statistical analysis will examine potential differences between conditions in health outcomes and stigma measures, stratified by HIV status. DISCUSSION ANC provides a unique and important entry point to address HIV stigma. Interventions are needed to improve retention in PMTCT care and to improve community attitudes toward people living with HIV. Results of the Maisha pilot trial will be used to generate parameter estimates and potential ranges of values to estimate power for a full cluster-randomized trial in PMTCT settings, with extended follow-up and enhanced adherence measurement using a biomarker. TRIAL REGISTRATION ClinicalTrials.gov, NCT03600142. Registered on 25 July 2018.
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Affiliation(s)
- Melissa H. Watt
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT 84108 USA
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC 27701 USA
| | | | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Godfrey Kisigo
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC 27701 USA
| | - Brandon A. Knettel
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC 27701 USA
| | - James S. Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jenny Renju
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Haika Osaki
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Rimel Mwamba
- Duke Global Health Institute, Duke University, Box 90519, Durham, NC 27701 USA
| | - Jane J. Rogathi
- Kilimanjaro Christian Medical Centre, School of Nursing, Moshi, Tanzania
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225
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Adams LV, Maseko TSB, Talbot EA, Grande SW, Mkhontfo MM, Simelane ZZ, Achilla AA, Haumba SM. Integrated and patient-selected care facilitates completion of isoniazid preventive therapy in Eswatini. Public Health Action 2019; 9:153-158. [PMID: 32042607 DOI: 10.5588/pha.19.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/03/2019] [Indexed: 01/12/2023] Open
Abstract
Setting Five human immunodeficiency virus (HIV) care facilities in Eswatini. Objective To identify critical factors that enabled persons living with HIV to successfully complete a 6-month course of isoniazid preventive therapy (IPT) provided through a choice of facility-based or community-based delivery, coordinated with antiretroviral therapy (ART) refills. Design This was a mixed methods, retrospective cross-sectional study. Results Between June and October 2017, we interviewed 150 participants who had completed IPT in the previous year. Fourteen participants did not recall being offered a choice, and were excluded from the analysis. Of the remaining 136, 56.6% were female and 64.7% chose facility-based care; the median age was 42.5 years. Most participants reported that having a choice was important to their treatment completion (87.7%) and that linking IPT and ART refills facilitated undergoing IPT (98.5%). Participants were knowledgeable about the benefits of IPT and valued the education received from their providers. Participants also reported a high rate of IPT disclosure (95%) to friends and family members. Conclusion Offering patients a choice of IPT delivery, linking IPT with ART refills, emphasizing patient education and engagement with healthcare workers, and supporting disclosure of IPT are critical factors to enabling IPT completion. These interventions should be incorporated throughout Eswatini and in similar high tuberculosis and HIV burden settings.
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Affiliation(s)
- L V Adams
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - E A Talbot
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - S W Grande
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH, USA
| | | | | | | | - S M Haumba
- University Research Co, Mbabane, Eswatini
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226
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Rosengren AL, Menza TW, LeGrand S, Muessig KE, Bauermeister JA, Hightow-Weidman LB. Stigma and Mobile App Use Among Young Black Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:523-537. [PMID: 31815533 PMCID: PMC6938279 DOI: 10.1521/aeap.2019.31.6.523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Young black men who have sex with men (YBMSM) are disproportionately affected by HIV. Intersectional stigmas are associated with increased HIV vulnerability, and worse outcomes for YBMSM with HIV. YBMSM find sex partners through sexual networking apps, but stigma on apps has been poorly studied. We conducted cross-sectional analysis of 324 YBMSM seeking sex partners through apps to assess stigma experiences in eight dimensions compared to non-users (N = 150). We conducted detailed stratified analyses to identify granular stigma data. App users had higher median scores than non-users in perceived HIV discrimination, perceived HIV stigma, experienced sexual minority stigma, racial discrimination, and perceived homophobia. We demonstrate higher levels of intersectional stigmas among app users than non-users, but did not find an overall increase in stigma with increasing app use. Considering the prominent role of apps in YBMSM sexual networking, interventions that reduce stigma on apps are needed.
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Affiliation(s)
- A Lina Rosengren
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Kathryn E Muessig
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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227
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McMahon JM, Braksmajer A, Zhang C, Leblanc N, Chen M, Aidala A, Simmons J. Syndemic factors associated with adherence to antiretroviral therapy among HIV-positive adult heterosexual men. AIDS Res Ther 2019; 16:32. [PMID: 31706357 PMCID: PMC6842154 DOI: 10.1186/s12981-019-0248-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suboptimal adherence to HIV antiretroviral therapy (ART) and concomitant lack of viral control can have severe consequences for health and onward transmission among persons living with HIV. Little is known about the barriers and facilitators of optimal ART adherence among heterosexual HIV-positive men. METHODS Structural equation modeling (SEM) was performed to test a theory-derived model of ART adherence using data from a cross-sectional sample of 317 HIV-positive self-identified heterosexual men residing in New York City. We assessed a conceptual model in which mental health (depression, anxiety) and substance use dependence mediated the effects of socio-structural factors (HIV-related stigma, social support) on ART adherence, and subsequently, undetectable viral load. RESULTS Structural equation modeling analyses indicated that men who reported higher levels of HIV-related stigma tended to experience higher levels of general anxiety, which in turn was associated with reduced probability of optimal ART adherence. Moreover, men who reported higher levels of social support tended to exhibit less dependence on illicit substance use, which in turn was associated with increased probability of optimal ART adherence. African-American men reported lower ART adherence compared to other racial/ethnic groups. CONCLUSIONS Our findings support the hypothesis that substance use dependence and mental health problems, particularly anxiety, may be primary drivers of suboptimal ART adherence among heterosexual men, and that socio-structural factors such as HIV-related stigma and social support are potential modifiable antecedents of these drivers.
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228
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Bilardi JE, Hulme-Chambers A, Chen MY, Fairley CK, Huffam SE, Tomnay JE. The role of stigma in the acceptance and disclosure of HIV among recently diagnosed men who have sex with men in Australia: A qualitative study. PLoS One 2019; 14:e0224616. [PMID: 31703087 PMCID: PMC6839846 DOI: 10.1371/journal.pone.0224616] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/17/2019] [Indexed: 01/11/2023] Open
Abstract
Background Our primary study aimed to explore the experiences of men who have sex with men (MSM) recently diagnosed with HIV and their partner notification practices. Themes relating to acceptance, and disclosure of, their HIV status strongly emerged during analysis in our larger study and are reported separately here. Method Fifteen MSM participated in semi-structured interviews by phone or face to face about their experience of a recent HIV diagnosis. In this paper we report on how they received and accepted the diagnosis, who they disclosed their diagnosis to and what is needed to improve support for MSM recently diagnosed with HIV. Results MSM’s reactions to their HIV diagnosis ranged from shock, devastation and anger to a calm acceptance and feeling HIV would not have a significant impact on their lives. MSM who reported strong social support networks, or knew others with HIV, seemed better able to cope with and accept their diagnosis than those with fewer support networks. Due to prevailing stigma around HIV, most MSM were very selective about who they disclosed their status to, often only telling partners perceived to be at risk but no, or only few, close friends. Regardless of how well men accepted their diagnosis, most did not disclose their status to family members for fear of rejection or causing distress due to ideologies based on outdated information about HIV. Conclusion The prevailing stigma around HIV can have a significant impact on MSM’s acceptance of, and willingness to disclose their HIV serostatus to others, and consequently the levels of professional and social support they receive. HIV-related stigma needs to be addressed through community campaigns which better educate the wider population about the current state of HIV prognosis and treatment.
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Affiliation(s)
- Jade E. Bilardi
- Central Clinical School, Monash University, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Victoria, Australia
- Department of General Practice, University of Melbourne, Victoria, Australia
| | - Alana Hulme-Chambers
- Centre for Excellence in Rural Sexual Health, University of Melbourne, Victoria, Australia
| | - Marcus Y. Chen
- Central Clinical School, Monash University, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Victoria, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Victoria, Australia
| | - Sarah E. Huffam
- Central Clinical School, Monash University, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Victoria, Australia
| | - Jane E. Tomnay
- Centre for Excellence in Rural Sexual Health, University of Melbourne, Victoria, Australia
- * E-mail:
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229
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Algarin AB, Zhou Z, Cook CL, Cook RL, Ibañez GE. Age, Sex, Race, Ethnicity, Sexual Orientation: Intersectionality of Marginalized-Group Identities and Enacted HIV-Related Stigma Among People Living with HIV in Florida. AIDS Behav 2019; 23:2992-3001. [PMID: 31392442 DOI: 10.1007/s10461-019-02629-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
HIV-related stigma is associated with many negative health outcomes among people living with HIV (PLHIV). The theory of intersectionality suggests that the interactions of social identities affect PLHIV's experiences of stigma. This study aims to identify individual and interactive marginalized-group identities correlated with enacted HIV-related stigma among PLHIV in Florida. The sample (n = 932) was majority male (66.6%), Black (58.5%), and non-Latino (80.2%) with 53% reporting experiences of HIV-related stigma. In multinomial regression models, the interaction between race and ethnicity was significant where non-White Latinos had higher odds of experiencing high levels of enacted stigma [AOR (CI) 7.71 (2.41, 24.73), p < 0.001] compared to white non-Latinos. Additionally, racial minorities were less likely to have experienced moderate or high levels of enacted stigma [AOR (CI) 0.47 (0.31, 0.72), p < 0.001; AOR (CI) 0.39 (0.22, 0.70), p = 0.002, respectively]. Moreover, women had higher odds of experiencing high levels of enacted stigma [AOR (CI) 2.04 (1.13, 3.67), p = 0.018]. The results suggest that intersectionality is important to consider in HIV-related stigma research and future interventions.
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Affiliation(s)
- Angel B Algarin
- Department of Epidemiology, Florida International University, 11200 SW 8th St., AHC5-505, Miami, FL, 33199, USA.
| | - Zhi Zhou
- Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, USA
| | - Christa L Cook
- College of Nursing, University of Central Florida, 12201 Research Parkway Suite 300, Orlando, FL, 32826, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Florida International University, 11200 SW 8th St., AHC5-505, Miami, FL, 33199, USA
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230
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Chittamuru D, Frye V, Koblin BA, Brawner B, Tieu HV, Davis A, Teitelman A. PrEP Stigma, HIV Stigma, and Intention to Use PrEP among Women in New York City and Philadelphia. STIGMA AND HEALTH 2019; 5:240-246. [PMID: 33184608 DOI: 10.1037/sah0000194] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Stigma is an important contributor to the continued HIV epidemic in the United States (US). In 2016, women made up nearly one in five of all new infections. Pre-exposure HIV Prophylaxis or PrEP is a medication that can be taken to prevent HIV acquisition; however, PrEP is significantly underutilized by women at risk for infection. How PrEP stigma relates to PrEP initiation among women is not well understood. Methods Surveys were completed by 160 PrEP-eligible women aged 18-55 in Philadelphia, PA and New York City, NY. Associations between PrEP stigma, HIV stigma, and PrEP initiation intention were modeled using multinomial logistic regression, controlling for sociodemographic and theoretically-relevant variables. Results Participants ranged in age from 18 to 55 years (M = 40.2; SD = 11.78). Most (79%) identified as Black or African-American and/or Latina and 36% had completed high-school or less. Higher PrEP stigma was significantly associated with lower PrEP initiation intention, while controlling for other theoretically-relevant and sociodemographic variables. HIV stigma was not related to PrEP initiation intention. Conclusions HIV prevention interventions seeking to increase PrEP initiation among PrEP-eligible, urban women need to address the role that PrEP stigma plays in PrEP uptake.
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Affiliation(s)
- Deepti Chittamuru
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California Merced, Merced, CA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY
| | - Beryl A Koblin
- School of Nursing, University of Pennsylvania, Philadelphia, PA
| | | | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY
| | - Annet Davis
- School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Anne Teitelman
- School of Nursing, University of Pennsylvania, Philadelphia, PA
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231
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HIV-Related Stigma, Motivation to Adhere to Antiretroviral Therapy, and Medication Adherence Among HIV-Positive Methadone-Maintained Patients. J Acquir Immune Defic Syndr 2019; 80:166-173. [PMID: 30383588 DOI: 10.1097/qai.0000000000001891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Opioid agonist therapies with methadone are associated with higher levels of adherence to antiretroviral therapy (ART); yet, no studies have explored factors associated with optimal ART levels in HIV-positive patients on methadone maintenance treatment, including explanatory pathways using mediation analysis. SETTING Participants included 121 HIV-positive, methadone-maintained patients who reported HIV-risk behaviors and were taking ART. METHODS Participants were assessed using an audio computer-assisted self-interview. Multivariable logistic regression was used to identify significant correlates and PROCESS macro to test the explanatory pathway (ie, mediational effect) for optimal ART adherence. RESULTS Among 121 participants, almost 40% reported suboptimal adherence to ART. Optimal ART adherence was significantly associated with being virally suppressed [adjusted odds ratio (aOR) = 6.470, P = 0.038], higher motivation to adhere to ART (aOR = 1.171, P = 0.011), and lower anticipated HIV-related stigma (aOR = 0.384, P = 0.015). Furthermore, results revealed an indirect effect of motivation on the relationship between HIV stigma and ART adherence (effect = -0.121, P = 0.043), thus supporting the mediation effect. CONCLUSIONS Our findings underscore the complexities surrounding ART adherence, even in patients on methadone maintenance treatment. These findings provide insights on how to more effectively intervene to optimize HIV treatment outcomes, including HIV treatment-as-prevention initiatives, in methadone-maintained patients.
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232
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Brown MJ, Serovich JM, Laschober TC, Kimberly JA, Lescano CM. Ways of coping and perceived HIV-related stigma among people living with HIV: moderation by sex and sexual orientation. PSYCHOL HEALTH MED 2019; 25:867-878. [PMID: 31631682 DOI: 10.1080/13548506.2019.1680852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Perceived HIV-related stigma continues to persist among people living with HIV and coping strategies are crucial to overall health. Coping may be associated with perceived HIV-related stigma. However, research examining differences by sex and sexual orientation is lacking. Therefore, the aims of the study were to assess the association between ways of coping and perceived HIV-related stigma, and to examine the relationship by sex and sexual orientation. Data were obtained from 346 individuals (191 men and 155 women) living with HIV. Multiple linear regression models showed that overall, distancing, and attack/escape avoidance coping were positively associated with perceived HIV-related stigma among the overall population, among men who have sex with men (MSM), and among women overall and heterosexual women. Among men overall, distancing and attack/escape avoidance coping were positively associated with perceived HIV-related stigma. Among women who have sex with women (WSW), attack/escape avoidance coping was positively associated with perceived HIV-related stigma. Effect sizes indicated small effects for overall coping and medium to large effects for distancing and attack/escape avoidance coping. Interventions focused on reducing perceived HIV-related stigma among populations living with HIV should address distancing and attack/escape avoidance strategies especially among women, regardless of sexual orientation, and MSM.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA.,Division of Biology and Medicine, Brown University , Providence, RI, USA.,Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida , Tampa, FL, USA.,Office for the Study on Aging, Arnold School of Public Health, University of South Carolina , Columbia, SC, USA
| | - Julianne M Serovich
- College of Behavioral and Community Sciences, University of South Florida , Tampa, FL, USA
| | - Tanja C Laschober
- College of Behavioral and Community Sciences, University of South Florida , Tampa, FL, USA
| | - Judy A Kimberly
- Division of Biology and Medicine, Brown University , Providence, RI, USA
| | - Celia M Lescano
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida , Tampa, FL, USA
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233
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Abstract
INTRODUCTION African American women encounter disproportionately high rates of HIV-related morbidity and mortality, which is partially mediated through stigma and its effect on HIV treatment adherence. OBJECTIVE To assess the effect of the UNITY peer support workshop on HIV-related stigma among African American women living with HIV, compared with a time and attention control group. METHODS African American women living with HIV were randomized to the UNITY workshop or a breast cancer education control group. Interventions took place in HIV clinics in Chicago, IL and Birmingham, AL. Participants self-reported HIV-related stigma and social support at baseline, after workshop, and at 4 follow-up visits over 12 months. RESULTS Two hundred thirty-nine participants (UNITY n = 124; breast cancer education n = 115) were assessed over 1 year. Both arms experienced decreases in mean stigma scores over time. Our model estimated that allocation to UNITY was not associated with a significant difference in stigma points over time. Post hoc analysis suggested that preceding increases in perceived social support are associated with decreased HIV-related stigma in this population. CONCLUSIONS Although UNITY did not significantly reduce HIV-related stigma in this population, our findings suggest that social support may be key to HIV-related stigma reduction.
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234
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Whittle HJ, Sheira LA, Wolfe WR, Frongillo EA, Palar K, Merenstein D, Wilson TE, Adedimeji A, Weber KM, Adimora AA, Ofotokun I, Metsch L, Turan JM, Wentz EL, Tien PC, Weiser SD. Food insecurity is associated with anxiety, stress, and symptoms of posttraumatic stress disorder in a cohort of women with or at risk of HIV in the United States. J Nutr 2019; 149:1393-1403. [PMID: 31127819 PMCID: PMC6675617 DOI: 10.1093/jn/nxz093] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/19/2019] [Accepted: 04/10/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Food insecurity, which disproportionately affects marginalized women in the United States, is associated with depressive symptoms. Few studies have examined relations of food insecurity with other mental health outcomes. OBJECTIVE The aim of this study was to investigate the associations of food insecurity with symptoms of generalized anxiety disorder (GAD), stress, and posttraumatic stress disorder (PTSD) in the Women's Interagency HIV Study (WIHS), a prospective cohort study of women with or at risk of HIV in the United States. METHODS Participants were 2553 women with or at risk of HIV, predominantly African American/black (71.6%). Structured questionnaires were conducted during April 2013-March 2016 every 6 mo. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. We measured longitudinal outcomes for GAD (GAD-7 score and a binary GAD-7 screener for moderate-to-severe GAD). Only cross-sectional data were available for outcomes measuring perceived stress (PSS-10 score) and PTSD (PCL-C score and a binary PCL-C screener for PTSD). We examined associations of FS with the outcomes through use of multivariable linear and logistic regression, including lagged associations with GAD outcomes. RESULTS After adjusting for sociodemographic and health-related factors including HIV serostatus, current marginal, low, and very low FS were associated with increasingly higher GAD-7 scores, and with 1.41 (95% CI: 1.10, 1.80; P < 0.01), 2.03 (95% CI: 1.59, 2.61; P < 0.001), and 3.23 (95% CI: 2.43, 4.29; P < 0.001) times higher odds of screening positive for moderate-to-severe GAD, respectively. Low and very low FS at the previous visit (6 mo earlier) were independently associated with GAD outcomes at current visit. Associations of FS with PSS-10 and PCL-C scores exhibited similar dose-response relations. Very low FS was associated with 1.93 (95% CI: 1.15, 3.24; P < 0.05) times higher odds of screening positive for PTSD. CONCLUSIONS Food insecurity may be associated with a range of poor mental health outcomes among women in the United States with or at risk of HIV.
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Affiliation(s)
- Henry J Whittle
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK,Address correspondence to HJW (e-mail: )
| | | | | | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | | | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Kathleen M Weber
- Cook County Health and Hospitals System and Hektoen Institute of Medicine, Chicago, IL
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University, Atlanta, GA, and Grady Healthcare System, Atlanta, GA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Eryka L Wentz
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Phyllis C Tien
- Department of Medicine, UCSF and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine,Center for AIDS Prevention Studies, UCSF, San Francisco, CA
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235
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Lipira L, Williams EC, Huh D, Kemp CG, Nevin PE, Greene P, Unger JM, Heagerty P, French AL, Cohn SE, Turan JM, Mugavero MJ, Simoni JM, Andrasik MP, Rao D. HIV-Related Stigma and Viral Suppression Among African-American Women: Exploring the Mediating Roles of Depression and ART Nonadherence. AIDS Behav 2019; 23:2025-2036. [PMID: 30343422 PMCID: PMC6815932 DOI: 10.1007/s10461-018-2301-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We used baseline data from a sample of African-American women living with HIV who were recruited to participate in a stigma-reduction intervention in Chicago and Birmingham (2013-2015) to (1) evaluate the relationship between HIV-related stigma and viral suppression, and (2) assess the role of depression and nonadherence to antiretroviral therapy (ART) as mediators. Data from women were included in this secondary analysis if they were on ART, had viral load data collected within 8-weeks of study entry and had complete covariate data. We used logistic regression to estimate the total effect of HIV-related stigma (14-item Stigma Scale for Chronic Illness) on viral suppression (< 200 copies/mL), and serial mediation analysis to estimate indirect effects mediated by depressive symptoms (8-item Patient Health Questionnaire) and ART nonadherence (number of days with missed doses). Among 100 women who met study inclusion criteria, 95% reported some level of HIV-related stigma. In adjusted models, higher levels of HIV-related stigma were associated with lower odds of being virally suppressed (AOR = 0.93, 95% CI = 0.89-0.98). In mediation analysis, indirect effects through depression and ART nonadherence were not significant. Findings suggest that HIV-related stigma is common among African-American women living with HIV, and those who experience higher levels of stigma are less likely to be virally suppressed. However, the mechanisms remain unclear.
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Affiliation(s)
- Lauren Lipira
- Department of Health Services, University of Washington, Seattle, WA, USA.
- Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660, USA.
| | - Emily C Williams
- Department of Health Services, University of Washington, Seattle, WA, USA
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - David Huh
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Paul E Nevin
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Joseph M Unger
- Department of Health Services, University of Washington, Seattle, WA, USA
- Fred Hutch, Seattle, WA, USA
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Audrey L French
- Stroger Hospital of Cook County and Ruth M. Rothstein CORE Center, Chicago, IL, USA
| | - Susan E Cohn
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michele P Andrasik
- Department of Global Health, University of Washington, Seattle, WA, USA
- Fred Hutch, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
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Abstract
OBJECTIVE African-American women are more likely than other women in the United States to experience poor HIV-related health; HIV stigma may contribute to these outcomes. This study assessed the relationship between HIV stigma and viral load, over time, among a sample of African-American women receiving treatment for HIV, and explored social support and depressive symptoms as mediators. DESIGN Secondary analysis of longitudinal data. METHODS Data came from a randomized trial of an intervention to reduce HIV stigma among African-American women in HIV care in Chicago, Illinois and Birmingham, Alabama. Sociodemographic and psychosocial data were collected at up to six study visits over 14 months. Viral loads were extracted from medical records during the study period. Generalized linear mixed effects models were used to estimate associations among overall, internalized, and enacted HIV stigma and viral load over time. Mediation analyses were used to estimate indirect effects via social support and depressive symptoms. RESULTS Data from 234 women were analyzed. Overall HIV stigma was significantly associated with subsequent viral load (adjusted β = 0.24, P = 0.005). Both between-subject (adjusted β = 0.74, P < 0.001) and within-subject (adjusted β = 0.34, P = 0.005) differences in enacted stigma were associated with viral load. Neither social support nor depressive symptoms were statistically significant mediators. CONCLUSION Ongoing experiences of HIV stigmatization may contribute to increased viral load among African-American women in primary HIV care. Interventions should aim to alleviate the consequences of stigma experienced by patients and prevent future stigmatization.
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Varas-Díaz N, Rivera-Segarra E, Neilands TB, Pedrogo Y, Carminelli-Corretjer P, Tollinchi N, Torres E, Soto Del Valle Y, Rivera Díaz M, Ortiz N. HIV/AIDS and intersectional stigmas: Examining stigma related behaviours among medical students during service delivery. Glob Public Health 2019; 14:1598-1611. [PMID: 31296120 DOI: 10.1080/17441692.2019.1633378] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
HIV/AIDS stigma remains a major global health issue with detrimental consequences for people with HIV/AIDS (PWHA), especially when manifested by health professionals. Research on HIV/AIDS stigma has documented negative attitudes towards PWHA among health professionals. However, fewer studies have examined how HIV/AIDS stigma is manifested behaviourally during clinical interactions and how it interacts with other stigmas (i.e. drug use, sexism, homophobia). This study aimed to: (1) examine behavioural manifestations of HIV/AIDS stigma among medical students during clinical interactions, and (2) explore HIV/AIDS stigma intersectionality with other stigmas. We implemented an experimental design using Standardised Patient (SP) simulations, observational techniques, and quantitative questionnaires. A total of 237 medical students engaged in SP encounters with three experimental scenarios: (1) PWHA infected via illegal drug use, (2) PWHA infected via unprotected heterosexual relations, (3) PWHA infected via unprotected homosexual relations. They also interacted with a person with common cold (control condition). Results evidenced statistically significant differences between the experimental and control simulation, with higher number of stigma behaviours manifested towards experimental conditions. Results also evidence higher HIV/AIDS stigma towards MSM when compared to the drug user and heterosexual woman SP's. We discuss the implications of these findings for training of medical students.
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Affiliation(s)
- Nelson Varas-Díaz
- Department of Global and Sociocultural Studies, Florida International University , Miami , USA
| | - Eliut Rivera-Segarra
- School of Behavioral and Brain Sciences, Ponce Health Sciences University , Ponce , Puerto Rico
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, University of California , San Francisco , USA
| | - Yasmín Pedrogo
- Department of Medicine, University of Puerto Rico , San Juan , Puerto Rico
| | | | - Nelmit Tollinchi
- School of Behavioral and Brain Sciences, Ponce Health Sciences University , Ponce , Puerto Rico
| | - Estefanía Torres
- School of Behavioral and Brain Sciences, Ponce Health Sciences University , Ponce , Puerto Rico
| | - Yanira Soto Del Valle
- School of Behavioral and Brain Sciences, Ponce Health Sciences University , Ponce , Puerto Rico
| | | | - Nerian Ortiz
- Department of Medicine, University of Puerto Rico , San Juan , Puerto Rico
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238
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Shokoohi M, Bauer GR, Kaida A, Logie CH, Lacombe-Duncan A, Milloy MJ, Lloyd-Smith E, Carter A, Loutfy M. Patterns of social determinants of health associated with drug use among women living with HIV in Canada: a latent class analysis. Addiction 2019; 114:1214-1224. [PMID: 30698902 PMCID: PMC6992379 DOI: 10.1111/add.14566] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/13/2018] [Accepted: 01/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Identifying typologies of social determinants of health (SDoH) vulnerability influencing drug use practices among women living with HIV (WLWH) can help to address associated harms. This research aimed to explore the association of SDoH clusters with drug use among WLWH. DESIGN Latent class analysis (LCA) was used to identify the distinct clusters of SDoH. Inverse probability weighting (IPW) was employed to account for confounding and potential selection bias. Associations were analyzed using generalized linear model with log link and Poisson distribution, and then weighted risk ratio (RR) and 95% confidence intervals (CI) were reported. SETTING AND PARTICIPANTS Data from 1422 WLWH recruited at time-point 1 of the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS, 2013-15), with 1252 participants at 18 months follow-up (time-point 2). MEASUREMENTS Drug use was defined as use of illicit/non-prescribed opioids/stimulants in the past 6 months. SDoH indicators included: race discrimination, gender discrimination, HIV stigma, social support, access to care, food security, income level, employment status, education, housing status and histories of recent sex work and incarceration. FINDINGS LCA identified four SDoH classes: no/least SDoH adversities (6.6%), discrimination/stigma (17.7%), economic hardship (30.8%) and most SDoH adversities (45.0%). Drug use was reported by 17.5% and 17.2% at time-points 1 and 2, respectively. WLWH with no/least SDoH adversities were less likely to report drug use than those in economic hardship class (weighted RR = 0.13; 95% CIs = 0.03, 0.63), discrimination/stigma class (weighted RR = 0.15; 95% CIs = 0.03, 0.78), and most SDoH adversities class (weighted RR = 0.13; 95% CIs = 0.03, 0.58). CONCLUSIONS Social determinants of health vulnerabilities are associated with greater likelihood of drug use, underscoring the significance of addressing interlinked social determinants and drug use through the course of HIV care and treatment.
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Affiliation(s)
- Mostafa Shokoohi
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Greta R. Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | | | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul’s Hospital, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Quinn K, Bowleg L, Dickson-Gomez J. "The fear of being Black plus the fear of being gay": The effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med 2019; 232:86-93. [PMID: 31075752 PMCID: PMC6588433 DOI: 10.1016/j.socscimed.2019.04.042] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/12/2019] [Accepted: 04/28/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Katherine Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Lisa Bowleg
- Department of Psychology, George Washington University, Washington, DC, USA; Washington DC Columbia Center for AIDS Research (DC CFAR), Social and Behavioral Sciences Core, USA
| | - Julia Dickson-Gomez
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA; Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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240
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Logie CH, Marcus N, Wang Y, Kaida A, O'Campo P, Ahmed U, O'Brien N, Nicholson V, Conway T, de Pokomandy A, Fernet M, Loutfy M. A longitudinal study of associations between HIV-related stigma, recent violence and depression among women living with HIV in a Canadian cohort study. J Int AIDS Soc 2019; 22:e25341. [PMID: 31328891 PMCID: PMC6643300 DOI: 10.1002/jia2.25341] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/05/2019] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Women living with HIV (WLHIV) experience stigma and elevated exposure to violence in comparison with HIV-negative women. We examined the mediating role of experiencing recent violence in the relationship between stigma and depression among WLHIV in Canada. METHODS We conducted a cohort study with WLHIV in three Canadian provinces. Recent violence was assessed through self-reported experiences of control, physical, sexual or verbal abuse in the past three months. At Time 1 (2013-2015) three forms of stigma were assessed (HIV-related, racial, gender) and at Time 2 (2015-2017) only HIV-related stigma was assessed. We conducted structural equation modelling (SEM) using the maximum likelihood estimation method with Time 1 data to identify direct and indirect effects of gender discrimination, racial discrimination and HIV-related stigma on depression via recent violence. We then conducted mixed effects regression and SEM using Time 1 and Time 2 data to examine associations between HIV-related stigma, recent violence and depression. RESULTS At Time 1 (n = 1296), the direct path from HIV-related stigma (direct effect: β = 0.200, p < 0.001; indirect effect: β = 0.014, p < 0.05) to depression was significant; recent violence accounted for 6.5% of the total effect. Gender discrimination had a significant direct and indirect effect on depression (direct effect: β = 0.167, p < 0.001; indirect effect: β = 0.050, p < 0.001); recent violence explained 23.15% of the total effect. Including Time 1 and Time 2 data (n = 1161), mixed-effects regression results indicate a positive relationship over time between HIV-related stigma and depression (Acoef: 0.04, 95% CI: 0.03, 0.06, p < 0.001), and recent violence and depression (Acoef: 1.95, 95% CI: 0.29, 4.42, p < 0.05), controlling for socio-demographics. There was a significant interaction between HIV-related stigma and recent violence with depression (Acoef: 0.04, 95% CI: 0.01, 0.07, p < 0.05). SEM analyses reveal that HIV-related stigma had a significant direct and indirect effect on depression over time (direct effect: β = 0.178, p < 0.001; indirect effect: β = 0.040, p < 0.001); recent violence experiences accounted for 51% of the total effect. CONCLUSIONS Our findings suggest that HIV-related stigma is associated with increased experiences of recent violence, and both stigma and violence are associated with increased depression among WLHIV in Canada. There is an urgent need for trauma-informed stigma interventions to address stigma, discrimination and violence.
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Affiliation(s)
- Carmen H Logie
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoOntarioCanada
- Women's College Research InstituteWomen's College HospitalTorontoOntarioCanada
| | - Natania Marcus
- Department of Applied Psychology and Human DevelopmentUniversity of TorontoTorontoOntarioCanada
| | - Ying Wang
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoOntarioCanada
| | - Angela Kaida
- Faculty of Health SciencesSimon Fraser UniversityVancouverBritish ColumbiaCanada
| | - Patricia O'Campo
- St. Michael's HospitalTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Uzma Ahmed
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoOntarioCanada
| | - Nadia O'Brien
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
| | - Valerie Nicholson
- Faculty of Health SciencesSimon Fraser UniversityVancouverBritish ColumbiaCanada
| | - Tracey Conway
- Women's College Research InstituteWomen's College HospitalTorontoOntarioCanada
| | - Alexandra de Pokomandy
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
- Chronic Viral Illness ServiceMcGill University Health CentreMontrealQuebecCanada
| | - Mylène Fernet
- Department of SexologyUniversité du Québec à MontréalMontrealQuebecCanada
| | - Mona Loutfy
- Women's College Research InstituteWomen's College HospitalTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
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241
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Sunguti JL, Tiam A, Masaba R, Waweru M, Kose J, Odionyi J, Matu L, Mwangi E. Assessing treatment outcomes among peer educators living with HIV in Kenya. PLoS One 2019; 14:e0218774. [PMID: 31247036 PMCID: PMC6597086 DOI: 10.1371/journal.pone.0218774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 06/11/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND People living with HIV (PLHIV) often face barriers in accessing quality and comprehensive HIV care, including stigma and discrimination, which results in poor retention and viral non-suppression. Peer-led interventions can help address these barriers. In Kenya, peer educators (PEs) are PLHIV who support other PLHIV to adhere to clinic schedules and antiretroviral medication uptake. In spite of their status as role models and their key role in supporting clients receiving HIV care and treatment, little is known about the characteristics and treatment outcomes of PEs themselves, specifically viral suppression. METHODS This is a retrospective descriptive analysis of program data on treatment outcomes of PEs engaged in active patient support activities between October 2010 and January 2017. All eligible PEs from 140 health facilities located in 23 counties of Kenya were included in the study. Data from 230 PEs were abstracted from the electronic medical records, patient files, and registers between June and August 2017. Study variables included key sociodemographic characteristics (sex, marital status, and age), duration on antiretroviral therapy (ART), WHO clinical staging, baseline CD4 count, current antiretroviral regimen and uptake of isoniazid preventive therapy (IPT). The outcome variable was viral suppression, defined as a viral load <1000 copies/ml. RESULTS Overall, 173/230 (75%) of the PEs were female, 144/230 (63%) were married, and median age (LQ, UQ) was 38.5 (33.0, 42.0) years. The PEs had been on ART for a median (LQ, UQ) duration of 76.0 (37.0, 105.0) months. Six months IPT completion was high at 97%. Of the 222 (97%) PEs with an up-to-date viral load taken within the last one year, 211 (95%) were virally suppressed. CONCLUSION Our study showed that peer educators actively engaged in patient support activities have achieved high viral suppression rates.
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Affiliation(s)
| | - Appolinaire Tiam
- Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
| | - Rose Masaba
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Michael Waweru
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Judith Kose
- Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America
| | | | - Lucy Matu
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Eliud Mwangi
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
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242
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Glynn TR, Llabre MM, Lee JS, Bedoya CA, Pinkston MM, O'Cleirigh C, Safren SA. Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use. Int J Behav Med 2019; 26:286-296. [PMID: 31065930 PMCID: PMC6563607 DOI: 10.1007/s12529-019-09786-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA. METHODS The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV. RESULTS Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use. CONCLUSION It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jasper S Lee
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - C Andres Bedoya
- Department of Psychiatry, The Fenway Institute, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Megan M Pinkston
- Department of Psychiatry and Human Behavior, The Miriam Hospital, Clinical Behavioral Medicine Service of the Immunology Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Conall O'Cleirigh
- Department of Psychiatry, The Fenway Institute, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
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243
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Stringer KL, Marotta P, Baker E, Turan B, Kempf MC, Drentea P, Stepanikova I, Turan JM. Substance Use Stigma and Antiretroviral Therapy Adherence Among a Drug-Using Population Living with HIV. AIDS Patient Care STDS 2019; 33:282-293. [PMID: 31166784 PMCID: PMC6588110 DOI: 10.1089/apc.2018.0311] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Among people living with HIV (PLWH), HIV-related stigma predicts nonadherence to antiretroviral therapy (ART); however, the role of stigma associated with drug use is largely unknown. We examined the association between substance use (SU) stigma and optimal ART adherence in a sample of 172 self-reported HIV-infected drug users. Participants completed surveys on SU, stigma, and ART adherence. The three substance classes with the greatest number of participants exhibiting moderate/high-risk scores were for cocaine/crack cocaine (66.28%), cannabis (64.53%), and hazardous alcohol consumption (65.70%). Multivariable logistic regression was conducted to investigate associations between levels of SU stigma and optimal ART adherence, adjusting for sociodemographic characteristics, severity of illicit drug use (alcohol, smoking and substance involvement screening test) and alcohol use severity (Alcohol Use Disorders Identification Test-C), HIV-related stigma, and social support. The odds of optimal adherence among participants experiencing moderate [Adjusted Odds Ratio (AOR) = 0.36, p = 0.039] and very high (AOR = 0.25, p = 0.010) levels of anticipated SU stigma were significantly lower than participants experiencing low levels of anticipated SU stigma. No other stigma subscales were significant predictors of ART adherence. Interventions aiming to improve ART adherence among drug-using PLWH need to address anticipated SU stigma.
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Affiliation(s)
| | - Phillip Marotta
- Department of Social Work, Columbia University, New York, New York
| | - Elizabeth Baker
- Department of Sociology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia Drentea
- Department of Sociology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Irena Stepanikova
- Department of Sociology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Janet M. Turan
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
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244
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Stringer KL, Mukherjee T, McCrimmon T, Terlikbayeva A, Primbetovac S, Darisheva M, Hunt T, Gilbert L, El-Bassel N. Attitudes towards people living with HIV and people who inject drugs: A mixed method study of stigmas within harm reduction programs in Kazakhstan. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:27-36. [PMID: 30981165 PMCID: PMC6550278 DOI: 10.1016/j.drugpo.2019.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/16/2019] [Accepted: 02/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND High levels of stigma towards people who inject drugs (PWID) and people living with HIV (PLWH) exist in Kazakhstan, yet little is known about the role of stigma in harm reduction service settings. In this paper, we use a mixed method design to explore and describe the actionable drivers and facilitators of stigma among harm reduction service providers. Additionally, we describe the manifestations of stigma among PWID who are living with HIV (PWID/LWH), and the impact that stigma has on harm reduction and healthcare service utilization. METHODS Eight focus groups with 57 PWID/LWH were convened between March 2016 and July 2016 to describe manifestations of stigma from the perspective of syringe exchange program (SEP) clients. Additionally, we surveyed 80 nurses, social workers, outreach workers, and providers of HIV care at SEPs between January 2017 and July 2017 to assess stigmatizing attitudes among staff within the SEP environment. Joint displays were used to integrate quantitative and qualitative data. RESULTS The actionable drivers of stigma identified in this study include negative opinions and moral judgements towards PWID/LWH. Facilitators identified included stigmatization as a social norm within the service provision environment, a lack of awareness of anti-discrimination policies, and lack of enforcement of anti-discrimination policies. Qualitative findings highlight manifestations of stigma in which PWID/LWH experienced denial of services, perceived negative attitudes, and avoidance from service provision staff. PWID/LWH also described segregation in healthcare settings, the use of unnecessary precautions by providers, and unauthorized disclosure of HIV status. CONCLUSIONS This paper highlights the urgent need to address stigma in the harm reduction and HIV service settings in Kazakhstan. These findings have implications for informing an actionable model for stigma reduction for providers who deliver services to PWID/LWH in Kazakhstan. Drivers, facilitators, and manifestations of stigma are multifaceted and addressing them will require a multilevel approach.
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Affiliation(s)
| | - Trena Mukherjee
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, United States
| | - Tara McCrimmon
- Columbia University, Department of Social Work, New York, NY, United States
| | | | | | | | - Timothy Hunt
- Columbia University, Department of Social Work, New York, NY, United States
| | - Louisa Gilbert
- Columbia University, Department of Social Work, New York, NY, United States
| | - Nabila El-Bassel
- Columbia University, Department of Social Work, New York, NY, United States
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245
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Crockett KB, Edmonds A, Johnson MO, Neilands TB, Kempf MC, Konkle-Parker D, Wingood G, Tien PC, Cohen M, Wilson TE, Logie CH, Sosanya O, Plankey M, Golub E, Adimora AA, Parish C, Weiser SD, Turan JM, Turan B. Neighborhood Racial Diversity, Socioeconomic Status, and Perceptions of HIV-Related Discrimination and Internalized HIV Stigma Among Women Living with HIV in the United States. AIDS Patient Care STDS 2019; 33:270-281. [PMID: 31166786 PMCID: PMC6588105 DOI: 10.1089/apc.2019.0004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Relationships that traverse sociodemographic categories may improve community attitudes toward marginalized groups and potentially protect members of those groups from stigma and discrimination. The present study evaluated whether internalized HIV stigma and perceived HIV-related discrimination in health care settings differ based on individual- and neighborhood-level characteristics of women living with HIV (WLHIV). We also sought to extend previous conceptual and empirical work to explore whether perceived HIV-related discrimination mediated the association between neighborhood racial diversity and internalized HIV stigma. A total of 1256 WLHIV in the Women's Interagency HIV Study (WIHS) attending 10 sites in metropolitan areas across the United States completed measures of internalized HIV stigma and perceived HIV-related discrimination in health care settings. Participants also provided residential information that was geocoded into Federal Information Processing Standard (FIPS) codes and linked with census-tract level indicators. In cross-sectional analyses, greater neighborhood racial diversity was associated with less internalized HIV stigma and less perceived HIV-related discrimination regardless of individual race. Neighborhood median income was positively associated with internalized HIV stigma and perceived discrimination, while individual income was negatively associated with perceptions of stigma and discrimination. In an exploratory mediation analysis, neighborhood racial diversity had a significant indirect effect on internalized HIV stigma through perceived HIV-related discrimination. An indirect effect between neighborhood income and internalized stigma was not supported. These findings suggest that greater neighborhood racial diversity may lessen HIV stigma processes at the individual level and that HIV stigma-reduction interventions may be most needed in communities that lack racial diversity.
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Affiliation(s)
- Kaylee B. Crockett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mallory O. Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Torsten B. Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deborah Konkle-Parker
- Department of Medicine/Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Gina Wingood
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California
| | - Mardge Cohen
- Department of Medicine, Stroger Hospital of Cook County Bureau of Health and Hospital Systems, Chicago, Illinois
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, New York
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Michael Plankey
- Georgetown University Medical Center, Washington, District of Columbia
| | - Elizabeth Golub
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Adaora A. Adimora
- Division of Infectious Diseases, University of North Carolina School of Medicine Chapel Hill, North Carolina
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carrigan Parish
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University Miami Research Center, Miami, Florida
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
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The social network context of HIV stigma: Population-based, sociocentric network study in rural Uganda. Soc Sci Med 2019; 233:229-236. [PMID: 31229909 DOI: 10.1016/j.socscimed.2019.05.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 04/25/2019] [Accepted: 05/11/2019] [Indexed: 02/06/2023]
Abstract
RATIONALE HIV-related stigma profoundly affects the physical and social wellbeing of people living with HIV, as well as the community's engagement with testing, treatment, and prevention. Based on theories of stigma elaborating how it arises from the relationships between the stigmatized and the stigmatizer as well as within the general community, we hypothesized that social networks can shape HIV-related stigma. OBJECTIVE To estimate social network correlates of HIV-related stigma. METHODS During 2011-2012, we collected complete social network data from a community of 1669 adults ("egos") in Mbarara, Uganda using six culturally-adapted name generators to elicit different types of social ties ("alters"). We measured HIV-related stigma using the 9-item AIDS-Related Stigma Scale. HIV serostatus was based on self-report. We fitted linear regression models that account for network autocorrelation to estimate the association between egos' HIV-related stigma, alters' HIV-related stigma and alters' self-reported HIV serostatus, while adjusting for egos' HIV serostatus, network centrality, village size, perceived HIV prevalence, and sociodemographic characteristics. RESULTS The average AIDS-Related Stigma Score was 0.79 (Standard Deviation = 0.50). In the population 116 (7%) egos reported being HIV-positive, and 757 (46%) reported an HIV-positive alter. In the multivariable model, we found that egos' own HIV-related stigma was positively correlated with their alters' average stigma score (b=0.53; 95% confidence interval [CI] 0.42-0.63) and negatively correlated with having one or more HIV-positive alters (b=-0.05; 95% CI -0.10 to -0.003). CONCLUSION Stigma-reduction interventions should be targeted not only at the level of the individual but also at the level of the network. Directed and meaningful contact with people living with HIV may also reduce HIV-related stigma.
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Associations Between Multiple Forms of Discrimination and Tobacco Use Among People Living With HIV: The Mediating Role of Avoidance Coping. J Acquir Immune Defic Syndr 2019; 78:9-15. [PMID: 29373394 DOI: 10.1097/qai.0000000000001636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND People living with HIV (PLWH) have higher levels of tobacco use compared with the general population, increasing their risk of morbidity and mortality. PLWH also face potential chronic stressors related to the stigma and discrimination associated with HIV and other characteristics (eg, race and sexual orientation). These experiences may be associated with harmful health behaviors, such as tobacco use. The purpose of the current study is to explore the psychosocial context of tobacco use in PLWH, examining avoidance coping as a mediator in the relationship between multiple forms of discrimination and tobacco use. SETTING Participants included 202 PLWH recruited from an HIV primary care clinic in Birmingham, AL, between 2013 and 2015. METHODS Participants responded to parallel items assessing experiences of discrimination related to HIV status, race, and sexual orientation, as well as items assessing avoidance coping. Data on current tobacco use were obtained from participants' clinic records. Mediation models for each form of discrimination (HIV, race and sexual orientation) adjusting for demographic variables and the other forms of discrimination were evaluated. RESULTS The indirect effect of HIV-related discrimination on likelihood of tobacco use through avoidance coping was significant, suggesting that avoidance coping mediates the association between HIV-related discrimination and tobacco use. However, the indirect effects of the other forms of discrimination were not significant. CONCLUSIONS Given the disparity in tobacco use in PLWH, behavioral scientists and interventionists should consider including content specific to coping with experiences of discrimination in tobacco prevention and cessation programs for PLWH.
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248
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Logie CH, Williams CC, Wang Y, Marcus N, Kazemi M, Cioppa L, Kaida A, Webster K, Beaver K, de Pokomandy A, Loutfy M. Adapting stigma mechanism frameworks to explore complex pathways between intersectional stigma and HIV-related health outcomes among women living with HIV in Canada. Soc Sci Med 2019; 232:129-138. [PMID: 31079013 DOI: 10.1016/j.socscimed.2019.04.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/12/2019] [Accepted: 04/28/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Ying Wang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Natania Marcus
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Lynne Cioppa
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Kerrigan Beaver
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
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249
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Kave S, Khuzwayo NF, Hatcher A, Sikweyiya Y. The role of support groups in linking and retaining newly diagnosed clients in HIV care in a peri-urban location in South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:9-17. [PMID: 30880579 DOI: 10.2989/16085906.2018.1551233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although South Africa has the largest number of people on antiretroviral therapy (ART) in the world, many HIV clients drop out of care immediately after HIV diagnosis. This qualitative study explored the perceptions and experiences of newly diagnosed clients on the role support groups play in linking and retaining newly diagnosed clients in HIV care in Mbandazayo peri-urban location. The data were analysed using the thematic content analysis approach. Data revealed four mechanisms through which support groups appeared to link and retain newly diagnosed clients in the HIV care continuum. First, support groups were a formal link between newly diagnosed clients and health facilities. Second, support groups mitigated the effects of both felt and enacted stigma, thereby facilitating acceptance of HIV diagnosis among newly diagnosed clients. Third, support groups were an advocacy and networking tool for newly diagnosed clients to make their health related needs, challenges, and concerns known to local health clinics, thereby forging and maintaining a close relationship with their local health facilities. Last, support groups were spaces within the community where practical needs of newly diagnosed clients are met, which in turn help in retaining them within support groups, and facilitate their linkage and retention in the HIV continuum of care in Mbandazayo. Our findings suggest that HIV support groups are critical in enhancing linkages and retention of newly diagnosed clients in HIV care. With the introduction of universal test and treat (UTT) in South Africa, our findings suggest that support groups can play a significant role in retaining HIV care clients who are diagnosed and immediately enrolled on ART.
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Affiliation(s)
- Siyabonga Kave
- a Department of Rural Health , University of KwaZulu-Natal , Durban , South Africa
| | - Nelisiwe F Khuzwayo
- a Department of Rural Health , University of KwaZulu-Natal , Durban , South Africa
| | - Abigail Hatcher
- b School of Public Health , University of the Witwatersrand , Johannesburg , South Africa
| | - Yandisa Sikweyiya
- c Gender & Health Research Unit, School of Public Health , University of the Witwatersrand , Johannesburg , South Africa
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250
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Nall A, Chenneville T, Rodriguez LM, O'Brien JL. Factors Affecting HIV Testing among Youth in Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1450. [PMID: 31022872 PMCID: PMC6517959 DOI: 10.3390/ijerph16081450] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/15/2019] [Accepted: 04/20/2019] [Indexed: 12/21/2022]
Abstract
With the high prevalence of HIV among youth in sub-Saharan Africa, it is vital to better understand factors affecting HIV testing among this population; this is the first step in the HIV treatment cascade. The purpose of this study was to examine factors related to behavioral intentions regarding HIV testing using existing pre-test data from the HIV SEERs (Stigma-reduction via Education, Empowerment, and Research) Project, a community-based participatory research program targeting 13-24-year-olds in Kenya. It was hypothesized that HIV knowledge, social support, subjective well-being, and mental health (depression, anxiety, and stress) would serve as facilitators to HIV testing while projected stigma and substance use would serve as barriers to HIV testing. In partial support of our hypotheses, findings from logistic regression analyses revealed that HIV knowledge, substance use, depression, and social support were significant predictors of HIV testing intentions. However, HIV knowledge and substance use served as facilitators while depression and social support served as barriers. While projected stigma was correlated with HIV testing intentions, it was not a significant predictor in the regression analysis. Subjective well-being, anxiety, and stress were not significant predictors in the regression analysis. These findings have important implications for HIV testing initiatives designed for youth in Kenya as well as future research on HIV testing with this population.
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Affiliation(s)
- Allison Nall
- Psychology Department, College of Arts and Sciences, University of South Florida St. Petersburg, St. Petersburg, FL 33701, USA.
| | - Tiffany Chenneville
- Psychology Department, College of Arts and Sciences, University of South Florida St. Petersburg, St. Petersburg, FL 33701, USA.
| | - Lindsey M Rodriguez
- Psychology Department, College of Arts and Sciences, University of South Florida St. Petersburg, St. Petersburg, FL 33701, USA.
| | - Jennifer L O'Brien
- Psychology Department, College of Arts and Sciences, University of South Florida St. Petersburg, St. Petersburg, FL 33701, USA.
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