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Lee JE, Haynes ER, Chan PA. Symptoms and Health-Related Quality of Life Among Older Adults Living With HIV. Nurs Res 2024; 73:364-372. [PMID: 39179246 DOI: 10.1097/nnr.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2024]
Abstract
BACKGROUND As individuals living with HIV age, they often experience both physical and psychological symptoms-along with potential reductions in social support-which can significantly affect their health-related quality of life (HRQOL)-a crucial measure in HIV care. However, research exploring the potential predictive roles of social support and symptom experiences in HRQOL among older people living with HIV (PLWH) is limited. OBJECTIVES This cross-sectional study aimed to investigate relationships between social support, symptom experiences, and HRQOL in older adults with HIV. METHODS Older adults with HIV aged ≥50 years completed surveys on demographic and HIV-related characteristics, social support, four symptoms, and HRQOL. Hierarchical multiple linear regression analyses were used to determine predictors for six HRQOL domains. RESULTS Among the 141 PLWH, significant associations were found between fatigue and health perceptions, physical functioning, and role functioning. Sleep disturbance was a significant predictor of health perceptions and social functioning. Anxiety displayed associations with physical functioning, role functioning, mental health, and pain. Depression was linked to health perceptions and mental health aspects of HRQOL. Notably, social support was not associated with any HRQOL domains. DISCUSSION These findings underscore the importance of assessing a range of common symptoms to enhance HRQOL among older adults living with HIV, necessitating tailored symptom management strategies for this growing population.
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Saberi P, Ming K, Arnold EA, Leddy AM, Weiser SD. Extreme weather events and HIV: development of a conceptual framework through qualitative interviews with people with HIV impacted by the California wildfires and their clinicians. BMC Public Health 2023; 23:950. [PMID: 37231393 DOI: 10.1186/s12889-023-15957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 05/22/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND People with HIV (PWH) are disproportionately vulnerable to the impacts of wildfires, given the need for frequent access to healthcare systems, higher burden of comorbidities, higher food insecurity, mental and behavioral health challenges, and challenges of living with HIV in a rural area. In this study, we aim to better understand the pathways through which wildfires impact health outcomes among PWH. METHODS From October 2021 through February 2022, we conducted individual semi-structured qualitative interviews with PWH impacted by the Northern California wildfires and clinicians of PWH who were impacted by wildfires. The study aims were to explore the influence of wildfires on the health of PWH and to discuss measures at the individual, clinic, and system levels that helped to mitigate these impacts. RESULTS We interviewed 15 PWH and 7 clinicians. While some PWH felt that surviving the HIV epidemic added to their resilience against wildfires, many felt that the wildfires compounded the HIV-related traumas that they have experienced. Participants outlined five main routes by which wildfires negatively impacted their health: (1) access to healthcare (medications, clinics, clinic staff), (2) mental health (trauma; anxiety, depression, or stress; sleep disturbances; coping strategies), (3) physical health (cardiopulmonary, other co-morbidities), (4) social/economic impacts (housing, finances, community), and (5) nutrition and exercise. The recommendations for future wildfire preparedness were at the (1) individual-level (what to have during evacuation), (2) pharmacy-level (procedural, staffing), and (3) clinic- or county-level (funds and vouchers; case management; mental health services; emergency response planning; other services such as telehealth, home visits, home laboratory testing). CONCLUSIONS Based on our data and prior research, we devised a conceptual framework that acknowledges the impact of wildfires at the community-, household-, and individual-level with implications for physical and mental health outcomes among PWH. These findings and framework can help in developing future interventions, programs, and policies to mitigate the cumulative impacts of extreme weather events on the health of PWH, particularly among individuals living in rural areas. Further studies are needed to examine health system strengthening strategies, innovative methods to improve access to healthcare, and community resilience through disaster preparedness. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Parya Saberi
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Kristin Ming
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Emily A Arnold
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anna M Leddy
- Division of pulmonary and critical care medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Walsh JL, John SA, Quinn KG, Hirshfield S, O’Neil A, Petroll AE. Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States. J Rural Health 2023; 39:488-498. [PMID: 36510755 PMCID: PMC10038895 DOI: 10.1111/jrh.12730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions. METHODS Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions. FINDINGS Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress. CONCLUSIONS In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.
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Affiliation(s)
- Jennifer L. Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Andrew O’Neil
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Health related quality of life of HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia: Evidence from a cross-sectional study. Heliyon 2023; 9:e13318. [PMID: 36747523 PMCID: PMC9898445 DOI: 10.1016/j.heliyon.2023.e13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
Background Evidence revealed that there is a statistically significant gender difference in Health-related quality of life (HRQoL) among HIV-positive people on Antiretroviral therapy (ART). Consequently, HIV-positive women have low scores in all HRQoL domains than men. Despite this fact, previous studies in Ethiopia focused on general HIV-positive people and paid less attention to HIV-positive women. Therefore, this study was intended to measure HRQoL and associated factors among HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia. Methods An institution-based cross-sectional study was conducted from February 01-April 30, 2022. Four hundred twenty-six women on ART were included using a systematic random sampling technique. Face-to-face interviews and medical record reviews were used to collect data. Both bivariable and multiple linear regressions were computed to identify the factors associated with HRQoL. A p-value <0.05 was used to assert statistically significant variables in multiple linear regression analysis. Results The overall mean (SD) score of the HRQoL was 11.84 (2.44). And, 44.7% [95% CI: 40.3, 49.5] of the women have poor HRQoL. In multiple linear regression analysis, factors like depression (β = -0.35), Post-Traumatic Stress Disorder (PTSD) (β = -0.16), age (β = -0.07), rural residence (β = -0.52), and bedridden functional status (β = -1.02) were inversely associated with HRQoL. Oppositely, good treatment adherence (β = 0.46) was positively associated with overall HRQoL, keeping other factors constant. Conclusion This study reveals a high magnitude of poor HRQoL among HIV-positive women. Therefore, as HRQoL domains are comprehensive indicators of living status, healthcare service providers should be dedicated to screening and supporting HIV-positive women with poor HRQoL. Additionally, healthcare providers should also pay special attention to routine PTSD screening and management for HIV-positive women due to its detrimental effect on HRQoL.
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Ndione AG, Procureur F, Senne JN, Cornaglia F, Gueye K, Ndour CT, Lépine A. Sexuality-Based Stigma and Access to Care: Intersecting Perspectives Between Health Care Providers and Men Who Have Sex With Men in HIV Care Centres in Senegal. Health Policy Plan 2022; 37:587-596. [PMID: 35147679 PMCID: PMC9113117 DOI: 10.1093/heapol/czac010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/18/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Men who have sex with men (MSM) in Senegal face a challenging socio-legal context, marked by homophobia and the illegality of homosexuality. In addition, human immunodeficiency virus (HIV) prevalence among MSM is 27.6%, 46 times greater than the one in the general population (0.5%). Nevertheless, access to healthcare by MSM may be hampered by stigmatizing attitudes from health facility staff (medical and non-medical). This article describes the health facility staff/MSM relationship and analyses its effects on access to healthcare by MSM. The data used were collected through a field survey based on observations and qualitative interviews conducted in 2019 and 2020 with 16 MSM, 1 non-governmental organization (NGO) staff and 9 healthcare providers in Dakar (the capital city) and Mbour (secondary city on the West Coast) hospitals. The data were subject to a thematic analysis assisted by the ATLAS software. The relationship between MSM and healthcare providers is ambiguous. On the one hand, healthcare providers are torn between their professional duty to treat MSM and the cost of being stigmatized by other colleagues. Therefore, they often limit their empathy with MSM within the hospital context. On the other hand, MSM, trusting in the confidentiality of healthcare providers, feel safe in the care pathway. However, we identify the following stigmatizing factors limiting access to care include (1) fear of meeting a relative, (2) difficult relationships with non-medical support staff (mainly security guards), (3) HIV status disclosure and (4) potential conflicts with other MSM. This study is unique as it includes non-medical staff in its respondents. It shows that hospitals are divided into several areas, based on the stigma perceived by MSM. It is important to map out MSM’s care trajectories and spaces and to identify all types of staff working within them, including non-medical staff, and enrol them in stigma reduction interventions.
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Affiliation(s)
| | | | | | | | - Khady Gueye
- Ministry of Health and Social Action of Senegal
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Massaroni V, Delle Donne V, Ciccarelli N, Lombardi F, Lamonica S, Borghetti A, Ciccullo A, Di Giambenedetto S. HIV-Related Internalized Stigma and Patient Health Engagement Model in an Italian Cohort of People Living With HIV. Psychol Rep 2022; 126:1181-1200. [PMID: 35015591 DOI: 10.1177/00332941211057142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The care engagement of people living with HIV (PLWH) measured with the patient health engagement (PHE) model and its association with HIV-related internalized stigma are not well established. Indeed, currently there are no data yet about the engagement of PLWH measured with the PHE model. This study aimed to evaluate the effects of HIV-related internalized stigma on care engagement and mental health and to fill the lack of data on PHE model applied to PLWH. We found that the internalized stigma score was significantly higher for PLWH (n=82) in worse care engagement phase and both higher internalized stigma scores and worse engagement were associated to major depression symptoms.In conclusion, our findings describe for the first time the engagement in care of PLWH measured with PHE and highlight the importance of PLWH support to find strategies to cope stigma-related stress and optimize their care engagement.
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Affiliation(s)
- Valentina Massaroni
- Infectious Diseases Institute, Department of Safety and Bioethics, 60234Catholic University of Sacred Heart, Rome, Italy
| | - Valentina Delle Donne
- Infectious Diseases Institute, Department of Safety and Bioethics, 60234Catholic University of Sacred Heart, Rome, Italy
| | | | - Francesca Lombardi
- UOC Infectious Diseases, 18654Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Lamonica
- UOC Infectious Diseases, 18654Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Borghetti
- UOC Infectious Diseases, 18654Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Simona Di Giambenedetto
- Infectious Diseases Institute, Department of Safety and Bioethics, 60234Catholic University of Sacred Heart, Rome, Italy.,UOC Infectious Diseases, 18654Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Scofield D, Moseholm E. HIV-related stigma and health-related quality of life in women living with HIV in developed countries: a systematic review. AIDS Care 2021; 34:7-15. [PMID: 33663284 DOI: 10.1080/09540121.2021.1891193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
HIV-related stigma has been shown to negatively affect the health-related quality of life (HRQoL) in people living with HIV. Women living with HIV (WLWH) suffer greater consequences from stigma on multiple health outcomes when compared to men. The objective of this review was to examine the association between HIV-related stigma and HRQoL in WLWH in developed countries. A systematic search was conducted in three medical databases. The PRISMA guideline was used as a methodical frame of reference, and the STROBE checklist as a quality assessment tool. Eight studies on a total of 2903 WLWH were included. All studies were cross-sectional of design and published between 2011-2019. All studies found a negative and statistically significant association between HIV-related stigma and HRQoL. The association was found to be weak to moderate in strength when examined using correlations statistics. Heterogeneity across the choice of measures and variables examined in the included studies made comparison difficult. Risk of bias was deemed present in majority of studies. Thus, this review reveals a negative association between HIV-related stigma and HRQoL in WLWH in developed countries. The association appears to be influenced by a range of complex factors, such as psychosocial variables and sociodemographic determinants.
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Affiliation(s)
- Ditte Scofield
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
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Effects of an intervention on internalized HIV-related stigma for individuals newly entering HIV care. AIDS 2020; 34 Suppl 1:S73-S82. [PMID: 32881796 DOI: 10.1097/qad.0000000000002566] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Considering the association between internalized HIV-related stigma and treatment adherence, an intervention addressing HIV treatment adherence may have the added benefit of reducing internalized stigma. The 'integrating ENGagement and Adherence Goals upon Entry' (iENGAGE) intervention was developed to facilitate adjustment to living with HIV among individuals newly engaged in HIV care. We evaluated the effects of this intervention on internalized stigma and examined whether the effect is moderated by depressive symptoms and coping styles. DESIGN The iENGAGE intervention was tailored individually to improve information, motivation, and behavioral skills to promote treatment adherence and viral suppression. Three hundred and seventy-one participants initiating HIV care at four sites in the United States were randomly assigned to either the intervention receiving four face-to-face sessions or standard of care control arm. METHODS Baseline and 48-week follow-up assessments were conducted, which included validated measures of internalized HIV-related stigma, depressive symptoms, and coping mechanisms (behavioral disengagement and self-blame) as secondary outcomes. A repeated measures ANOVA evaluated the effect of the intervention on change in internalized HIV stigma. Furthermore, the moderating effects of depressive symptoms and coping mechanisms on the decrease in internalized stigma were examined. RESULTS The decrease in internalized stigma from baseline to 48 weeks was significantly larger in the intervention arm compared with the control arm. This effect was significantly moderated by baseline levels of depressive symptoms and self-blame. CONCLUSION The multifaceted iENGAGE intervention is effective in reducing internalized stigma for new-to-HIV care individuals, especially with higher depressive symptoms or when using higher levels of self-blame coping.
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Serovich JM, Laschober TC, Brown MJ, Kimberly JA, Lescano CM. Effects of a Decision-Making Intervention to Help Decide Whether to Disclose HIV-Positive Status to Family Members on Well-Being and Sexual Behavior. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2091-2101. [PMID: 32328912 PMCID: PMC7321873 DOI: 10.1007/s10508-020-01703-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
An HIV diagnosis is often followed by uncertainty, questions over next steps, and concerns over how to share the diagnosis with others. The goal of the current study was to investigate the effects of an intervention designed to help people living with HIV decide whether or not they want to disclose their status to family members (i.e., decision-making process rather than actual disclosure) and the subsequent decision on their well-being and sexual behavior. Additionally, differences in outcomes among men who have sex with men (MSM), heterosexual men (HSM), and women were examined. A total of 346 women and men living in the Southeastern part of the United States. Participated in the study, which consisted of a baseline assessment, followed by randomization into either the disclosure intervention or attention control case management group. Both treatments consisted of seven sessions over a 12-month period. Results from repeated measures ANOVA indicated that although there was no significant intervention effect, participants in both groups reported some improvements in well-being and decreases in risky sexual behavior. However, no consistent differences in outcomes emerged among MSM, HSM, and women. Assisting with the disclosure decision-making process and reducing HIV transmission risk should continue to be an essential focus in future research endeavors and for frontline professionals dedicated to HIV-related care and prevention.
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Affiliation(s)
- Julianne M Serovich
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, 33612, USA.
| | - Tanja C Laschober
- College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, 33612, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 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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Azmach NN, Hamza TA, Husen AA. Socioeconomic and Demographic Statuses as Determinants of Adherence to Antiretroviral Treatment in HIV Infected Patients: A Systematic Review of the Literature. Curr HIV Res 2020; 17:161-172. [PMID: 31538899 DOI: 10.2174/1570162x17666190919130229] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/24/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Socioeconomic and demographic statuses are associated with adherence to the treatment of patients with several chronic diseases. However, there is a controversy regarding their impact on adherence among HIV/AIDS patients. Thus, we performed a systematic review of the evidence regarding the association of socioeconomic and demographic statuses with adherence to antiretroviral therapy (ART) among HIV/AIDS patients. METHODS The PubMed database was used to search and identify studies concerning about socioeconomic and demographic statuses and HIV/AIDS patients. Data were collected on the association between adherence to ART and varies determinants factors of socioeconomic (income, education, and employment/occupation) and socio-demographic (sex and age). FINDINGS From 393 potentially-relevant articles initially identified, 35 original studies were reviewed in detail, which contained data that were helpful in evaluating the association between socioeconomic/ demographic statuses and adherence to ART among HIV patients. Two original research study has specifically focused on the possible association between socioeconomic status and adherence to ART. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 7 studies (36.8%), 7 studies (28.0%), and 4 studies (23.5%) respectively out of 19, 25, and 17 studies reviewed. Sex (being male), and age (per year increasing) were significantly and positively associated with the level of adherence in 5 studies (14.3%), and 9 studies (25.7%) respectively out of 35 studies reviewed. However, the determinant of socioeconomic and demographic statuses was not found to be significantly associated with adherence in studies related to income 9(47.4%), education 17(68.0%), employment/ occupational 10(58.8%), sex 27(77.1%), and age 25(71.4%). CONCLUSION The majority of the reviewed studies reported that there is no association between socio- demographic and economic variables and adherence to therapy. Whereas, some studies show that age of HIV patients (per year increasing) and sex (being male) were positively associated with adherence to ART. Among socio-economic factors, the available evidence does not provide conclusive support for the existence of a clear association with adherence to ART among HIV patients. There seems to be a positive trend between socioeconomic factors and adherence to ART in some of the reviewed studies.
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Affiliation(s)
- Nuredin Nassir Azmach
- Department of Statistics, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Temam Abrar Hamza
- Department of Biotechnology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Awel Abdella Husen
- Department of Physics, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
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Ezeamama AE, Zalwango SK, Tuke R, Pad RL, Boivin MJ, Musoke PM, Giordani B, Sikorskii A. Toxic Stress and Quality of Life in Early School-Aged Ugandan Children With and Without Perinatal Human Immunodeficiency Virus Infection. New Dir Child Adolesc Dev 2020; 2020:15-38. [PMID: 32662113 DOI: 10.1002/cad.20355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Caregiver's and child's self-reported quality of life (QOL) was defined using standardized questionnaires in a sample (N = 277) of 6-10 years old HIV-infected, HIV-exposed uninfected, and HIV-unexposed uninfected children from Uganda. Psychosocial stress (acute stress and cumulative lifetime adversity) and physiologic stress (dysregulations across 13 biomarkers), perinatal HIV status, and their interaction were related to child QOL via general linear models. Lower child- and caregiver-reported psychosocial stress were dose-dependently associated with higher QOL (acute stress: mean difference coefficient b = 8.1-14.8, effect size [ES] = 0.46-0.83). Lower allostasis was dose-dependently associated with higher QOL (b = 6.1-9.7, ES = 0.34-0.54). Given low caregiver acute stress, QOL for HIV-infected was similar to HIV-uninfected children; however, given high caregiver acute stress, a QOL disadvantage (b = -7.8, 95% CI: -12.8, -2.8; ES = -0.73) was evident for HIV-infected versus uninfected children. Testing of caregiver stress reduction interventions is warranted to increase wellbeing in dependent children.
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Affiliation(s)
| | | | - Robert Tuke
- Michigan State University, East Lansing, MI, USA
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Junkins A, Psaros C, Ott C, Azuero A, Lambert CC, Cropsey K, Savage R, Haberer JE, Safren SA, Kempf MC. Feasibility, acceptability, and preliminary impact of telemedicine-administered cognitive behavioral therapy for adherence and depression among African American women living with HIV in the rural South. J Health Psychol 2020; 26:2730-2742. [PMID: 32515245 DOI: 10.1177/1359105320926526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Women living with HIV are disproportionally affected by depression and mental healthcare access. A pilot feasibility trial using videoconferencing compared cognitive behavioral therapy for antiretroviral therapy adherence and depression (N = 11) to supportive psychotherapy (N = 11). Participants completed 10-12 weekly therapy sessions and 6-month follow-up. Retention at 6 months was 95 percent. Depression symptoms significantly decreased in both arms; antiretroviral therapy adherence remained high as measured via self-report and Wisepill. Satisfaction with intervention components was high; videoconferencing was highly acceptable and comparable to face-to-face counseling. This study demonstrates the feasibility of telemedicine-administered psychotherapy addressing mental health needs among women living with HIV.
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Affiliation(s)
| | - Christina Psaros
- Massachusetts General Hospital, USA.,Harvard Medical School, USA
| | - Corilyn Ott
- The University of Alabama at Birmingham, USA
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A Systematic Mixed Studies Review of the Intersections of Social-Ecological Factors and HIV Stigma in People Living With HIV in the U.S. South. J Assoc Nurses AIDS Care 2020; 30:330-343. [PMID: 31021963 DOI: 10.1097/jnc.0000000000000076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The role of stigma on psychological wellness and treatment outcomes in people living with HIV (PLWH) has been well documented. However, within the context of the southern United States, the intersection between HIV-related stigma and social-ecological factors has been understudied. Thus, a results-based convergent, mixed synthesis design was used to examine the manifestations of HIV-related stigma in PLWH in the U.S. South. A literature search was conducted using PsycINFO, PubMed (includes MEDLINE), and CINAHL. The first level of screening by title and abstract was administered on 1,829 articles. A full-text screening of 169 studies was completed, and a total of 30 relevant articles were extracted. The mixed synthesis highlighted intervention strategies that can reduce HIV-related stigma while promoting positive health-behavior change. The findings of this review underscored the uniqueness of PLWH in the south and demonstrated the crucial role of intersectionality in investigating HIV-related stigma in treating and preventing HIV.
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Choi Y, Choi BY, Kim SM, Kim SI, Kim J, Choi JY, Kim SW, Song JY, Kim YJ, Park DW, Kim HY, Choi HJ, Kee MK, Shin YH, Yoo M. Epidemiological characteristics of HIV infected Korean: Korea HIV/AIDS Cohort Study. Epidemiol Health 2019; 41:e2019037. [PMID: 31623426 PMCID: PMC6815876 DOI: 10.4178/epih.e2019037] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/03/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To manage evidence-based diseases, it is important to identify the characteristics of patients in each country. METHODS The Korea HIV/AIDS Cohort Study seeks to identify the epidemiological characteristics of 1,442 Korean individuals with human immunodeficiency virus (HIV) infection (12% of Korean individuals with HIV infection in 2017) who visited 21 university hospitals nationwide. The descriptive statistics were presented using the Korea HIV/AIDS cohort data (2006-2016). RESULTS Men accounted for 93.3% of the total number of respondents, and approximately 55.8% of respondents reported having an acute infection symptom. According to the transmission route, infection caused by sexual contact accounted for 94.4%, of which 60.4% were caused by sexual contact with the same sex or both males and females. Participants repeatedly answered the survey to decrease depression and anxiety scores. Of the total participants, 89.1% received antiretroviral therapy (ART). In the initial ART, 95.3% of patients were treated based on the recommendation. The median CD4 T-cell count at the time of diagnosis was 229.5 and improved to 331 after the initial ART. Of the patients, 16.6% and 9.4% had tuberculosis and syphilis, respectively, and 26.7% had pneumocystis pneumonia. In the medical history, sexually transmitted infectious diseases showed the highest prevalence, followed by endocrine diseases. The main reasons for termination were loss to follow-up (29.9%) and withdrawal of consent (18.7%). CONCLUSIONS Early diagnosis and ART should be performed at an appropriate time to prevent the development of new infection.
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Affiliation(s)
- Yunsu Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea.,Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea.,Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Soo Min Kim
- Institute for Health and Society, Hanyang University, Seoul, Korea.,Department of Applied Statistics, Yonsei University College of Business and Economics, Seoul, Korea
| | - Sang Il Kim
- Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - June Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Young Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Youn Jeong Kim
- Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Won Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee-Jung Choi
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Mee-Kyung Kee
- Division of Viral Disease Research Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Young Hyun Shin
- Division of Viral Disease Research Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Myeongsu Yoo
- Division of Viral Disease Research Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
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15
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Chapman Lambert C, Westfall A, Modi R, Amico RK, Golin C, Keruly J, Quinlivan EB, Crane HM, Zinski A, Turan B, Turan JM, Mugavero MJ. HIV-related stigma, depression, and social support are associated with health-related quality of life among patients newly entering HIV care. AIDS Care 2019; 32:681-688. [PMID: 31167537 DOI: 10.1080/09540121.2019.1622635] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Entering HIV care is a vulnerable time for newly diagnosed individuals often exacerbating psychosocial difficulties, which may contribute to poor health-related quality of life (HRQOL) ultimately influencing health behaviors including ART adherence, the driver of viral load suppression. Understanding HRQOL in people newly entering HIV care is critical and has the potential to guide practice and research. This exploratory cross-sectional study examined demographic, clinical, and psychosocial factors associated with limitations in four specific domains of HRQOL among persons initially entering outpatient HIV care at four sites in the United States (n = 335). In the unadjusted analysis, female gender was significantly associated with sub-optimal HRQOL with women having increased odds of reporting HRQOL challenges with pain, mood, mobility, and usual activity when compared to men. The adjusted models demonstrated attenuation of parameter estimates and loss of statistical significance for the associations with impaired HRQOL observed among women in unadjusted analyses, suggesting psychosocial factors related to HRQOL are complex and interrelated. Findings are consistent with a robust literature documenting gender-related health disparities. Programs aimed at improving HRQOL for persons initially entering HIV care are warranted generally, and specifically for women, and must address modifiable psychosocial factors via mechanisms including coping and social support.
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Affiliation(s)
| | - Andrew Westfall
- School of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Riddhi Modi
- School of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rivet K Amico
- School of Public Health, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Carol Golin
- School of Public Health, Department of Heath Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeanne Keruly
- School of Medicine, Division of Infectious Disease, John Hopkins University, Baltimore, MD, USA
| | - Evelyn Byrd Quinlivan
- School of Public Health, Department of Heath Behaviors, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heidi M Crane
- School of Medicine, Division of Infectious Disease, John Hopkins University, Baltimore, MD, USA
| | - Anne Zinski
- School of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent Turan
- College of Arts and Sciences, Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M Turan
- School of Public Health, Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- School of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Webel AR, Willig AL, Liu W, Sattar A, Boswell S, Crane HM, Hunt P, Kitahata M, Matthews WC, Saag MS, Lederman MM, Rodriguez B. Physical Activity Intensity is Associated with Symptom Distress in the CNICS Cohort. AIDS Behav 2019; 23:627-635. [PMID: 30368620 PMCID: PMC6408232 DOI: 10.1007/s10461-018-2319-7] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Symptom distress remains a challenging aspect of living with HIV. Physical activity is a promising symptom management strategy, but its effect on symptom distress has not been examined in a large, longitudinal HIV-infected cohort. We hypothesized that higher physical activity intensity would be associated with reduced symptom distress. We included 5370 people living with HIV (PLHIV) who completed patient-reported assessments of symptom distress, physical activity, alcohol and substance use, and HIV medication adherence between 2005 and 2016. The most frequent and burdensome symptoms were fatigue (reported by 56%), insomnia (50%), pain (46%), sadness (45%), and anxiety (45%), with women experiencing more symptoms and more burdensome symptoms than men. After adjusting for age, sex, race, time, HIV medication adherence, alcohol and substance use, site, and HIV RNA, greater physical activity intensity was associated with lower symptom intensity. Although individual symptoms may be a barrier to physical activity (e.g. pain), the consistent association between symptoms with physical activity suggests that more intense physical activity could mitigate symptoms experienced by PLHIV.
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Affiliation(s)
- Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44122, USA.
| | - Amanda L Willig
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wei Liu
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44122, USA
| | - Abdus Sattar
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44122, USA
| | | | - Heidi M Crane
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Peter Hunt
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mari Kitahata
- School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Michael S Saag
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Benigno Rodriguez
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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17
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Braksmajer A, Simmons J, Aidala A, McMahon JM. Effects of Discrimination on HIV-Related Symptoms in Heterosexual Men of Color. Am J Mens Health 2018; 12:1855-1863. [PMID: 30168363 PMCID: PMC6199419 DOI: 10.1177/1557988318797790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
HIV-related symptoms have a deleterious effect on quality of life. One determinant of HIV symptom burden among individuals of color may be discrimination. The aim of this study was to explore whether multiple lifetime discrimination events are associated with a greater number of HIV-related symptoms among heterosexual HIV-positive men of color and to examine the influence of anxiety and social support on this relationship. Data for this study were drawn from a cross-sectional survey of 307 heterosexual HIV-positive men recruited from health and social service agencies in New York City (NYC). This study indicated that the number of discrimination events experienced in one’s lifetime was positively associated with the number of HIV-related symptoms experienced in the past month. Moreover, the direct effect of discrimination on HIV symptoms remained significant after anxiety was included as a mediator in the model, and there was a significant indirect effect of discrimination on HIV symptoms through anxiety. Evidence supported a potential moderated mediation effect involving social support: As social support increased, the indirect effect of discrimination on HIV symptoms through anxiety decreased. The results of this study suggest an association between discrimination and HIV-related symptom burden. Furthermore, the relationship between number of major discrimination experiences and HIV symptom burden was partially mediated by anxiety. Future research should consider how lifetime discrimination might be associated with negative health outcomes among HIV-positive individuals of color.
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Affiliation(s)
- Amy Braksmajer
- 1 University of Rochester School of Nursing, Rochester, NY, USA
| | - Janie Simmons
- 2 National Development and Research Institutes, New York, NY, USA
| | - Angela Aidala
- 3 Mailman School of Public Health, Columbia University, New York, NY, USA
| | - James M McMahon
- 1 University of Rochester School of Nursing, Rochester, NY, USA
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18
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Shrestha S, Shibanuma A, Poudel KC, Nanishi K, Koyama Abe M, Shakya SK, Jimba M. Perceived social support, coping, and stigma on the quality of life of people living with HIV in Nepal: a moderated mediation analysis. AIDS Care 2018; 31:413-420. [PMID: 29996657 DOI: 10.1080/09540121.2018.1497136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Perceived social support, coping strategy, and internalized stigma have been linked with the quality of life (QOL) among people living with HIV (PLHIV). However, little is known about how these psychosocial factors interact with each other and affect QOL. This study incorporated a moderated mediation model to investigate whether coping strategy mediates the relationship between perceived social support and QOL, and to examine whether this mediating effect varies with the level of internalized stigma among PLHIV. A cross-sectional study was conducted among 599 PLHIV in Nepal. The multidimensional scale of perceived social support, World Health Organization Quality of Life-BREF, Brief COPE, and AIDS-related stigma scales were used to measure perceived social support, QOL, coping strategy, and internalized stigma, respectively. Data were analyzed using structural equation modeling, and moderated mediation analysis was conducted with multi-group approach. The relationship between perceived social support and QOL was significantly and partially mediated by problem-focused coping strategy. Internalized stigma significantly moderated the mediating effect of coping strategies on the association between perceived social support and QOL. For high internalized stigma group (total stigma score > 2), the effects of perceived social support on QOL were indirect (β = 1.48; 61.0% of total effects) through the mediating effect of coping strategy, especially problem-focused coping one. For low internalized stigma group (total stigma score ≤ 2), problem-focused coping strategy did not significantly affect the QOL, and most of the effects of perceived social support were direct (β = 1.24; 99.2% of total effects). Internalized stigma was found to moderate the mediating effect of problem-focused coping on the relationship between perceived social support and QOL. Enhancing the problem-focused coping and social support may be helpful to improve QOL among PLHIV reporting high stigma.
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Affiliation(s)
- Sabina Shrestha
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Akira Shibanuma
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Krishna C Poudel
- b Department of Health Promotion and Policy, School of Public Health and Health Sciences , University of Massachusetts Amherst , Amherst , MA , USA
| | - Keiko Nanishi
- c Office of International Academic Affairs, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Momoko Koyama Abe
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
| | - Sushil K Shakya
- d National Academy of Medical Sciences , Bir Hospital , Kathmandu , Nepal
| | - Masamine Jimba
- a Department of Community and Global Health, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan
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19
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Seffren V, Familiar I, Murray SM, Augustinavicius J, Boivin MJ, Nakasujja N, Opoka R, Bass J. Association between coping strategies, social support, and depression and anxiety symptoms among rural Ugandan women living with HIV/AIDS. AIDS Care 2018; 30:888-895. [PMID: 29471677 PMCID: PMC9850497 DOI: 10.1080/09540121.2018.1441969] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Poor mental health detrimentally affects quality of life among women living with HIV/AIDS. An improved understanding of how coping and social support relate to depression and anxiety in this population can facilitate the design and implementation of appropriate mental health treatment and support services. Secondary analysis was conducted on baseline data from 288 HIV-positive women enrolled in a parenting intervention in Uganda. Depression and anxiety symptoms, social support, and coping were assessed with the Hopkins Symptom Checklist and adapted versions of the Multidimensional Scale for Perceived Social Support and Ways of Coping Questionnaire. General linear regression models were used to estimate associations between coping and mental health. Based on report of elevated symptoms, approximately 10% of women were categorized as having clinically-relevant depression or anxiety. Emotion-focused (EF: p < .001) and problem-focused (PF: p = .01) coping were associated with more depressive symptoms while greater family support (EF: p = .002; PF: p = .003) was associated with fewer depression symptoms. More anxiety symptoms were associated with reporting both coping strategies (EF: p < .001; PF: p = .02) and higher community support (EF&PF: p = .01). The cross-sectional nature of the study limits our ability to rule out the role of reverse causation in the significant relationship between coping and mental health. Findings do suggest that high family support can be protective against depression and anxiety symptoms among women living with HIV.
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Affiliation(s)
- Victoria Seffren
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Itziar Familiar
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
| | - Sarah M Murray
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Jura Augustinavicius
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Michael J Boivin
- b Department of Psychiatry , Michigan State University , East Lansing , MI , USA
- f Departments of Psychiatry and Neurology & Ophthalmology , Michigan State University , East Lansing , MI , USA
- g Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA
| | | | - Robert Opoka
- e Department of Pediatrics and Child Health , Makerere University , Kampala , Uganda
| | - Judith Bass
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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20
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Schnall R, Siegel K, Jia H, Olender S, Hirshfield S. Racial and socioeconomic disparities in the symptom reporting of persons living with HIV. AIDS Care 2018; 30:774-783. [PMID: 29353489 PMCID: PMC5911686 DOI: 10.1080/09540121.2017.1417532] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Persons living with HIV (PLWH) today can survive decades with the disease, making the symptom experience much more relevant to their lifestyle and health outcomes. The goal of the research reported here was to assess the symptom reporting of PLWH in the Unites States (US) in the combined antiretroviral therapy (cART) age of the epidemic. We conducted an anonymous online survey of symptomatic PLWH in the US and asked participants to report the frequency and intensity of 28 frequently occurring symptoms in the past 30 days. The relationship between symptom reporting and demographic factors was investigated using the adaptive least absolute shrinkage and selection operator (LASSO) method. Fatigue was the most frequently reported symptom in our study population. Those with the lowest income were more likely to report more burdensome symptoms. In comparison to other racial and ethnic groups, Black non-Hispanic participants were significantly more likely to report a lower symptom burden score for fatigue, depression, muscle aches, anxiety, difficulties with memory and concentration. There were no racial/ ethnic differences in the burden of the symptoms related to sleep or neuropathy. Findings from this study present new evidence on the symptom reporting of PLWH in the US. Neuropathy continues to be a pervasive neurological symptom with no difference noted between racial/ ethnic groups.
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Affiliation(s)
| | - Karolynn Siegel
- b Mailman School of Public Health , Columbia University , New York , NY , USA
| | - Haomiao Jia
- c Division of Infectious Diseases, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Susan Olender
- c Division of Infectious Diseases, College of Physicians and Surgeons , Columbia University , New York , NY , USA
| | - Sabina Hirshfield
- d Public Health Solutions, Research and Evaluation Division , New York , NY , USA
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21
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Logie CH, Wang Y, Lacombe-Duncan A, Wagner AC, Kaida A, Conway T, Webster K, de Pokomandy A, Loutfy MR. HIV-related stigma, racial discrimination, and gender discrimination: Pathways to physical and mental health-related quality of life among a national cohort of women living with HIV. Prev Med 2018; 107:36-44. [PMID: 29277410 DOI: 10.1016/j.ypmed.2017.12.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/02/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
Social inequities compromise health-related quality of life (HR-QoL) among women living with HIV (WLWH). Little is known about health impacts of intersecting stigma based on HIV status, race and gender among WLWH or potential mechanisms to promote HR-QoL. We tested pathways from multiple types of stigma (HIV-related, racial, gender) to physical and mental HR-QoL utilizing baseline survey data from a national cohort of WLWH in Canada (2013-2015). Structural equation modeling was conducted using maximum likelihood estimation methods to test the direct effects of HIV-related stigma, racial discrimination, and gender discrimination on HR-QoL and indirect effects via social support and economic insecurity, adjusting for socio-demographic factors. Among 1425 WLWH (median age: 43years [IQR=35-50]), HIV-related stigma and gender discrimination had significant direct effects on mental HR-QoL. Social support mediated the relationship between HIV-related stigma and mental HR-QoL, accounting for 22.7% of the effect. Social support accounted for 41.4% of the effect of gender discrimination on mental HR-QoL. Economic insecurity accounted for 14.3% of the effect of HIV-related stigma, and 42.4% of the effect of racial discrimination, on physical HR-QoL. Fit indices suggest good model fit (χ2[1]=3.319, p=0.069; CFI=0.998; RMSEA=0.042 (90% CI: 0-0.069); SRMR=0.004). Findings reveal complex relationships between intersecting stigma and HR-QoL. Strategies that address intersecting stigma and economic insecurity among WLWH may prevent the harmful impacts of HIV-related stigma and gender discrimination on physical HR-QoL. Increasing social support may mitigate the impacts of stigma on mental health. Findings can inform multi-level interventions to promote health and wellbeing among WLWH.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada; Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.
| | - Ying Wang
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
| | - Ashley Lacombe-Duncan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada.
| | - Anne C Wagner
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada.
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Tracey Conway
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, QC H3S 1Z1, Canada; Chronic Viral Illness Service, McGill University Health Centre, 3801 University Street, Montreal, QC H3A 2B4, Canada.
| | - Mona R Loutfy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada; Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
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22
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Willie TC, Kershaw T, Gupta J, Hansen N. The Implications of Intimate Partner Violence on Health-Related Quality of Life Among Adults Living With HIV Who Experienced Childhood Sexual Abuse. J Assoc Nurses AIDS Care 2017; 29:317-322. [PMID: 28967488 DOI: 10.1016/j.jana.2017.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
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23
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Hiremath SB, Desai M. A study on prevalence and correlates of depression among women living with human immunodeficiency virus/acquired immune deficiency syndrome in North Karnataka. Ind Psychiatry J 2017; 26:188-193. [PMID: 30089968 PMCID: PMC6058429 DOI: 10.4103/ipj.ipj_3_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
CONTEXT Depression is the most prevalent psychiatric condition seen in human immunodeficiency virus (HIV)-positive individuals. Various biological, sociocultural, and economic factors make women more vulnerable to HIV and acquired immune deficiency syndrome (AIDS). Depression affects medication adherence and immunity against HIV thus contribute significantly to disease progression. AIMS The aim is to assess the prevalence, sociodemographic, and clinical correlates of depression among women living with HIV/AIDS. SETTINGS AND DESIGN Antiretroviral therapy (ART) centre attached to government medical college hospital in North Karnataka and cross-sectional design. MATERIALS AND METHODS This study was conducted among of 145 women living with HIV/AIDS, depression was assessed using Beck Depression Inventory, and social support was assessed using Lubben Social Network Scale and quality of life (QoL) using the World Health Organization QoL BREF scale. STATISTICAL ANALYSIS USED Data were analyzed using Statistical Package for the Social Sciences version 20.0. Chi-square test with P value less than 0.05 was taken as statistically significant. RESULTS Among 145 HIV-positive women, 50 (34.5%) were depressed. Depression was statistically significant in women from rural background. Significant association between depression and risk of social isolation was observed. Scores of all domains of QoL, that is, physical, psychological, social, and environmental were reducing with increase in the severity of depression indicating that QoL was decreasing with increase in severity of depression. Among the four domains, social domain was the most affected. CONCLUSIONS Depression among women living with HIV/AIDS which is underdiagnosed and undertreated. Depression negatively impacts adherence and immunity leading rapid progression of the infection. Therefore, early diagnosis and treatment of depression are essential.
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Affiliation(s)
- Shivanand B Hiremath
- Department of Psychiatry, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Mahesh Desai
- Department of Psychiatry, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
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24
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Rzeszutek M, Gruszczyńska E, Firląg-Burkacka E. Coping profiles and subjective well-being among people living with HIV: less intensive coping corresponds with better well-being. Qual Life Res 2017; 26:2805-2814. [PMID: 28584892 PMCID: PMC5597686 DOI: 10.1007/s11136-017-1612-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 01/07/2023]
Abstract
Purpose The aim of this study was to investigate the relationship between coping strategies and subjective well-being (SWB) among people living with HIV (PLWH) using the latent profile analysis (LPA) with control for socio-medical covariates. Methods The sample comprised five hundred and thirty people (N = 530) with a confirmed diagnosis of HIV+. The study was cross-sectional with SWB operationalized by satisfaction with life (Satisfaction with Life Scale) and positive and negative affect (PANAS-X). Coping with stress was measured by the Brief COPE Inventory, enriched by several items that assessed rumination and enhancement of positive emotional states. Additionally, the relevant socio-medical variables were collected. Results The one-step model of LPA revealed the following: (1) a solution with five different coping profiles suited the data best; (2) socio-medical covariates, except for education, were not related to the profiles’ membership. Further analysis with SWB as a distal outcome showed that higher intensity coping profiles have significantly worse SWB when compared with lower intensity coping profiles. However, the lowest SWB was noted for mixed intensity coping profile (high adaptive/low maladaptive). Conclusions The person-centered approach adopted in this study informs about the heterogeneity of disease-related coping among PLWH and its possible reactive character, as the highest SWB was observed among participants with the lowest intensity of coping.
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Affiliation(s)
- Marcin Rzeszutek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland.
| | - Ewa Gruszczyńska
- Health Psychology Department, University of Social Sciences and Humanities, Chodakowska 19/31, 03-815, Warsaw, Poland
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25
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Schafer KR, Albrecht H, Dillingham R, Hogg RS, Jaworsky D, Kasper K, Loutfy M, MacKenzie LJ, McManus KA, Oursler KAK, Rhodes SD, Samji H, Skinner S, Sun CJ, Weissman S, Ohl ME. The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions. J Acquir Immune Defic Syndr 2017; 75:35-44. [PMID: 28225437 PMCID: PMC6169533 DOI: 10.1097/qai.0000000000001329] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and health care resources are limited. Rural-urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.
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Affiliation(s)
- Katherine R Schafer
- *Section on Infectious Diseases, Wake Forest University Health Sciences, Winston-Salem, NC; †Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine; ‡Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA; §Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; ‖BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; ¶Clinician Investigator Program, University of British Columbia, Vancouver, BC, Canada; #Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada; **Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada; ††CIHR Canadian HIV Trials Network, Vancouver, BC, Canada; ‡‡Clinician Investigator Program, University of Manitoba, Winnipeg, MB, Canada; §§Carver College of Medicine, University of Iowa, Iowa City, IA; ‖‖Salem Veterans Affairs Medical Center, Virginia Tech Carilion School of Medicine, Salem, VA; ¶¶Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC; ##British Columbia Centre for Disease Control, Vancouver, BC, Canada; ***University of Saskatchewan, Saskatoon, SK, Canada; and †††Oregon Health & Science University-Portland State University School of Public Health, Portland, OR
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Darlington CK, Hutson SP. Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review. AIDS Behav 2017; 21:12-26. [PMID: 27492025 DOI: 10.1007/s10461-016-1504-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Societal stigmatization of HIV/AIDS due to assumptions about transmission and associated behaviors plays a substantial role in the psychosocial well-being of people living with this chronic illness, particularly for women in traditionally conservative geographic regions. Known for social conservatism, the Southern United States (US) holds the highest incidence rate of HIV infection in the US. A systematic search of four databases was used to identify 27 relevant scientific articles pertaining to HIV-related stigma among women living with HIV/AIDS in the Southern US. These studies revealed a rudimentary understanding of stigma sources, effects, and stigma-reduction interventions in this population. Due to the cultural specificity of stigma, further differentiation of stigma in discrete sectors of the South as well as a dialogue about the moral implications of stigma is necessary to lay the groundwork for patient-centered interventions to mitigate the destructive effects of stigma experienced by women in this region.
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Affiliation(s)
- Caroline K Darlington
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Room 337, Knoxville, TN, 37996, USA.
| | - Sadie P Hutson
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Room 337, Knoxville, TN, 37996, USA
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Testing a model of health-related quality of life in women living with HIV infection. Qual Life Res 2016; 26:655-663. [PMID: 28004319 DOI: 10.1007/s11136-016-1482-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this secondary analysis was to test Ferrans et al.'s (J Nurs Scholarsh 37(4):336-342, 2005) revised model of health-related quality of life (HRQoL) (2005) modified from the Wilson and Cleary (J Am Med Assoc 273(1):59-65, 1995) model on women living with HIV. The primary aim was to test this model, examining the relations among the five central components (biological function, symptoms, functional status, general health perceptions, and HRQoL). The secondary aim was to explore the individual (age, children, race, marital status, education) and environmental (HIV-related stigma, social support) characteristics that may impact the main components of the model. METHODS This study employed a cross-sectional correlational design using baseline data from 178 women living with HIV/AIDS who participated in one of the two independent randomized controlled trials designed to enhance HIV medication adherence. Path analysis using structural equation modeling was used to examine the hypothesized multivariate relations proposed in the revised Wilson and Cleary (J Am Med Assoc 273(1):59-65, 1995) model of HRQoL. RESULTS While the revised model did not fit, exploratory post hoc modified models with a path from depressive symptoms to overall general health had an adequate model fit. Women with lower depressive symptoms (r = -.457, p < .01), lower HIV-related stigma (r = -.462, p < .01), higher social support (r = .413, p < .01), higher physical functioning (r = .350, p < .01), and higher general health perceptions (r = .537, p < .01) had higher overall HRQoL. CONCLUSIONS The results of this study have the potential to assist healthcare professionals in improving HRQoL for women living with HIV/AIDS.
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Jang N, Bakken S. Relationships Between Demographic, Clinical, and Health Care Provider Social Support Factors and Internalized Stigma in People Living With HIV. J Assoc Nurses AIDS Care 2016; 28:34-44. [PMID: 27720356 DOI: 10.1016/j.jana.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
Internalized HIV stigma (IHS) threatens people living with HIV (PLWH) and the public. Our purpose was to identify relationships between PLWH perceptions of IHS and demographic, clinical, overall health, health-related quality of life, and perceived health care provider (HCP) social support. Using survey data from PLWH (n = 292) in an urban HIV clinic, we first examined the reliability and validity of an existing IHS measure. Exploratory factor analysis revealed that the IHS score was composed of three factors: (a) Perception of Negative Societal Beliefs, (b) Fear of Disclosure, and (c) Perception of Negative HCP Beliefs, which were used as dependent variables in the multivariate analysis. In multivariate regression models, gender, education, quality of life, Getting Needed Care, and Trust in HCP were significantly related to at least one IHS factor. Our findings advance the measurement of IHS and provide a foundation for intervention development to reduce IHS in care settings.
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Brandt CP, Jardin C, Sharp C, Lemaire C, Zvolensky MJ. Main and interactive effects of emotion dysregulation and HIV symptom severity on quality of life among persons living with HIV/AIDS. AIDS Care 2016; 29:498-506. [PMID: 27546879 DOI: 10.1080/09540121.2016.1220484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
HIV symptoms are associated with a poorer quality of life (QOL) among persons living with HIV/AIDS (PLWHA). Yet, there is little understanding of emotional factors that impact the relation between HIV symptom severity and QOL. The present study examined the main and interactive effects of emotion dysregulation and HIV symptom severity on multiple indices of QOL, including physical (impact of physical problems related to HIV), psychological (frequency of negative feelings), independence (necessity of medical treatment to function in daily life), social (feelings of acceptance), environmental (satisfaction with living conditions and medical care), and spiritual (fear of the future and death) among a sample of 74 PLWHA. Participants (72.9% male; mean age = 48.24, SD = 7.85) were recruited from AIDS Service Organizations in the United States. Results indicated that higher HIV symptom severity is significantly associated with lower physical and independence QOL, whereas higher emotion dysregulation is significantly associated with lower scores on all measured aspects of QOL. Additionally, results indicated that the interaction of emotion dysregulation and HIV symptom severity was significantly associated with both physical and environmental QOL. The form of the observed significant interactions indicated that HIV symptom severity was related to poorer QOL among those with lower (versus higher) emotion dysregulation. The present findings indicate that emotion dysregulation is related to QOL among PLWHA and may interact with HIV symptom severity to negatively impact certain aspects of QOL. Given the profound impact that HIV has on QOL, this finding is important in understanding these relations mechanistically, and may be important in the development of novel psychological treatment strategies.
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Affiliation(s)
- Charles P Brandt
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Charles Jardin
- b Department of Behavioral Health , Legacy Community Health Services , Houston , TX , USA
| | - Carla Sharp
- a Department of Psychology , University of Houston , Houston , TX , USA
| | - Chad Lemaire
- b Department of Behavioral Health , Legacy Community Health Services , Houston , TX , USA
| | - Michael J Zvolensky
- a Department of Psychology , University of Houston , Houston , TX , USA.,c Department of Behavioral Sciences , University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, Wilson M, Logie CH, Shi Q, Morassaei S, Rourke SB. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open 2016; 6:e011453. [PMID: 27412106 PMCID: PMC4947735 DOI: 10.1136/bmjopen-2016-011453] [Citation(s) in RCA: 510] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To conduct a systematic review and series of meta-analyses on the association between HIV-related stigma and health among people living with HIV. DATA SOURCES A structured search was conducted on 6 electronic databases for journal articles reporting associations between HIV-related stigma and health-related outcomes published between 1996 and 2013. STUDY ELIGIBILITY CRITERIA Controlled studies, cohort studies, case-control studies and cross-sectional studies in people living with HIV were considered for inclusion. OUTCOME MEASURES Mental health (depressive symptoms, emotional and mental distress, anxiety), quality of life, physical health, social support, adherence to antiretroviral therapy, access to and usage of health/social services and risk behaviours. RESULTS 64 studies were included in our meta-analyses. We found significant associations between HIV-related stigma and higher rates of depression, lower social support and lower levels of adherence to antiretroviral medications and access to and usage of health and social services. Weaker relationships were observed between HIV-related stigma and anxiety, quality of life, physical health, emotional and mental distress and sexual risk practices. While risk of bias assessments revealed overall good quality related to how HIV stigma and health outcomes were measured on the included studies, high risk of bias among individual studies was observed in terms of appropriate control for potential confounders. Additional research should focus on elucidating the mechanisms behind the negative relationship between stigma and health to better inform interventions to reduce the impact of stigma on the health and well-being of people with HIV. CONCLUSIONS This systematic review and series of meta-analyses support the notion that HIV-related stigma has a detrimental impact on a variety of health-related outcomes in people with HIV. This review can inform the development of multifaceted, intersectoral interventions to reduce the impact of HIV-related stigma on the health and well-being of people living with HIV.
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Affiliation(s)
- Sergio Rueda
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Sanjana Mitra
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Shiyi Chen
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | | | | | - Lori Chambers
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Mike Wilson
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Qiyun Shi
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | | | - Sean B Rourke
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Catunda C, Seidl EMF, Lemétayer F. Illness perception and quality of life of HIV-positive persons: mediation effects of tenacious and flexible goal pursuit. PSYCHOL HEALTH MED 2016; 22:129-137. [PMID: 26837540 DOI: 10.1080/13548506.2016.1146404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Medical advances contribute to raise life expectancy of people living with HIV/AIDS (PLHIV). However, they still face challenges related to the disease, thus, quality of life (QOL) became a priority on the field. The self-regulatory model (SRM) guided this study. Illness perceptions (IP) are the beliefs, cognitions, representations of a disease, impacting PLHIV coping strategies and QOL. Tenacious goal pursuit (TGP) is the pursuit of goals with determination, flexible goal adjustment (FGA) is doing it with flexibility, disengaging if necessary, they can both be considered as coping strategies. This study aims to measure the impact of HIV Perception in the QOL of PLHIV mediated by the TGP and FGA. Data was collected from 196 PLHIV with the WHOQOL-HIV Bref, the Brief-IPQ and the FGA and TGP scales. Structural equation model provided a good fit consistent with the theoretical SRM. IP, TGP and FGA had direct effects on the QOL of PLHIV. IP had also an indirect effect (partially mediated by TGP/FGA), suggesting that TGP/FGA reduce the impact of a threatening IP in the QOL. Goal oriented interventions should focus in the HIV perception of PLHIV to ameliorate their QOL.
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Affiliation(s)
- Carolina Catunda
- a Research Unit APEMAC , Université de Lorraine , Metz , France.,b Institute of Psychology, University of Brasilia , Brasilia , Brazil
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Catunda C, Seidl EMF, Lemétayer F. Qualidade de vida de pessoas vivendo com HIV/aids: efeitos da percepção da doença e de estratégias de enfrentamento. PSICOLOGIA: TEORIA E PESQUISA 2016. [DOI: 10.1590/0102-3772e32ne218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A pesquisa objetivou investigar preditores da qualidade de vida (QV) de pessoas vivendo com HIV/aids (PVHA), baseada no modelo de autorregulação de Leventhal, no qual a influência da percepção da doença na QV é mediada por estratégias de enfrentamento. Foram 95 PVHA a responder aos instrumentos Brief IPQ, Brief Cope e WHOQOL-HIV Bref relativos, respectivamente, à percepção da doença, estratégias de enfrentamento e QV. Os resultados indicaram que a percepção da doença teve efeito direto e indireto na QV, mediado por estratégias de enfrentamento. Maior percepção de ameaça da doença associou-se à pior QV percebida; porém, o uso mais frequente das estratégias aceitação, distração e suporte instrumental e a menor utilização de desengajamento comportamental e de reinterpretação positiva amenizaram esse efeito negativo.
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Chambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, Rourke SB. Stigma, HIV and health: a qualitative synthesis. BMC Public Health 2015; 15:848. [PMID: 26334626 PMCID: PMC4557823 DOI: 10.1186/s12889-015-2197-0] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background HIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. This review aims to synthesize qualitative evidence that explored the intersections of stigma and health for people with HIV. Methods A thematic summary was conducted that was guided by the qualitative metasummary technique developed by Sandelowski and Barraso. Literature searches yielded 8,622 references of which 55 qualitative studies were identified that illustrated HIV-related stigma in the context of health. Results The metasummary classified qualitative findings into three overarching categories: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma is avoided or addressed. To better illustrate these connections, the qualitative literature was summarized into the following themes: stigma within health care settings, the role of stigma in caring for one’s health, and strategies to address HIV-related stigma in the health context. A number of health care practices were identified – some rooted in institutional practices, others shaped by personal perceptions held by practitioners – that could be stigmatizing or discriminatory towards people with HIV. There existed interconnections between enacted stigma and felt stigma that influenced health care utilization, treatment adherence, and overall health and well-being of people with HIV. Intersectional stigma also emerged as instrumental in the stigma experiences of people living with HIV. A number of strategies to address stigma were identified including social support, education, self-efficacy, resilience activities, and advocacy. Conclusion This review of the qualitative evidence indicates that HIV-related stigma within health contexts is a broad social phenomenon that manifests within multiple social spheres, including health care environments. Findings from this review indicate that future stigma research should consider the social structures and societal practices – within and outside of health care environments – that perpetuate and reinforce stigma and discrimination towards people with HIV. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2197-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lori A Chambers
- School of Social Work, McMaster University, Kenneth Taylor Hall, KTH-319, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada.
| | - Sergio Rueda
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, c/o Research Services Office, 33 Russell St., T100, Toronto, ON, M5S 2S1, Canada. .,Department of Psychiatry, University of Toronto, 250 College St., 8th floor, Toronto, ON, M5T 1R8, Canada. .,Institute for Work & Health, 481 University Ave., Suite 800, Toronto, ON, M5G 2E9, Canada.
| | - D Nico Baker
- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada.
| | - Michael G Wilson
- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Communications Research Laboratory, CRL-209, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada. .,McMaster Health Forum, McMaster University, Mills Memorial Library, MML-417, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada.
| | - Rachel Deutsch
- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada.
| | - Elmira Raeifar
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Rd., White Plains, NY, 10605, USA.
| | - Sean B Rourke
- Department of Psychiatry, University of Toronto, 250 College St., 8th floor, Toronto, ON, M5T 1R8, Canada. .,Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada. .,Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1 T8, Canada.
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- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada
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Abrefa-Gyan T, Cornelius L, Okundaye J. Gender and Children as the Moderators of the Relationship between Social Support and Quality of Life: An Empirical Study of People Living with HIV/AIDS in Ghana. SOCIAL WORK IN PUBLIC HEALTH 2015; 30:550-558. [PMID: 26317440 DOI: 10.1080/19371918.2015.1071611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although gender differences persist in the receipt of social support and the report of quality of life among people living with HIV/AIDS in Sub-Saharan Africa, the knowledge base on this topic is scant. For those living with HIV/AIDS, women tend to participate more than men in support group activities, but their gender predisposes them to lower quality of life. Therefore, this study seeks to determine what demographic factors moderate the relationship between social support and quality of life among those living with HIV/AIDS in Ghana. A convenience sample of 300 HIV/AIDS support group members who have experience participating in research studies and was obtained for use via cross-sectional design survey in September and October 2013. The Medical Outcome Studies (MOS) HIV Health Survey, the MOS Social Support Survey, and demographic questionnaire instruments were used to assess quality of life, social support, and demographic information respectively. Gender (male) F(3, 296) = 66.04, t = 2.26, p = .024) and having children (have children) (F(5, 294) = 40.34, t = 2.50, p = .013) moderated the relationship between social support and quality of life. Implications of the findings for practice, policy, and research in Ghana and the rest of the developing world were discussed.
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Affiliation(s)
- Tina Abrefa-Gyan
- a Ethelyn R. Strong School of Social Work, Norfolk State University , Norfolk , Virginia , USA
| | | | - Joshua Okundaye
- c School of Social Work, University of Maryland , Baltimore County, Baltimore, Maryland , USA
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Feng MC, Feng JY, Yu CT, Chen LH, Yang PH, Shih CC, Lu PL. Stress, needs, and quality of life of people living with human immunodeficiency virus/AIDS in Taiwan. Kaohsiung J Med Sci 2015; 31:485-92. [PMID: 26362962 DOI: 10.1016/j.kjms.2015.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/24/2015] [Accepted: 07/02/2015] [Indexed: 11/30/2022] Open
Abstract
Human immunodeficiency virus (HIV)/AIDS is a manageable infectious disease by the effectiveness of highly active antiretroviral therapy. AIDS-related stigma and conflict may create distress and deteriorate quality of life (QoL) of people living with HIV/AIDS (PLWHA). This cross-sectional, descriptive, correlational study using structural questionnaires aimed to explore the stress, needs, QoL, and associated factors of PLWHA in Taiwan. A total of 200 PLWHA participating in this study needed most on treatment of HIV and prevention of AIDS, and health maintenance. They had worse QoL in physical, psychological, and social domains (all p < 0.001) than the general population. Stress was the most significant predictor (β = -0.25 to -0.54, p < 0.01) for all four domains of QoL. Needs was not significantly associated with QoL. The QoL of PLWHA can be explained by demographics, self-perception on health, needs, and stress for 25.3-40.7% of variances. No association existed between CD4(+) counts and QoL in Taiwanese PLWHA. It is important to recognize the perception of PLWHA on their health status, which is significantly associated with their QoL, besides monitoring their physical indicators of health (CD4(+) counts). To recognize the stress and needs that PLWHA experience and to develop intervention programs targeting strategies on HIV disclosure, prevention and health maintenance are crucial for PLWHA's QoL.
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Affiliation(s)
- Ming-Chu Feng
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jui-Ying Feng
- Department of Nursing, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - Chien-Tai Yu
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Hua Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Hsuan Yang
- Department of Nursing, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
| | - Chung-Ching Shih
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Webel AR, Wantland D, Rose CD, Kemppainen J, Holzemer WL, Chen WT, Johnson MO, Nicholas P, Eller LS, Chaiphibalsarisdi P, Sefcik E, Nokes K, Corless IB, Tyer-Viola L, Kirksey K, Voss J, Sullivan K, Rivero-Méndez M, Brion J, Iipinge S, Phillips JC, Portillo C. A Cross-Sectional Relationship Between Social Capital, Self-Compassion, and Perceived HIV Symptoms. J Pain Symptom Manage 2015; 50:59-68. [PMID: 25659523 PMCID: PMC4492802 DOI: 10.1016/j.jpainsymman.2014.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/15/2014] [Accepted: 01/07/2015] [Indexed: 01/28/2023]
Abstract
CONTEXT Individual resources of social capital and self-compassion are associated with health behaviors and perceived symptoms, suggesting that both are positive resources that can be modified to improve a person's symptom experience. OBJECTIVES The aim was to examine the relationship between self-compassion and social capital and its impact on current HIV symptom experience in adult people living with HIV (PLWH). We further explored the impact of age on this relationship. METHODS We conducted a cross-sectional analysis of 2182 PLWH at 20 sites in five countries. Social capital, self-compassion, and HIV symptom experience were evaluated using valid and reliable scales. To account for inflated significance associated with a large sample size, we took a random sample of 28% of subjects (n = 615) and conducted correlation analyses and zero-inflated Poisson regression, controlling for known medical and demographic variables impacting HIV symptom experience. RESULTS Controlling for age, sex at birth, year of HIV diagnosis, comorbid health conditions, employment, and income, our model significantly predicted HIV symptom experience (overall model z = 5.77, P < 0.001). Employment status and social capital were consistent, negative, and significant predictors of HIV symptom experience. Self-compassion did not significantly predict HIV symptom experience. For those reporting symptoms, an increase in age was significantly associated with an increase in symptoms. CONCLUSION Employment and social capital modestly predicted current HIV symptom experience. Social capital can be incorporated into symptom management interventions, possibly as a way to reframe a person's symptom appraisal. This may be increasingly important as PLWH age. The relationship between employment status and HIV symptom experience was significant and should be explored further.
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Affiliation(s)
- Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
| | | | - Carol Dawson Rose
- Community Health Systems, University of California School of Nursing at San Francisco, San Francisco, California, USA
| | - Jeanne Kemppainen
- University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | | | - Wei-Ti Chen
- Yale University, New Haven, Connecticut, USA
| | - Mallory O Johnson
- University of California at San Francisco, San Francisco, California, USA
| | - Patrice Nicholas
- Global Health and Academic Partnerships, Brigham and Women's Hospital and Massachusetts General Hospital, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | | | | | | | - Kathleen Nokes
- Hunter College, City University of New York, and Hunter-Bellevue School of Nursing, New York, New York, USA
| | - Inge B Corless
- Global Health and Academic Partnerships, Brigham and Women's Hospital and Massachusetts General Hospital, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Lynda Tyer-Viola
- Global Health and Academic Partnerships, Brigham and Women's Hospital and Massachusetts General Hospital, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Kenn Kirksey
- Center for Nursing Research, Seton Family of Hospitals, Austin, Texas, USA
| | - Joachim Voss
- University of Washington, Seattle, Washington, USA
| | - Kathy Sullivan
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | | | - John Brion
- Ohio State University College of Nursing, Columbus, Ohio, USA
| | | | | | - Carmen Portillo
- Community Health Systems, University of California School of Nursing at San Francisco, San Francisco, California, USA
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Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health 2015; 129:611-20. [PMID: 26025176 DOI: 10.1016/j.puhe.2015.04.001] [Citation(s) in RCA: 560] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/11/2015] [Accepted: 04/09/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To review research published before and after the passage of the Patient Protection and Affordable Care Act (2010) examining barriers in seeking or accessing health care in rural populations in the USA. STUDY DESIGN This literature review was based on a comprehensive search for all literature researching rural health care provision and access in the USA. METHODS Pubmed, Proquest Allied Nursing and Health Literature, National Rural Health Association (NRHA) Resource Center and Google Scholar databases were searched using the Medical Subject Headings (MeSH) 'Rural Health Services' and 'Rural Health.' MeSH subtitle headings used were 'USA,' 'utilization,' 'trends' and 'supply and distribution.' Keywords added to the search parameters were 'access,' 'rural' and 'health care.' Searches in Google Scholar employed the phrases 'health care disparities in the USA,' inequalities in 'health care in the USA,' 'health care in rural USA' and 'access to health care in rural USA.' After eliminating non-relevant articles, 34 articles were included. RESULTS Significant differences in health care access between rural and urban areas exist. Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by a scarcity of services, a lack of trained physicians, insufficient public transport, and poor availability of broadband internet services. Rural residents were found to have poorer health, with rural areas having difficulty in attracting and retaining physicians, and maintaining health services on a par with their urban counterparts. CONCLUSIONS Rural and urban health care disparities require an ongoing program of reform with the aim to improve the provision of services, promote recruitment, training and career development of rural health care professionals, increase comprehensive health insurance coverage and engage rural residents and healthcare providers in health promotion.
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Affiliation(s)
- N Douthit
- Medical School for International Health, Ben Gurion University, Beer Sheva, Israel
| | - S Kiv
- Medical School for International Health, Ben Gurion University, Beer Sheva, Israel
| | - T Dwolatzky
- Medical School for International Health, Ben Gurion University, Beer Sheva, Israel
| | - S Biswas
- Ben Gurion University, Beer Sheva, Israel.
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Barroso J, Relf MV, Williams MS, Arscott J, Moore ED, Caiola C, Silva SG. A randomized controlled trial of the efficacy of a stigma reduction intervention for HIV-infected women in the Deep South. AIDS Patient Care STDS 2014; 28:489-98. [PMID: 25084499 DOI: 10.1089/apc.2014.0014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to compare outcomes (self-esteem, coping self-efficacy, and internalized stigma) across time in HIV-infected women living in the Deep South who received a stigma reduction intervention (n=51) with those of a control group (n=49) who received the usual care at baseline, and at 30 and 90 days. We recruited 99 women from clinics and an AIDS service organization; they were randomized by recruitment site. A video developed from the results of a qualitative metasynthesis study of women with HIV infection was loaded onto iPod Touch devices. Participants were asked to watch the video weekly for 4 weeks, and to record the number of times they viewed it over a 12-week period. We examined the trajectory model results for efficacy outcomes for the intent-to-treat and the supplemental completers groups. There was a treatment-by-time effect for improved self-esteem (intent-to-treat: p=0.0308; completers: p=0.0284) and decreases in internalized stigma (intent-to-treat: p=0.0036; completers: p=0.0060), and a treatment-by-time-by-time effect for improved coping self-efficacy (intent-to-treat: p=0.0414; completers: p=0.0321). A medium effect of the intervention in terms of improving self-esteem was observed when compared with the control condition in those who completed the study. The magnitude of the intervention effect, however, was large with regard to reducing overall stigma, improving social relationships, and decreasing stereotypes in both groups.
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Affiliation(s)
- Julie Barroso
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
| | | | | | - Joyell Arscott
- Duke University School of Nursing, Durham, North Carolina
| | | | | | - Susan G. Silva
- Duke University School of Nursing, Durham, North Carolina
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Willig AL, Richardson BS, Agne A, Cherrington A. Intuitive eating practices among African-American women living with type 2 diabetes: a qualitative study. J Acad Nutr Diet 2014; 114:889-896. [PMID: 24699138 DOI: 10.1016/j.jand.2014.02.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/30/2014] [Indexed: 11/20/2022]
Abstract
Intuitive eating programs that improve self-efficacy and dietary habits could enhance glycemic control in African-American women with type 2 diabetes. The goal of our study was to investigate how current eating practices and beliefs of African-American women living with diabetes aligned with intuitive eating concepts. African-American women with type 2 diabetes referred for diabetes education class during 2009-2012 were recruited for a qualitative study using focus groups for data collection. Verbatim group transcriptions were analyzed by two independent reviewers for themes using a combined inductive-deductive approach. Participants (n=35) had an average age 52±9 years, mean body mass index 39±7, and mean time with a type 2 diabetes diagnosis of 10±10 years. Participants' self-reported dietary practices were poorly aligned with intuitive eating concepts. The women reported a lack of self-control with food and regularly eating in the absence of hunger, yet stated that the determinant factor for when to stop eating was to recognize a feeling of fullness. Participants reported knowing they were full when they felt physically uncomfortable or actually became sick. Women frequently cited the belief that individuals with diabetes have to follow a different diet than that recommended for the general public. Many women also discussed diabetes-related stigma from family/friends, and often did not tell others about their diabetes diagnosis. These findings demonstrate that intuitive eating techniques are not currently applied by the women in this sample. Future studies should assess the influence of intuitive eating interventions on dietary habits among low-income African-American women with type 2 diabetes.
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Tyer-Viola LA, Corless IB, Webel A, Reid P, Sullivan KM, Nichols P. Predictors of medication adherence among HIV-positive women in North America. J Obstet Gynecol Neonatal Nurs 2014; 43:168-78. [PMID: 24502460 PMCID: PMC4409428 DOI: 10.1111/1552-6909.12288] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To explore the relationships among contextual, environmental, and regulatory factors with antiretroviral (ARV) medication adherence to assist care providers in improving care for women living with HIV. DESIGN Descriptive, multicenter study. SETTING Sixteen HIV clinics and service organizations in North America. PARTICIPANTS This convenience sample was drawn from a larger study of 2,182 persons living with HIV recruited from clinics and service from September 2009 to January 2011. We included 383 women living with HIV who were taking ARV medications. METHODS We assessed the relationship of contextual, environmental, and psychological factors specific to women living with HIV in relation to adherence to ARV medication. Descriptive and multivariate statistics were used to examine the effects of these factors on self-reported ARV drug adherence. RESULTS Age, depression symptoms, stigma, engagement with health care provider, and four psychological factors were correlated with self-reported ARV medication adherence (p = .01). Regression analysis indicated that adherence self-efficacy and depression symptoms accounted for 19% for 3-day and 22% for 30-day self-reported medication adherence. CONCLUSIONS Adherence self-efficacy and depression symptoms predict ARV medication adherence in women and should be evaluated by nurses. Future research is needed to identify antecedents to and interventions that support adherence self-efficacy and decrease depression symptoms.
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Weissman S, Duffus WA, Vyavaharkar M, Samantapudi AV, Shull KA, Stephens TG, Chakraborty H. Defining the rural HIV epidemic: correlations of 3 definitions--South Carolina, 2005-2011. J Rural Health 2013; 30:275-83. [PMID: 24329575 DOI: 10.1111/jrh.12057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To gain a better understanding of the HIV epidemic in rural South Carolina (SC) by contrasting 3 definitions of rural and urban areas. METHODS The sample included newly diagnosed HIV cases aged ≥18 years in SC between January 1, 2005, and December 31, 2011. Each individual was assigned a rural or urban status as defined by the Office of Management and Budget (OMB), Census Bureau (CB), and Rural Urban Commuting Area (RUCA) classifications. Descriptive statistics were conducted to compare sociodemographic characteristics, CD4 counts, viral loads, and time to AIDS diagnosis between rural and urban populations. Kappa statistics measured the agreement between the 3 definitions of rurality. FINDINGS Depending on the definition used, the proportion of newly diagnosed HIV cases in rural areas varied from 23.3% to 32.0%. Based on the OMB and RUCA definitions, rural residents with HIV were more likely to be older, women, black, and non-Hispanic, report heterosexual contact, and have an AIDS diagnosis within 1 year of their HIV diagnosis. The OMB and RUCA definitions had a nearly perfect agreement (kappa = 0.8614; 95% CI = 0.8457, 0.8772), while poor agreements were noted between the OMB and CB or the RUCA and CB definitions. CONCLUSION When examining the rural HIV epidemic, how "rural" is defined matters. Using 3 definitions of rurality, statistically significant differences were found in demographic characteristics, timing of HIV diagnosis and the proportion of rural residents diagnosed with HIV in SC. The findings suggest possible misclassification biases that may adversely influence services and resource distribution.
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Affiliation(s)
- Sharon Weissman
- Division of Infectious Diseases, Department of Medicine, University of South Carolina, Columbia, South Carolina
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DeMoss M, Bonney L, Grant J, Klein R, del Rio C, Barker JC. Perspectives of middle-aged African-American women in the Deep South on antiretroviral therapy adherence. AIDS Care 2013; 26:532-7. [PMID: 24099510 DOI: 10.1080/09540121.2013.841835] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite evidence of stabilization in some areas of the USA, HIV infection in black women is not declining in the Deep South. Using a phenomenological approach to qualitative inquiry, we investigated women's experiences influencing their adherence to highly active antiretroviral therapy (HAART) in an urban setting. Inclusion criteria specified black women who had been aware of their HIV status for at least two years and were engaged in HIV outpatient care. Twelve single face-to-face confidential in-depth semi-structured interviews were conducted from a sample of predominantly middle-aged women retained in care at an HIV clinic in Atlanta, Georgia. Data were analyzed by two independent reviewers and three themes emerged from the group of women's accounts of their experiences. First, sentinel events led to changes in perspective and motivated women to adhere to HAART. Second, recognition that one had the personal strength necessary to cope with HIV fostered adherence. Finally, relationships with healthcare providers especially trust issues surrounding this relationship, impacted adherence both positively and negatively. These findings suggest that HAART adherence is a complex issue among middle-aged urban black women with HIV in the Deep South. Providers caring for this patient population should recognize that sentinel events, personal strength, and positive healthcare relationships are opportunities to improve adherence.
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Affiliation(s)
- Margaret DeMoss
- a J. Willis Hurst Internal Medicine Residency Program , Emory University School of Medicine , Atlanta , GA , USA
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43
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Su X, Lau JTF, Mak WWS, Choi KC, Chen L, Song J, Zhang Y, Zhao G, Feng T, Chen X, Liu C, Liu J, Liu D, Cheng J. Prevalence and associated factors of depression among people living with HIV in two cities in China. J Affect Disord 2013; 149:108-15. [PMID: 23452645 DOI: 10.1016/j.jad.2013.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 12/31/2012] [Accepted: 01/02/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Depression has significant effects on morbidity and mortality in people living with HIV (PLWH). Current study estimated the rate of depressive disorder and identified the correlates of depressive disorder among PLWH in China. METHODS 258 PLWH in China were recruited and interviewed with a structured questionnaire including measurements testing perceived stress, social support, perceived discrimination, and depression. Mediating effect of perceived stress between perceived discrimination and depression and moderating effect of social support on effect of perceived discrimination and perceived stress to depression were tested. Multivariate regression was used to examine the determinants of depression. RESULTS The prevalence of mild to severe depression is 71.9%. The relationship between the perceived discrimination and depression is fully mediated by perceived stress (perceived discrimination that was statistically significant (β=0.153) to depression became non-significant after adding perceived stress in the regression model). Interaction term between social support and perceived stress has negative effects (β=-0.117) and explained a significant amount of variance (R(2)=0.018) in depression. Lower income, and higher perceived stress predicted more depressive symptoms. LIMITATIONS Cross-sectional study and self-report bias are major limitations of this study. CONCLUSION Depression among PLWH is a severe problem in China. Primary health care workers need to be trained in recognition and treatment in depression. Stress management skills and social support for PLWH are warranted.
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Affiliation(s)
- Xiaoyou Su
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Abstract
To identify psychosocial variables related to the use of coping strategies by HIV-positive South African women diagnosed during pregnancy, structured interviews were conducted with 224 HIV-positive women at antenatal clinics over a period of 2 years. Two coping styles, active and avoidant coping, were assessed using an adapted version of the Brief COPE. Psychosocial variables associated with changes in coping over time were identified with mixed linear analysis. Increases in active coping were associated with decreasing levels of internalized stigma and depression, increasing self-esteem and positive social support, knowing someone who is living with HIV, being physically healthy and living above the poverty line. Increases in avoidant coping were associated with increasing internalized stigma and depression, lower levels of self-esteem, HIV-knowledge and lower levels of education. Recommendations are made for psychological support services to strengthen women's ability to cope and enhance their health and that of their infants.
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De Santis JP, Florom-Smith A, Vermeesch A, Barroso S, DeLeon DA. Motivation, management, and mastery: a theory of resilience in the context of HIV infection. J Am Psychiatr Nurses Assoc 2013; 19:36-46. [PMID: 23392433 PMCID: PMC3773721 DOI: 10.1177/1078390312474096] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clients with HIV infection have been conceptualized as a resilient population. Although a few researchers have documented resilience among clients with HIV infection, a theory of resilience in the context of HIV infection has not been developed. The purpose of this study was to describe the process by which resilience occurs for clients in the context of HIV infection. METHOD Grounded theory methodology was used to sample and analyze data from 15 qualitative interviews with adults with HIV infection. Data were collected until saturation was reached. RESULTS A theory, motivation, management, and mastery, a description of the process by which resilience occurs in the context of HIV infection, emerged from the data. CONCLUSION Many clients living with HIV infection are resilient, despite the physical, psychological, and social challenges of this chronic illness. Nursing interventions to promote resilience among clients with HIV infection should be directed toward identification of client motivation factors and disease management strategies that may influence health outcomes of people living with HIV infection.
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Affiliation(s)
- Joseph P De Santis
- University of Miami School of Nursing and Health Studies, Coral Gables, FL 33146, USA.
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Utility of a partner communication scale and a personal meaning scale in newly diagnosed HIV-infected persons. J Assoc Nurses AIDS Care 2012; 24:126-34. [PMID: 22943981 DOI: 10.1016/j.jana.2012.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 05/11/2012] [Indexed: 11/21/2022]
Abstract
No studies to our knowledge have examined the Lepore Social Constraint Scale or Fife Constructed Meaning Scale in recently diagnosed HIV-infected persons. Twenty-four participants in a prospective observational cohort completed the social-constraint measure, and 47 completed the constructed-meaning scale at either 3 or 9 months after diagnosis. Participants completed a 4-week visual analogue scale to assess adherence to antiretroviral therapy, and validated depression and self-efficacy scales. Spearman correlation coefficients compared measures. In cross-sectional analyses, participants with higher social-constraint scores had lower constructed meaning and adherence. Higher social constraint correlated negatively with self-efficacy and positively with depression. Higher constructed-meaning scores did not correlate with adherence but correlated positively with self-efficacy and negatively with depression. The quality of HIV-infected individuals' discussions of HIV with their partners and positive constructed meaning were associated with better mental health and could be targets for improving medication adherence.
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Unnikrishnan B, Jagannath V, Ramapuram JT, Achappa B, Madi D. Study of Depression and Its Associated Factors among Women Living with HIV/AIDS in Coastal South India. ISRN AIDS 2012; 2012:684972. [PMID: 24052882 PMCID: PMC3767188 DOI: 10.5402/2012/684972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 04/29/2012] [Indexed: 11/26/2022]
Abstract
Background. Depression is one of the most prevalent psychiatric diagnoses seen in HIV-positive individuals. Women with HIV are about four times more likely to be depressed than those who are not infected. Aims. To assess the sociodemographic and clinical correlates of depression among women living with HIV/AIDS. Setting and Design. One public and one private hospital in Mangalore, Coastal South India, and cross-sectional design. Methods and Materials. Study constituted of 137 HIV-positive women, depression was assessed using BDI (Beck Depression Inventory), and social support was assessed using Lubben Social Network Scale. Statistical Analysis. All analysis was conducted using SPSS version 11.5. Chi-square test with P value less than 0.05 was taken as statistically significant. Results. Among 137 HIV-positive women, 51.1% were depressed. Around 16% were having moderate to high risk for isolation. Depression was statistically significant in rural women, widowed women, and lower socioeconomic class women. Conclusion. Depression is highly prevalent among women living with HIV which is still underdiagnosed and undertreated, and there is a need to incorporate mental health services as an integral component of HIV care.
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Affiliation(s)
- B Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal University, Light House Hill Road, Mangalore 575001, India
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Taft TH, Ballou S, Keefer L. A preliminary evaluation of internalized stigma and stigma resistance in inflammatory bowel disease. J Health Psychol 2012; 18:451-60. [PMID: 22689587 DOI: 10.1177/1359105312446768] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Illness stigmatization among inflammatory bowel diseases (IBDs) is poorly understood. We aim to characterize internalized stigma and stigma resistance in IBD patients, and evaluate their relationships to outcomes. A total of 191 IBD patients reported internalized stigma, resistance, demographic and clinical information, and several outcomes: health-related quality of life (HRQOL), psychological distress, self-esteem, and self-efficacy. Overall 36% experienced internalized stigma and 88% moderate to high stigma resistance behaviors. Internalized stigma strongly related to poorer outcomes while resistance demonstrated a weaker, opposite effect. Internalized stigma and stigma resistance are important considerations for IBD outcomes. Interventions to reduce internalized stigma and leverage resistance are warranted.
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Affiliation(s)
- Tiffany H Taft
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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