The relationship between internalised HIV-related stigma and posttraumatic growth

"As I Grew Older, My Life Got Better": Conceptions of Successful Aging among Older Women Living with or at Risk of HIV

Successful aging (SA) is an important target for HIV care. However, we have insufficient understanding of how older women living with HIV (OWLH) in the US define SA. We explored conceptions of SA by OWLH and older women at risk of HIV and examined whether SA conceptions differed by (1) HIV serostatus, and (2) participation in the Women's Interagency HIV Study (WIHS). These analyses were part of a larger mixed-methods study with a sequential design. Participants were recruited at two clinical WIHS sites. We enrolled both WIHS participants and non-WIHS clinic patients. Our sample was 84% Black and included 29 OWLH and 15 older women at risk of HIV. We conducted 21 semi-structured interviews and four focus groups. The dataset was analyzed using descriptive, comparative, and relational analysis. We found four interlinked themes: life course perspective, accepting and celebrating aging, taking care of yourself, and looking good. The life course perspective was a core theme: participants assessed their aging in comparison to their earlier life hardships. These themes were similarly present among OWLH and older women at risk of HIV, although OWLH emphasized taking care of HIV. SA conceptualizations by OWLH did not differ whether or not they participated in the WIHS. Women living with or at risk of HIV may experience severe hardships throughout their lives. Overcoming these hardships may be linked to SA. Assessing the needs and connecting women to resources and programs are critical for SA promotion.

Group Intervention Program to Facilitate Post-Traumatic Growth and Reduce Stigma in HIV

Background: Research on post-traumatic growth (PTG) and HIV is scarce and the relationship between PTG and stigma is controversial. Group psychotherapeutic interventions to facilitate PTG in clinical samples are effective but none exist to simultaneously decrease stigma in the HIV population. The main objective was to evaluate the effectiveness of an intervention in increasing PTG and decreasing stigma in HIV, as well as to explore relationships between the variables. Methods: Quasi-experimental design with a sample of 42 HIV-positive adults (M = 46.26, SD = 11.90). The experimental group (EG) was subjected to a 9-week group intervention. Instruments: CBI, PTGI-X, PSS-10, HIV stigma, emotional expression, HIV stress indicators, HIV literacy, and skills. Multiple linear regression analysis was performed to assess the relationship between the variables. Results: There was an increase in PTG and a significant decrease in stigma in all domains and subscales in the EG. Compared to the control group, stigma (t(42) = -3.040, p = 0.004) and negative self-image (W = -2.937, p = 0.003) were significant, showing the efficacy of the intervention. Discussion: The intervention demonstrated success in facilitating PTG, attesting that in order to increase PTG, personal strength, and spiritual change, it is necessary to reduce stigma and negative self-image. The research provides more information on group interventions for PTG in HIV, relationships between variables, and population-specific knowledge for professionals.

Posttraumatic growth and posttraumatic depreciation among people living with HIV: the role of resilience and HIV/AIDS stigma in the person-centered approach

Posttraumatic growth (PTG) among people living with HIV (PLWH) remains an understudied and controversial topic, and several research gaps need to be filled. In our study, we focused on one such gap by implementing parallel assessment of positive (PTG) and negative changes (posttraumatic depreciation [PTD]) following trauma related to HIV diagnosis, along with measurement of resilience and HIV/AIDS stigma and socio-medical data. The study sample comprised 509 PLWH, which completed the standardized psychometric inventories measuring the study variables. The results showed an unexpected positive relationship between PTG and PTD among participants. In addition, following the person-centered approach, we observed specific PTG/PTD clusters in the study sample with different resilience and HIV/AIDS stigma levels. Our study may shed some light on understanding PTG/PTD processes among PLWH and inspire planning for effective psychological help adjusted to patients' specific needs.

The role of resilience in daily experiences of posttraumatic growth, affect, and HIV/AIDS stigma among people living with HIV

This study investigated the intraindividual variability in daily posttraumatic growth (PTG) versus posttraumatic depreciation (PTD), positive and negative affect (PA and NA), and HIV/AIDS stigma among people living with HIV (PLWH). In particular, we examined whether this variability derives from participants' resilience operationalized on a trait level. The participants included 67 PLWH, who completed a baseline questionnaire on resilience, measured with the Brief Resilience Scale. Following this, they completed the shortened versions of the following inventories over five consecutive days: the Posttraumatic Growth and Posttraumatic Depreciation Inventory V Expanded version Inventory, the Positive and Negative Affect Schedule - Expanded Form, and the Berger HIV Stigma Scale. Hierarchical linear modeling (HLM) was utilized to analyze the study results. We observed significant intraindividual variability in PTG, PTD, PA, NA, and perceived HIV/AIDS stigma. Resilience was related to PTG, PTD, PA, and NA but not to stigma. Moreover, higher resilience was associated with higher, stabler PA and lower, stabler NA. Our results highlight the need of further studies on the daily functioning of PLWH. Specifically, while health status is important, it does not appear to be the predominant source of everyday distress for PLWH. Consequently, psychological counselling for PLWH should concentrate more on the life of the person as a whole and not only on coping with HIV infection.

Trajectories of posttraumatic growth and posttraumatic depreciation: A one-year prospective study among people living with HIV

Objective

Posttraumatic growth (PTG) and posttraumatic depreciation (PTD) are considered two sides of growth after trauma. Nevertheless, previous studies pointed out that in trauma living with a life-threatening illness, they may be experienced as two independently and share distinct predictors. In our study we aimed to find the different trajectories of PTG and PTD among a sample of people living with HIV (PLWH) and to investigate its predictors out of psychological resilience, and gain and loss of resources from the conservation of resources theory (COR).

Methods

We designed a longitudinal study that consisted of three measurements at 6-month intervals, and we recruited, respectively, 87, 85 and 71 PLWH. Each time participants filled out the following questionnaires: the expanded version of the PTG and PTD Inventory (PTGDI-X), the Brief Resilience Scale (BRS), the Conservation of Resources Evaluation (COR-E), and a survey on sociodemographic and medical data.

Results

We observed two separate trajectories of PTG and PTD within participants and found that each of the trajectories were related to different predictors from the studied variables. More specifically, we found a positive relationship between resilience and a descending PTD trajectory that stabilized over time. Gain of resources generally predicted a PTG trajectory, while loss of resources predicted the dynamics of PTD.

Conclusions

Including two parallel constructs, i.e., PTG and PTD, confirmed the independence of their mechanisms in growth processes among PLWH. The initial insight concerning the role of resilience and resources in PTG/PTD processes may inspire more effective planning for psychological help for PLWH, and it may stimulate studies on growth after trauma to further examine the two sides of this phenomenon.

Posttraumatic growth and well-being among people living with HIV: A systematic review and meta-analysis in recognition of 40 years of HIV/AIDS

OBJECTIVES

This systematic review and meta-analysis aimed to synthesize, analyze, and critically review existing studies on the relationship between posttraumatic growth (PTG) and psychological well-being (operationalized either via positive or negative well-being indicators) among people living with HIV (PLWH). We also investigated whether this association varies as a function of socio-demographic, clinical characteristics, and study publication year.

METHOD

We conducted a structured literature search on Web of Science, Scopus, MedLine, PsyARTICLES, ProQuest, and Google Scholar. The most important inclusion criteria encompassed quantitative and peer-reviewed articles published in English.

RESULTS

After selection, we accepted 27 articles for further analysis (N = 6333 participants). Eight studies used positive indicators of well-being. The other 19 studies focused on negative indicators of well-being. Meta-analysis revealed that there was a negative weak-size association between PTG and negative well-being indicators (r = - 0.18, 95% CI [- 0.23; - 0.11]) and a positive medium-size association between PTG and positive well-being measures (r = 0.35, 95% CI [0.21; 0.47]). We detected no moderators.

CONCLUSIONS

The present meta-analysis and systematic review revealed expected negative and positive associations between PTG and negative versus positive well-being indicators among PLWH. Specifically, the relationship between PTG and positive well-being indicators was more substantial than the link between PTG and negative well-being measures in these patients. Finally, observed high heterogeneity between studies and several measurement problems call for significant modification and improvement of PTG research among PLWH.

The Changes and the Predictors of Suicidal Ideation Among HIV-positive Sexual Minority Men: A Five-year Longitudinal Study from China

This study aimed to explore whether there were differences in suicidal ideation at different time points among sexual minority men (SMM) within five years of HIV diagnosis, and to investigate the influence of time and psychosocial variables on suicidal ideation. This was a five-year follow-up study focusing on the suicidal ideation among HIV-positive SMM who were recruited when they were newly diagnosed with HIV. Suicidal ideation and psychosocial characteristics including depression, anxiety, HIV-related stress, and social support were assessed within one month, the first year, and the fifth year after HIV diagnosis. A total of 197 SMM newly diagnosed with HIV completed three-time point surveys in this study. The prevalence of suicidal ideation was 27.4%, 15.7%, and 23.9% at one month, the first year, and the fifth year after HIV diagnosis, respectively. The risk of suicidal ideation was lower in the first year than baseline, but there was no significant difference between the fifth year and baseline. Emotional stress and objective support independently predicted suicidal ideation and they had interactions with time. The suicidal ideation of SMM newly diagnosed with HIV decreased in the first year and then increased in the fifth year, not showing a sustained decline trend in a longer trajectory of HIV diagnosis. Stress management, especially long-term stress assessment and management with a focus on emotional stress should be incorporated into HIV health care in an appropriate manner. In addition, social support should also be continuously provided to this vulnerable population.

Posttraumatic growth and positive determinants in nursing students after COVID-19 alarm status: A descriptive cross-sectional study

PURPOSE

To determine the relationship between posttraumatic growth (PTG), psychological flexibility, and psychological resilience of nursing students after the COVID-19 alarm status.

DESIGN AND METHODS

This descriptive cross-sectional study was conducted with nursing students (N = 292) studying at a nursing school of a university. The data collection instruments included a form on descriptive variables, and the PTG, psychological flexibility, and psychological resilience scales. Descriptive statistics, independent-samples t test, ANOVA, correlation, simple, and hierarchical linear regression analyses were used to analyze the data.

FINDINGS

The mean scores regarding psychological flexibility, psychological resilience, and PTG were 27.56 ± 11.06, 18.10 ± 5.75, and 63.49 ± 20.64, respectively. While psychological flexibility explained 36.7% of the total variance in psychological resilience, the predictive effect of seven descriptive variables, including psychological flexibility and psychological resilience, on PTG was determined as 13.4%.

PRACTICE IMPLICATIONS

PTG, psychological flexibility, and psychological resilience may help nursing students prepare for their transition to the profession.

Post-traumatic Growth in Inflammatory Bowel Disease Patients: The Role of Illness Cognitions and Physical Quality of Life

BACKGROUND AND AIMS

The symptoms and complications associated with inflammatory bowel disease [IBD] have been found to be associated significantly with impaired health-related quality of life. Nevertheless, there may also be a positive psychological change such as post-traumatic growth, as was noted among patients with other chronic diseases, but this remains understudied in patients with IBD. In this study, we explored associations between post-traumatic growth and illness cognitions (helplessness, acceptance and perceived benefits). In addition, we evaluated whether physical quality of life in IBD patients mediates the link between illness cognitions and post-traumatic growth.

METHODS

The study employed a cross-sectional design. Two hundred patients diagnosed with IBD completed questionnaires assessing illness cognitions, physical quality of life and post-traumatic growth.

RESULTS

There was a negative association between illness cognition of helplessness and post-traumatic growth, and positive associations between illness cognitions of acceptance and illness cognitions of perceived benefits, and post-traumatic growth. In addition, the association between an illness cognition of helplessness and post-traumatic growth was mediated via physical quality of life. Yet, the signs of the direct and the indirect paths of an illness cognition of helplessness on post-traumatic growth were opposite.

CONCLUSIONS

This study extends the literature on the role of illness cognitions as an important component in facilitating the process of post-traumatic growth among IBD patients. Based on the findings, the management of IBD patients should incorporate more interventions aimed at exploring cognitive aspects of the illness in order to improve physical quality of life and enhance personal growth.

The Association between HIV-Stigma and Depressive Symptoms among People Living with HIV/AIDS: A Systematic Review of Studies Conducted in South Africa

BACKGROUND

People living with HIV/AIDS (PLWHA) are at increased risk of stigma and mental illness, and this appears to be a particular issue in South Africa, which is home to 19% of the world's HIV-positive population. This paper aims to systematically review the literature investigating the relationship between HIV-stigma and depressive symptoms among PLWHA in South Africa.

METHODS

A keyword search of four bibliographic databases (CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science) and two grey literature websites was conducted. The quality of eligible studies was assessed using established criteria.

RESULTS

Fourteen quantitative studies were included in the review. PLWHA in South Africa experience high levels of HIV-stigma and depressive symptoms. All forms of stigma were found to be associated with depressive symptoms amongst PLWHA. Prospective findings were mixed, with one study finding that stigma did not predict depressive symptoms over 36 months, and another that depressive symptoms predicted stigma 12 months later, suggesting a potentially bidirectional relationship. Females and young adults may be particularly vulnerable to HIV-stigma and its negative psychological effects. Some support was found for the moderating role of social support in the relationship between stigma and depressive symptoms across different sub-populations.

LIMITATIONS

Few studies conducted prospective analyses or tested mediation/moderation.

CONCLUSIONS

Despite limitations, this study highlights the importance of understanding the mechanisms underlying HIV-stigma across different sub-populations in South Africa. This may lead to more effective and context-specific interventions to combat adverse mental health outcomes.

Associations Between Experienced and Internalized HIV Stigma, Adversarial Growth, and Health Outcomes in a Nationwide Sample of People Aging with HIV in Germany

HIV-related stigmatization and adversarial growth are known to influence health outcomes in people living with HIV. But not much is known how these psychosocial factors are related to each other and how they interact to influence health outcomes. We tested whether the effect of experienced and internalized stigma on mental health and self-rated health is mediated by adversarial growth, and whether each of these factors is uniquely associated with health outcomes. In our sample of 839 people aging with HIV in Germany based on a cross-sectional study design we did not find an indirect effect of experienced HIV stigma on health outcomes and a very small indirect effect of internalized HIV stigma. All variables were significant predictors of health outcomes in multiple regression analyses.

Challenges to the conceptualization and measurement of resilience in HIV research

The purpose of this study was to evaluate the conceptualization and measurement of resilience in HIV research. Terms related to resilience and HIV were searched in three databases to identify peer-reviewed research articles. Of the 156 articles identified, 49 were included in the analyses. Applied thematic analysis was used to analyze the definitions and measurement of resilience. Articles were reviewed independently by two raters to establish inter-rater reliability. Six recurring themes were identified in the definitions of resilience: adaptation, positive mental health symptoms, the absence of negative mental health symptoms, hardiness, coping, and the ability to "bounce back". Among the articles examined, 14 measures were used to assess resilience, half of which were indirect. These findings help make sense of the available literature on resilience and highlight the importance of clearly operationalizing resilience and measuring it in a way that is congruent with its definition in future HIV research studies.

Negative centralisation of HIV/AIDS trauma and health-related quality of life: do post-traumatic stress symptoms explain the link?

Over-integration of HIV-related trauma into the client's memory in a negative emotional valence could be a serious health debilitating process which may result in negative post-traumatic health outcomes, affecting health-related quality of life (HRQoL) of people living with HIV (PLWH). We hypothesized that post-traumatic stress disorder (PTSD) symptoms are the mediating link between negative event centrality (NEC) and HRQoL among PLWH. Nine hundred and sixty-nine PLWH in Nigeria completed measures of NEC, PTSD symptoms and HRQoL. Model 4 of Hayes' regression-based PROCESS macro version 3.0 for SPSS was employed to investigate relationships between variables of interest. NEC was positively associated with all domains of HRQoL. PLWH who had high negatively centralized identity on HIV also had high scores on PTSD symptoms. PTSD symptoms were also positively associated with all domains of HRQoL. PTSD symptoms also mediated the relationship between NEC and all domains of HRQoL. Assessing and treating PTSD symptoms among PLWH by clinicians could be helpful in enhancing HRQoL.

Experiences of stigma in healthcare settings by people living with HIV in Ireland: a qualitative study

Stigma in healthcare settings remains a barrier to accessing screening, treatment and care for HIV and is a driver of the global HIV epidemic. This study examined the stigma experiences in healthcare settings of people living with HIV (PLHIV) in Ireland. Semi-structured interviews were carried out with 4 women and 10 men living with HIV. Data were analysed using a Directed Content Analysis approach to assess experiences of enacted, anticipated and internalised stigma. The findings indicate experiences of enacted, anticipated and internalised stigma were common. A further finding of spatial stigma was also uncovered. Analysis showed these experiences impacted participants' engagement with care and affected health-seeking behaviours and treatment adherence. The results suggest stigma experienced in healthcare settings may impact negatively on health outcomes.

Direct and Indirect Associations Between Interpersonal Resources and Posttraumatic Growth Through Resilience Among Women Living with HIV in China

This study aims to test the associations between interpersonal resources and posttraumatic growth (PTG) and their indirect associations through resilience among women living with HIV (WLWH). A cross-sectional study interviewed 546 WLWH from eight clinics of Yunnan and Guangxi provinces in China. PTG, resilience and doctors' empathy were assessed by the validated scales. Family support, friend support, and partner intimacy were assessed by the self-constructed scales. Significant background factors of PTG included duration of residence in the area, monthly family income, number of years since HIV diagnosis, self-reported presence of AIDS-related symptoms, and current pregnancy. Family social support, partner intimacy, doctors' empathy, and resilience were positively associated with PTG; friend support was negatively associated with PTG (p < .05). Furthermore, resilience partially mediated the relationships between family support/partner intimacy and PTG, explaining 13.6-14.2% of the variance. Structural equation modeling showed that family support was significantly and indirectly associated with PTG through resilience when controlling for other interpersonal resource indicators. Implications and potential interventions to promote PTG are discussed.

HIV-Related Stress Experienced by Newly Diagnosed People Living with HIV in China: A 1-Year Longitudinal Study

This study explored the HIV-related stressors that people living with HIV (PLWH) commonly experience and express as stressful at the time of diagnosis and 1 year later. The factors associated with stress levels and whether social support would moderate the negative effects of stress on psychological health (depressive and anxiety symptoms) were also investigated. Newly diagnosed PLWH were consecutively recruited in this study. Participants rated their stress with the HIV/AIDS Stress Scale at baseline and 1 year later. Social support, depression, and anxiety were also self-reported at both time points. There were significant decreases in stress levels 1 year after diagnosis. Stressors regarding confidentiality, disclosure, emotional distress, fear of infecting others, and excessive attention to physical functions were the most problematic at baseline and 1-year follow-up. A younger age, married status, not living alone, less income, presence of HIV symptoms, and lack of social support were associated with higher levels of stress. No stress-buffering effect of social support on depressive and anxiety symptoms was found in this study. Interventions to reduce stress among PLWH should take into consideration the following priority stressors: confidentiality, discrimination/stigma, serostatus disclosure, distressing emotions, fear of infecting others, and excessive attention to physical functions. More attention should be paid to PLWH with younger age, not living alone, less income, presence of HIV symptoms, and lack of social support.

Health benefits of positive reappraisal coping among people living with HIV/AIDS: A systematic review

People living with HIV/AIDS (PLWHA) often face significant stress, ranging from perceiving identity changes to encountering barriers to daily health behavior engagement. To manage these experiences, many people use positive reappraisal coping (including benefit finding and perceiving growth). Effective coping is highly important for PLWHA; stress reduction has salutary effects on multiple indicators of health. The present systematic review, conducted in PubMed, PsycINFO, and CINAHL, synthesises findings from 33 studies of PLWHA, addressing effects of positive reappraisal on health-related outcomes for adults living with HIV as a chronic illness. Studies were evaluated based on methodological considerations, measurement of key variables, and implications for specific aspects of health. Results suggest that positive reappraisal is often beneficial when dealing with the implications of a potentially traumatic HIV diagnosis on one's identity, although effects may be contextually bound. Implications of these findings are reviewed, emphasizing the importance of positive reappraisal for enhancing health promotion and self-management of HIV. Although the present review is limited by inclusion of multiple disparate outcomes and exclusion of non-English-language articles, these findings inform a comprehensive model of direct and indirect effects of positive reappraisal on emotional, functional, physiological, and behavioural aspects of health useful for guiding future research.

Navigating between rules and reality: a qualitative study of HIV positive MSM's experiences of communication at HIV clinics in Sweden about the rules of conduct and infectiousness

The rules of conduct given to people living with HIV in Sweden in accordance with the Swedish Communicable Diseases Act stipulate disclosure obligation to sexual partners and mandatory condom use. Since 2013, treating physicians have the possibility to exempt patients from this disclosure obligation when no considerable risk of transmission is present. This study explored experiences of communication with clinical staff at HIV clinics regarding rules of conduct and infectiousness among men who have sex with men (MSM) living with HIV in Sweden. In-depth interviews were carried out with 10 MSM living with HIV in Sweden. Study participants all reported unmeasurable viral loads. Data were analyzed using qualitative content analysis. Five categories and one theme, "Navigating between rules and reality", were identified. We found that MSM living with HIV had good relationships with clinical staff at HIV clinics. Inconsistencies emerged regarding how they experienced receiving information about the rules of conduct and infectiousness. The findings indicate that lack of sound routines regarding how information and rules of conduct are communicated negatively affects MSM living with HIV and poses potential risks for the individual. The participants' expressed trust in staff at HIV clinics can provide a good basis for improved communication.

Assessing Stigma, Disclosure Regret and Posttraumatic Growth in People Living with HIV

Posttraumatic growth after a diagnosis of HIV is positively associated with adjustment, yet stigma and disclosure regret are negatively associated with adjustment. Research into whether posttraumatic growth is experienced while perceiving stigma and disclosure regret is still growing. This study aimed to determine whether posttraumatic growth maintains a positive relation with life satisfaction after controlling for disclosure regret and perceived stigma. Using a cross-sectional design, a questionnaire measuring life satisfaction, health status, depression, posttraumatic growth, disease severity, perceived stigma, disclosure regret, and demographical information was completed by 73 people living with HIV (PLWH). Results showed that all participants had disclosed to at least one person. Regression results showed that after controlling for other variables, including stigma and disclosure regret, posttraumatic growth was positively associated with life satisfaction. The importance of the relation of posttraumatic growth with subjective measures of adjustment may be important for interventions aimed at supporting PLWH.

Posttraumatic growth among people living with HIV: A systematic review

OBJECTIVES

The aim of this systematic review was to analyse, synthesise and review existing results on posttraumatic growth (PTG) among PLWH. In particular, we investigated the relationship of PTG with sociodemographic, HIV-related clinical variables, positive and negative psychological correlates as well as HIV-related social issues among PLWH.

METHOD

A literature search was performed on Web of Science, PsyARTICLES, MedLine, Proquest and Scopus databases using appropriate descriptors for positive changes among PLWH. Articles were analysed by title, abstract, and full text.

RESULTS

We accepted a set of 24 articles for systematic review and analysis. Consistent findings were obtained with respect to the positive association between psychological and social correlates (optimism, resilience, positive reappraisal coping, positive affect, self-efficacy and social support) and PTG among PLWH. PTG was also negatively related to various aspects of HIV-related distress (depression, substance use, PTSD symptoms, HIV stigma). On the contrary, sociodemographic and especially HIV-related clinical variables were mostly unrelated to PTG among PLWH.

CONCLUSIONS

The self-reported PTG among PLWH may be related to psychological variables rather than to objective characteristics of HIV infection itself. Nevertheless, several aspects of research on PTG among PLWH require modification, both theoretically and methodologically.

A longitudinal analysis of posttraumatic growth and affective well-being among people living with HIV: The moderating role of received and provided social support

Objectives

The aim of this one-year longitudinal study was to examine the temporal relationship between the level of posttraumatic growth (PTG) and affective well-being, measured by the presence of positive and negative affect among people living with the HIV (PLWH). In addition, the moderating effects of received and provided support with respect to the above-mentioned relationship were investigated.

Method

Study participants completed the following psychometric inventories: the Posttraumatic Growth Inventory (PTGI), the Positive and Negative Affect Schedule (PANAS-X), and the Berlin Social Support Scales (BSSS). Three assessments were performed: 129 patients were recruited for the first assessment, 106 patients agreed to participate in the second assessment, and 82 of the initial 129 participants (63.6%) participated in all three assessments.

Results

An indirect association between PTG and positive affect was observed. However, no association was found between PTG and negative affect. Received support, but not provided support, completely moderated the relationship between PTG and positive affect.

Conclusions

This study adds to the literature by examining the temporal relationship between PTG and affective-wellbeing among PLWH. It appears from the results that in this patient group, PTG may enhance the positive affect over time. However, receiving support is vital in this process.

Timing of Diagnosis: Understanding Resilience Narratives of HIV Positive Older Adults Diagnosed Pre- and Post-HAART

BACKGROUND

Despite the growing population of older adults living with human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS), few studies have examined this population in terms of timing of HIV diagnosis. This study explores resilience and protective factors among HIV-positive older adults, 17 of whom were diagnosed prior to the development of highly active antiretroviral therapy (HAART), and 13 of whom were diagnosed after the development of HAART.

METHODS

We explored the concepts of resilience and protective factors in 30 older adults living with HIV in Ontario, Canada. A qualitative approach was used to conduct in-depth interviews and grounded theory techniques were used to analyze the interview transcripts.

RESULTS

Having lived with HIV for nearly 30 years, the pre-HAART group had developed more personal strategies for enhancing resilience, including self-care behaviors. They were more regimented and dedicated to their daily health, and were more engaged in their medical care as opposed to the post-HAART group who viewed self-care as staying adherent and refraining from risky health behaviors.

IMPLICATIONS

Although HAART has radically changed the prognosis of HIV, we have limited information about the differences between those who were diagnosed before and after the development of HAART. We will present recommendations for addressing previous trauma and improving self-care.

Predictors of Resilience and Posttraumatic Growth Among People Living with HIV: A Longitudinal Study

This longitudinal study investigated the predictors of HIV-related resilience (HR) and posttraumatic growth (PTG) among Spanish-speaking HIV-positive people. Perceived past resilience, internalised stigma, and coping strategies were hypothesised as possible predictors. Data were collected at two time points from 119 HIV-positive people. Path analyses with latent variables revealed that half of HR 8 months after diagnosis was predicted by rumination, emotional expression, positive thinking, internalised stigma, and perceived past resilience. The latter three, along with isolation, self-blame, thinking avoidance, and help seeking predicted some PTG dimensions 8 months after diagnosis. The results highlight the importance of internalised stigma associated with HIV infection and of the differential use of coping strategies, and point to the need for clinicians and policy makers to implement stigma reduction and appropriate coping strategies interventions.

Social support, stress coping strategies, resilience and posttraumatic growth in a Polish sample of HIV-infected individuals: results of a 1 year longitudinal study

This study investigated the level of posttraumatic growth (PTG) and its association with the level of social support, stress coping strategies and resilience among a people living with HIV (PLWH) in a 1 year longitudinal study. We also controlled for age, HIV infection duration and the presence of posttraumatic stress symptoms (PTSS). From the 290 participants, initially eligible for the study, 110 patients were recruited for the first assessment and 73 patients participated in a follow-up assessment. Participants filled out following psychometric tools: the Posttraumatic Growth Inventory (PTGI), the Berlin Social Support Scales (BSSS), the Mini-COPE Inventory, the Resiliency Assessment Scale (SPP-25) and the PTSD-F questionnaire. Received support and resilience were positively, whereas return to religion as coping strategy was negatively related to the PTG. Clinicians and researchers need to focus on potentially positive consequences of HIV infection, i.e. PTG, and factors that might promote it among PLWH.

Post-Traumatic Growth Following Politically Motivated Acts of Violence: 10 Years Post Injury

The study explored posttraumatic growth (PTG) and its relationship with the quality of life (QOL), posttraumatic stress, and resilience among survivors of terror attacks over 10 years post-injury. Participants were patients of Hadassah Medical Center, Israel, who were injured in terror attacks between 2000 and 2004 during the second Intifada. Variables of interest were obtained from a survey and patients' medical files. In total, 42 patients participated, 66% were men, and the average age was 41.4 years. Multivariate analysis was utilized to predict PTG from a variety of demographic variables including gender, ethnicity, relationship status, age, education, income, religiosity, and injury/disability type. Additional primary variables of study included current levels of QOL, posttraumatic stress, and resilience. Results revealed that married/partnered individuals had higher levels of PTG than divorced or single individuals. Findings suggest that social support following trauma is important for PTG and should be prioritized in recovery interventions with trauma survivors.

Posttraumatic growth inventory: factor structure in Spanish-speaking people living with HIV

This cross-sectional study analyzed the factorial structure of the Posttraumatic Growth Inventory (PTGI) in a sample of 304 Spanish-speaking HIV-positive adults. Participants completed the PTGI and a socio-demographic questionnaire. Exploratory factor analysis (EFA) was carried out through structural equations modeling, with a Varimax rotation. Factors with eigenvalues greater than 1 were extracted, and items with loadings higher than .5 on a factor and lower than .4 on the rest were retained. Two confirmatory factor analyses (CFA) were performed to test a hierarchical model and a bifactor model. Reliability analyses were conducted. EFA suggested a three-factor model keeping 11 of the original 21 items. The three factors that emerged were changes in philosophy of life, in the self and in interpersonal relationships. CFAs suggested that only the bifactor model fitted the data. The three factors as well as the global scale showed good reliability. The factor structure of PTGI's scores in our data is consistent with the three dimensions theorized by Tedeschi and Calhoun, which speaks in favor of the construct validity of this measure.

Social support and posttraumatic growth in a longitudinal study of people living with HIV: the mediating role of positive affect

Background: Psychological research in people living with HIV (PLWH) has been dominated by studies on the negative consequences of HIV infection. However, recently, positive changes following the diagnosis of HIV have been examined, namely the phenomenon of posttraumatic growth (PTG). Objectives: The aim of this one-year longitudinal study was to investigate the level of PTG and its relationship with social support dimensions (perceived support, need for support, actually received support) and positive and negative affect among PLWH. Specifically, this study explored the mediating role of positive and negative affect in the link between social support and PTG. Method: Participants filled out the following psychometric tools: Posttraumatic Growth Inventory (PTGI), Berlin Social Support Scales (BSSS) and Positive and Negative Affect Schedule (PANAS-X). Three assessments were performed. Altogether, 129 patients were recruited for the first assessment, 106 patients participated in the second assessment and 82 participants (63.6%) out of the initial sample of 129 participated in all three assessments. Results: The positive relationship between all examined social support dimensions and PTG was entirely mediated by positive affect. There was no association between negative affect and PTG. Selected socio-medical covariates (sex, employment, higher education, being in a stable relationship and HIV/AIDS status) were related to social support and PTG among participants. Conclusions: This study points to the need for more research on positive aspects of HIV/AIDS, notably PTG. More specifically, interventions focused on enhancement and sustainment of positive affect among PLWH should be an adjunct to traditional mental health screening among this patient group.

Internalized HIV Stigma and Disclosure Concerns: Development and Validation of Two Scales in Spanish-Speaking Populations

Internalized stigma and disclosure concerns are key elements for the study of mental health in people living with HIV. Since no measures of these constructs were available for Spanish population, this study sought to develop such instruments, to analyze their reliability and validity and to provide a short version. A heterogeneous sample of 458 adults from different Spanish-speaking countries completed the HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale, along with the Hospital Anxiety and Depression Scale, Rosenberg's Self-esteem Scale and other socio-demographic variables. Reliability and correlation analyses, exploratory factor analyses, path analyses with latent variables, and ANOVAs were conducted to test the scales' psychometric properties. The scales showed good reliability in terms of internal consistency and temporal stability, as well as good sensitivity and factorial and criterion validity. The HIV-Internalized Stigma Scale and the HIV-Disclosure Concerns Scale are reliable and valid means to assess these variables in several contexts.

Latent Profiles of Posttraumatic Growth and Their Relation to Differences in Resilience among Only-Child-Lost People in China

AIMS

Since the early 1980s, the one-child policy has been implemented nationwide in China. A special group called the "only-child-lost family" (OCL family) has emerged and has become a social phenomenon that cannot be ignored. We report latent profiles of posttraumatic growth and their relation to differences in resilience among OCL people in China.

METHODS

A total of 222 OCL people were investigated using the Posttraumatic Growth Inventory and the Connor-Davidson Resilience Scale. Latent profile analysis was applied to explore PTG latent profiles. Multinomial logistic regression was used to analyze the socio-demographic variables in each latent profile and the association between profile membership and resilience.

RESULTS

Three latent profiles were identified and labeled the "high appreciation-power group" (30.6%), the "general moderate growth group" (47.7%) and the "low growth and extreme possibility group" (21.7%). Compared to those in the high appreciation-power group, individuals with monthly income >2000 ($312) were less likely to be in the general moderate growth group (OR = 0.13, P<0.01), whereas individuals with a spouse were less likely to be in the low growth and extreme possibility group (OR = 0.43, P<0.01). Individuals in the "general moderate growth group"(OR = 0.92, P<0.01, 95%CI:0.89-0.94) and the "low growth and extreme possibility" groups (OR = 0.83, P<0.01, 95%CI:0.79-0.87) demonstrated significantly lower levels of resilience compared to the high appreciation-power group.

CONCLUSION

The PTG patterns in only-child-lost parents were varied. Promoting resilience may be a way to foster these parents' PTG. Targeted intervention should be developed based on the characteristics of each latent class, and timely attention must be paid to the mental health of OCL parents who are without a spouse and have low income.

Serostatus Disclosure, Stigma Resistance, and Identity Management Among HIV-Positive Gay Men in Ireland

In this study, we examined how non-infectiousness due to antiretroviral therapy has affected HIV-positive gay men's experience of serostatus disclosure to casual sex partners. Interviews were conducted with 15 seropositive gay men living in Ireland. Using grounded theory, three constructions of non-disclosure were proposed-as self-protection, as a morally permissible act, and as a rejection of the HIV-positive identity. Each construction entailed an aspect related to the sexual exclusion of those living with HIV, and an aspect related to their social exclusion. The extent to which the lives of those interviewed were affected by stigma was starkly revealed, as was the extent to which they stigmatized others living with HIV and rejected the HIV-positive identity. The research highlights the failure to socially normalize HIV and that interventions are needed to reduce the distress associated with seropositivity.

‘I'm happy in my life now, I'm a positive person’: approaches to successful ageing in older adults living with HIV in Ontario, Canada

Worldwide approximately 3.6 million people aged 50 and older are living and ageing with the human immunodeficiency virus (HIV). Few studies have explored successful ageing from the insider perspective of those living well and ageing with HIV. This study draws upon the lived experience and wisdom of older, HIV-positive adults living in Ontario, Canada in order to understand their views and strategies for successful ageing. This qualitative study involved semi-structured interviews with 30 individuals age 50 years and older who are HIV-positive. Purposive sampling techniques were used to recruit individuals who shared their experiences of successful ageing. Constructivist grounded theory coding techniques were used for analysis. Themes related to successful ageing included resilience strategies and challenges, social support and environmental context. Stigma and struggles to maintain health were identified as impediments to successful ageing. Models of successful ageing must take into account the potential for a subjective appraisal of success in populations suffering from chronic and life-threatening illnesses including HIV. Practitioners can draw upon organically existent strengths in this population in order to provide intervention development for older adults around the world who are struggling to manage their HIV.

Impacts of making sense of adversity on depression, posttraumatic stress disorder, and posttraumatic growth among a sample of mainly newly diagnosed HIV-positive Chinese young homosexual men: the mediating role of resilience

The experience of HIV, as a life-transforming event, might produce both negative and positive outcomes. Guided by the stress appraisal model, the present study investigated the hypothesized pathways in predicting symptomatology and posttraumatic growth (PTG) in a sample of Chinese male patients with HIV (PHIV) who were mainly newly diagnosed, young, and homosexual. In this cross-sectional study, 141 Chinese male PHIV (87.2% of them were homosexual) completed measures of making negative/positive sense of adversity, resilience, depression, posttraumatic stress disorder (PTSD), and PTG. The path analysis results showed that making negative sense of adversity was associated with depression and PTSD, partially mediated by low levels of resilience, whereas making positive sense of adversity was associated with PTG, partially mediated by resilience. The results suggest that negative and positive outcomes of trauma are impacted by making negative and positive sense of adversity, respectively, via two separate pathways, both mediated by resilience. Our findings contribute to an understanding of the cognitive process of symptomatology and PTG in the HIV context. Theoretical considerations, clinical implications, and future directions are discussed.

Fate control and well-being in Chinese rural people living with HIV: mediation effect of resilience

Fate control has been often misconceptualized as a superstitious belief and overlooked in health psychology. It is not known how this cultural belief might impact the well-being of Chinese people living with HIV. This study examined the protective role of fate control for well-being and the potential mediation effect of resilience. Participants in this study were rural patients who contracted HIV via commercial blood donation. In this cross-sectional survey, 250 participants completed measures of fate control, well-being, and resilience. The results showed that fate control and resilience were positively associated with well-being. Resilience mediated the association between fate control and well-being. Our findings provide insight into the adaptive function of fate control as a cognitive defensive mechanism and highlight the need to incorporate this cultural belief in developing culturally sensitive intervention programs for resilience enhancement tailored for this understudied population infected with HIV living in rural China.

Gender differences in posttraumatic stress symptoms and the level of posttraumatic growth among a Polish sample of HIV-positive individuals

The main goal of the current study was to investigate gender differences in the relationship between the level of posttraumatic stress symptoms (PTSSs) and the intensity of posttraumatic growth (PTG), treated as the explained variable, among a Polish sample of HIV-positive individuals (n = 250) while controlling for participants' ages and time since HIV diagnosis. The level of PTG was measured using the Polish adaptation of the Posttraumatic Growth Inventory. The level of PTSSs was assessed using the PTSD Factorial Version Inventory. HIV-positive women scored higher for some PTSSs (intrusion/arousal) and for a particular PTG dimension (spiritual change). In addition, the PTSSs that occurred were negatively related to the PTG level but only among HIV-positive women. Given the important health-related benefits associated with PTG among HIV-positive people, it is vital to shape competencies for effective growth promotion among these individuals, taking into account gender differences within this phenomenon.