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Quach LT, Ritchie CS, Reynolds Z, Paul R, Seeley J, Tong Y, Hoeppner S, Okello S, Nakasujja N, Olivieri-Mui B, Saylor D, Greene M, Asiimwe S, Tindimwebwa E, Atwiine F, Sentongo R, Siedner MJ, Tsai AC. HIV, Social Networks, and Loneliness among Older Adults in Uganda. AIDS Behav 2024; 28:695-704. [PMID: 38281251 PMCID: PMC10947585 DOI: 10.1007/s10461-023-04258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
Loneliness among older adults has been identified as a major public health problem. Yet little is known about loneliness, or the potential role of social networks in explaining loneliness, among older people with HIV (PWH) in sub-Saharan Africa, where 70% of PWH reside. To explore this issue, we analyzed data from 599 participants enrolled in the Quality of Life and Ageing with HIV in Rural Uganda study, including older adults with HIV in ambulatory care and a comparator group of people without HIV of similar age and gender. The 3-item UCLA Loneliness Scale was used to measure loneliness, and HIV status was the primary explanatory variable. The study found no statistically significant correlation between loneliness and HIV status. However, individuals with HIV had smaller households, less physical and financial support, and were less socially integrated compared to those without HIV. In multivariable logistic regressions, loneliness was more likely among individuals who lived alone (aOR:3.38, 95% CI:1.47-7.76) and less likely among those who were married (aOR:0.34, 95% CI:0.22-0.53) and had a higher level of social integration (aOR:0.86, 95% CI: 0.79-0.92). Despite having smaller social networks and less support, older adults with HIV had similar levels of loneliness as those without HIV, which may be attributed to resiliency and access to HIV-related health services among individuals with HIV. Nonetheless, further research is necessary to better understand the mechanisms involved.
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Affiliation(s)
- Lien T Quach
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Centre for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA.
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- The Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, USA.
| | - Christine S Ritchie
- Centre for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Zahra Reynolds
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri at St. Louis, St. Louis, USA
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Yao Tong
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susanne Hoeppner
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University School of Medicine, Kampala, Uganda
| | - Brianne Olivieri-Mui
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith Greene
- Department of Medicine, Indiana University School of Medicine and Indiana University Center for Aging Research, Regenstreif Institute, Inc., Indianapolis, IN, USA
| | - Stephen Asiimwe
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Kabwohe Clinical Research Center, Kabwohe, Uganda
| | | | - Flavia Atwiine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
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Denardo D, Mojola SA, Schatz E, Gómez-Olivé FX. Antiretroviral therapy and aging as resources for managing and resisting HIV-related stigma in rural South Africa. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100148. [PMID: 36687383 PMCID: PMC9851406 DOI: 10.1016/j.ssmqr.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The widespread roll-out of antiretroviral therapy (ART) in Africa has contributed to a large population of adults aging with HIV. However, little is known about how HIV-related stigma interacts with aging in the ART era. This study uses in-depth interviews with middle-aged and older South Africans living with HIV to explore stigma-related experiences and response strategies. Participants describe a persistence of stigma which requires the deployment of a range of common and age-based stigma management and resistance strategies. We find that participants minimize their exposure to stigma through selective disclosure of their HIV status; neutralize HIV-related stigma through comparisons to chronic illnesses common among older adults, and deflect stigma through asserting an ART-adherent identity and othering younger non-adherent adults. Overall, our study highlights the roles of ART and aging as resources for managing and resisting HIV-related stigma.
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Affiliation(s)
- Danielle Denardo
- Social and Behavioral Sciences, Soka University of America, Aliso Viejo, CA, USA
| | - Sanyu A. Mojola
- Department of Sociology, School of Public and International Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
- Department of Public Health and Department of Women’s & Gender Studies, University of Missouri, Columbia, MO, USA
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
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Chipanta D, Amo-Agyei S, Giovenco D, Estill J, Keiser O. Socioeconomic inequalities in the 90-90-90 target, among people living with HIV in 12 sub-Saharan African countries - Implications for achieving the 95-95-95 target - Analysis of population-based surveys. EClinicalMedicine 2022; 53:101652. [PMID: 36159044 PMCID: PMC9489496 DOI: 10.1016/j.eclinm.2022.101652] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background Inequalities undermine efforts to end AIDS by 2030. We examined socioeconomic inequalities in the 90-90-90 target among people living with HIV (PLHIV) -men (MLHIV), women (WLHIV) and adolescents (ALHIV). Methods We analysed the available Population HIV Impact Assessment (PHIA) survey data for each of the 12 sub-Saharan African countries, collected between 2015 and 2018 to estimate the attainment of each step of the 90-90-90 target by wealth quintiles. We constructed concentration curves, computed concentration indices (CIX) -a negative (positive) CIX indicated pro-poor (pro-rich) inequalities- and identified factors associated with, and contributing to inequality. Findings Socioeconomic inequalities in achieving the 90-90-90 target components among PLHIV were noted in 11 of the 12 countries surveyed: not in Rwanda. Awareness of HIV positive status was pro-rich in 5/12 countries (Côte d'Ivoire, Tanzania, Uganda, Malawi, and Zambia) ranging from CIX=0·085 (p< 0·05) in Tanzania for PLHIV, to CIX = 0·378 (p<0·1) in Côte d'Ivoire for ALHIV. It was pro-poor in 5/12 countries (Côte d'Ivoire, Ethiopia, Malawi, Namibia and Eswatini), ranging from CIX = -0·076 (p<0·05) for PLHIV in Eswatini, and CIX = -0·192 (p<0·05) for WLHIV in Ethiopia. Inequalities in accessing ART were pro-rich in 5/12 countries (Cameroun, Tanzania, Uganda, Malawi and Zambia) ranging from CIX=0·101 (p<0·05) among PLHIV in Zambia to CIX=0·774 (p<0·1) among ALHIV in Cameroun and pro-poor in 4/12 countries (Tanzania, Zimbabwe, Lesotho and Eswatini), ranging from CIX = -0·072 (p<0·1) among PLHIV in Zimbabwe to CIX = -0·203 (p<0·05) among WLHIV in Tanzania. Inequalities in HIV viral load suppression were pro-rich in 3/12 countries (Ethiopia, Uganda, and Lesotho), ranging from CIX = 0·089 (p< 0·1) among PLHIV in Uganda to CIX = 0·275 (p<0·01) among WLHIV in Ethiopia. Three countries (Tanzania CIX = 0·069 (p< 0·5), Uganda CIX = 0·077 (p< 0·1), and Zambia CIX = 0·116 (p< 0·1)) reported pro-rich and three countries (Côte d'Ivoire CIX = -0·125 (p< 0·1), Namibia CIX = -0·076 (p< 0·05), and Eswatini CIX = -0·050 (p< 0·05) pro-poor inequalities for the cumulative CIX for HIV viral load suppression. The decomposition analysis showed that age, rural-urban residence, education, and wealth were associated with and contributed the most to inequalities observed in achieving the 90-90-90 target. Interpretation Some PLHIV in 11 of 12 countries were not receiving life-saving HIV testing, treatment, or achieving HIV viral load suppression due to socioeconomic inequalities. Socioeconomic factors were associated with and explained the inequalities observed in the 90-90-90 target among PLHIV. Governments should scale up equitable 95-95-95 target interventions, prioritizing the reduction of age, rural-urban, education and wealth-related inequalities. Research is needed to understand interventions to reduce socioeconomic inequities in achieving the 95-95-95 target. Funding This study was supported by the Swiss National Science Foundation (grant 202660).
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Affiliation(s)
- David Chipanta
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- United nations joint programme on HIV/AIDS (UNAIDS), Equality and Rights for All, Geneva 27, CH1211, Switzerland
| | - Silas Amo-Agyei
- Department of Economics, University of Lausanne, Lausanne, Switzerland
| | - Danielle Giovenco
- Brown University, School of Public Health, International Health Institute, Providence, RI, USA
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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de Andrade SLE, Moreira Freire ME, Collet N, Brandão GCG, Souza MHDN, Nogueira JDA. Structure of social networks of people living with HIV and AIDS. Rev Esc Enferm USP 2022; 56:e20210525. [PMID: 35201256 PMCID: PMC10184756 DOI: 10.1590/1980-220x-reeusp-2021-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the structure of the social network of people living with HIV and AIDS. METHOD Exploratory and descriptive research with a qualitative approach, developed through interviews with twenty-two people living with HIV and AIDS, from November to December 2019. For analysis, the theoretical-methodological framework of social network was used. RESULTS The primary networks were of medium size and low density, formed by family members, relatives, friends, neighbors, and colleagues. The secondary networks were characterized by public, private, third sector institutions, workplaces, and by the informal network, which provided support according to the need for care. CONCLUSION The family was considered the center of the primary social network structure; however, weaknesses in these social relationships were evidenced. The family relational context of the person with HIV and AIDS was influenced by the secrecy of the diagnosis due to the fear of prejudice and discrimination for being HIV-positive. There was a predilection for the services of the secondary social network that took on the role of specific care for the disease.
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Affiliation(s)
| | - Maria Eliane Moreira Freire
- Universidade Federal da Paraíba, Programa de Pós-graduação em Enfermagem, Departamento de Enfermagem Clínica, João Pessoa, PB, Brazil
| | - Neusa Collet
- Universidade Federal da Paraíba, Programa de Pós-graduação em Enfermagem, Departamento de Enfermagem de Saúde Coletiva, João Pessoa, PB, Brazil
| | | | - Maria Helena do Nascimento Souza
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem e Saúde Pública, Rio de Janeiro, RJ, Brazil
| | - Jordana de Almeida Nogueira
- Universidade Federal da Paraíba, Programa de Pós-graduação em Enfermagem, Departamento de Enfermagem Clínica, João Pessoa, PB, Brazil
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