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Zhabokritsky A, Klein M, Loutfy M, Guaraldi G, Andany N, Guillemi S, Falutz J, Arbess G, Tan DHS, Walmsley S. Non-AIDS-defining comorbidities impact health related quality of life among older adults living with HIV. Front Med (Lausanne) 2024; 11:1380731. [PMID: 38690177 PMCID: PMC11058201 DOI: 10.3389/fmed.2024.1380731] [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: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction The life expectancy of people living with HIV receiving effective combination antiretroviral therapy is approaching that of the general population and non AIDS-defining age-related comorbidities are becoming of greater concern. In order to support healthy aging of this population, we set out to explore the association between multimorbidity (defined as presence of 2 or more non AIDS-defining comorbidities) and quality of life (QoL). Methods We performed a cross-sectional analysis using data from the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, a Canadian cohort of people living with HIV age 65 years and older. Study participants completed two QoL modules, the general QoL and health related QoL (HR-QoL). Results 433 participants were included in the analysis with a median age of 69 years (interquartile range, IQR 67-72). The median number of comorbidities among study participants was 3 (IQR 2-4), with 78% meeting the definition of multimorbidity. General QoL scores (median 66, IQR 58-76) were lower than HR-QoL scores (median 71, IQR 61-83) and were not associated with multimorbidity after adjusting for age, sex, relationship status, household income, exercise, tobacco smoking history, malnutrition, time since HIV diagnosis, and HIV-related stigma. In contrast, multimorbidity was associated with lower HR-QoL (adjusted β = -4.57, 95% CI -8.86, -0.28) after accounting for the same variables. Several social vulnerabilities (not having a partner, low household income), health behaviours (lower engagement in exercise, smoking), and HIV-related factors (HIV stigma, longer time since HIV diagnosis) were also associated with lower QoL. Discussion Overall, our study demonstrated a high burden of multimorbidity among older adults living with HIV in Canada, which has a negative impact on HR-QoL. Interventions aimed at preventing and managing non-AIDS-defining comorbidities should be assessed in people living with HIV to determine whether this can improve their HR-QoL.
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Affiliation(s)
- Alice Zhabokritsky
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marina Klein
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Mona Loutfy
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, ON, Canada
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Nisha Andany
- Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - Silvia Guillemi
- BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada
| | - Julian Falutz
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Gordon Arbess
- Unity Health Toronto, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Darrell H. S. Tan
- Unity Health Toronto, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharon Walmsley
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
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Pitpitan EV, Horvath KJ, Aldous J, Stockman JK, Patterson TL, Liang M, Barrozo C, Moore V, Penninga K, Smith LR. Peers plus mobile app for treatment in HIV (PATH): protocol for a randomized controlled trial to test a community-based integrated peer support and mHealth intervention to improve viral suppression among Hispanic and Black people living with HIV. Trials 2024; 25:212. [PMID: 38520030 PMCID: PMC10958824 DOI: 10.1186/s13063-024-08042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Significant disparities continue to exist in the HIV care continuum, whereby Hispanic and Black people living with HIV (PLWH) are less likely to achieve viral suppression compared to their White counterparts. Studies have shown that intervention approaches that involve peer navigation may play an important role in supporting patients to stay engaged in HIV care. However, implementation may be challenging in real-world settings where there are limited resources to support peer navigators. Combining a peer navigation approach with scalable mobile health (mHealth) technology may improve impact and implementation outcomes. METHODS We combined a peer navigation intervention with a mHealth application and are conducting a randomized controlled trial (RCT) to test the efficacy of this integrated "Peers plus mobile App for Treatment in HIV" (PATH) intervention to improve HIV care engagement, and ultimately sustained viral suppression, among Hispanic and Black PLWH. We will enroll up to 375 PLWH into a two-arm prospective RCT, conducting follow-up assessments every 3 months up to 12 months post-baseline. Participants randomized to the control arm will continue to receive usual care Ryan White Program case management services. Individuals randomized to receive the PATH intervention will receive usual care plus access to two main intervention components: (1) a peer navigation program and (2) a mHealth web application. The primary outcome is sustained HIV viral suppression (undetectable viral load observed at 6- and 12-month follow-up). Secondary outcomes are retention in HIV care, gaps in HIV medical visits, and self-reported ART adherence. Recruitment for the RCT began in November 2021 and will continue until June 2024. Follow-up assessments and medical chart abstractions will be conducted to collect measurements of outcome variables. DISCUSSION The efficacy trial of PATH will help to fill gaps in our scientific understanding of how a combined peer navigation and mHealth approach may produce effects on HIV care outcomes while addressing potential implementation challenges of peer navigation in Ryan White-funded clinics. TRIAL REGISTRATION The PATH trial is registered at the United States National Institutes of Health National Library of Medicine (ClinicalTrials.gov) under ID # NCT05427318 . Registered on 22 June 2022.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, San Diego, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA.
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, USA
| | | | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, USA
| | - Megan Liang
- San Diego State University Research Foundation, San Diego, USA
| | | | | | | | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, USA
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Wagner GJ, Bogart LM, Klein DJ, Lawrence SJ, Goggin K, Gizaw M, Mutchler MG. Culturally Relevant Africultural Coping Moderates the Association Between Discrimination and Antiretroviral Adherence Among Sexual Minority Black Americans Living with HIV. AIDS Behav 2024; 28:408-420. [PMID: 38060112 PMCID: PMC10876751 DOI: 10.1007/s10461-023-04233-7] [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: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Exposure to discrimination has been linked to lower HIV antiretroviral therapy (ART) adherence and poor HIV care outcomes among Black Americans. Coping has been shown to mitigate the harmful effects of discrimination on health behaviors, but the use of cultural relevant Africultural coping strategies is understudied as a moderator of the association between intersectional discrimination and ART adherence among Black Americans. We used adjusted logistic regression to test whether Africultural coping strategies (cognitive/emotional debriefing; collective; spiritual-centered; ritual-centered) moderated associations between multiple forms of discrimination (HIV, sexual orientation, race) and good ART adherence (minimum of 75% or 85% of prescribed doses taken, as measured by electronic monitoring in separate analyses) among 92 sexual minority Black Americans living with HIV. Mean adherence was 66.5% in month 8 after baseline (36% ≥ 85% adherence; 49% ≥ 75% adherence). Ritual-centered coping moderated the relationship between each of the three types of discrimination at baseline and good ART adherence in month 8 (regardless of the minimum threshold for good adherence); when use of ritual coping was low, the association between discrimination and adherence was statistically significant. The other three coping scales each moderated the association between racial discrimination and good ART adherence (defined by the 75% threshold); cognitive/emotional debriefing was also a moderator for both HIV- and race-related discrimination at the 85% adherence threshold. These findings support the benefits of Africultural coping, particularly ritual-centered coping, to help sexual minority Black Americans manage stressors associated with discrimination and to adhere well to ART.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | | | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri - Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Matt G Mutchler
- APLA Health & Wellness, Los Angeles, CA, USA
- California State University Dominguez Hills, Carson, CA, USA
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4
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Quinn KG, Walsh JL, DiFranceisco W, Edwards T, Takahashi L, Johnson A, Dakin A, Bouacha N, Voisin DR. The Inherent Violence of Anti-Black Racism and its Effects on HIV Care for Black Sexually Minoritized Men. J Urban Health 2024; 101:23-30. [PMID: 38158546 PMCID: PMC10897081 DOI: 10.1007/s11524-023-00823-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
The goal of this study was to examine the effects of racial discrimination, depression, and Black LGBTQ community support on HIV care outcomes among a sample of Black sexually minoritized men living with HIV. We conducted a cross-sectional survey with 107 Black sexually minoritized men living with HIV in Chicago. A path model was used to test associations between racial discrimination, Black LGBTQ community support, depressive symptoms, and missed antiretroviral medication doses and HIV care appointments. Results of the path model showed that men who had experienced more racism had more depressive symptoms and subsequently, missed more doses of HIV antiretroviral medication and had missed more HIV care appointments. Greater Black LGBTQ community support was associated with fewer missed HIV care appointments in the past year. This research shows that anti-Black racism may be a pervasive and harmful determinant of HIV inequities and a critical driver of racial disparities in ART adherence and HIV care engagement experienced by Black SMM. Black LGBTQ community support may buffer against the effects of racial discrimination on HIV care outcomes by providing safe, inclusive, supportive spaces for Black SMM.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Jennifer L Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wayne DiFranceisco
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Travonne Edwards
- School of Child and Youth Care, Toronto Metropolitan University, Toronto, Canada
| | - Lois Takahashi
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Anthony Johnson
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
| | | | | | - Dexter R Voisin
- School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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5
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Barreras JL, Bogart LM, MacCarthy S, Klein DJ, Pantalone DW. Discrimination and adherence in a cross-sectional study of Latino sexual minority men with HIV: Coping with discrimination as a mediator and coping self-efficacy as a moderator. J Behav Med 2023; 46:1057-1067. [PMID: 37392342 PMCID: PMC10577103 DOI: 10.1007/s10865-023-00426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/25/2023] [Indexed: 07/03/2023]
Abstract
Discrimination is associated with antiretroviral therapy non-adherence and reduced well-being among people with HIV. We examined the potential for coping to mediate the associations between intersectional discrimination and non-adherence and coping self-efficacy (confidence in one's ability to cope with discrimination) as a moderator that may buffer the negative effects of discrimination on non-adherence in a cross-sectional convenience sample of 82 Latino sexual minority men with HIV. In bivariate linear regressions, discrimination targeting Latino ethnic origin, undocumented residency status, and sexual orientation were each significantly associated with lower self-reported antiretroviral therapy non-adherence (percentage of prescribed doses taken in the last month) and greater use of disengagement coping (denial, substance use, venting, self-blame, behavioral disengagement). Associations between discrimination targeting Latino ethnicity and non-adherence, and discrimination targeting undocumented residency status and non-adherence, were each mediated by disengagement coping responses. Moderation analyses highlighted significant discrimination by coping self-efficacy interaction effects-both coping self-efficacy for problem solving and stopping unpleasant emotions/thoughts each moderated the associations between Latino discrimination and adherence, between undocumented residency status discrimination and adherence, and between HIV discrimination and adherence. Coping self-efficacy for getting social support moderated the association between undocumented residency status discrimination and adherence. Further, the interaction coefficients across models indicated that the negative effects of discrimination on adherence were attenuated at higher levels of coping self-efficacy. Findings highlight the need for structural interventions that reduce-and ultimately eliminate-discrimination, and interventions that address the harmful effects of discrimination and adherence improvement interventions to enhance coping skills among people faced with intersectional discrimination.
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Affiliation(s)
- Joanna L Barreras
- School of Social Work, California State University Long Beach, 1250 Bellflower Boulevard, Long Beach, CA, 90840, USA.
- Bienestar Human Services, Inc, 5326 East Beverly Blvd, Los Angeles, CA, 90022, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
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6
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Zhang H, Sanchez T, Zlotorzynska M, Baral S, Hecht J. Experiences of Stigma and HIV Status Associated with Awareness and Usage of Safer Sex Functions in Dating Apps Among MSM, 2019 American Men's Internet Survey (AMIS) Study. AIDS Behav 2023; 27:3603-3611. [PMID: 37421546 DOI: 10.1007/s10461-023-04074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 07/10/2023]
Abstract
Dating apps represent opportunities to implement sexual health interventions among gay, bisexual, and other men who have sex with men (MSM), particularly those who may avoid traditional health services due to intersecting stigmas. We used multivariable models to explore whether stigma experience was associated with awareness and usage of safer sex functions in dating apps among 7700 MSM who completed a 2019 US nationwide online survey. Perceived community intolerance of gay and bisexual men was associated with reduced awareness of sexual health strategy profile options (adjusted prevalence ratio [aPR] 0.95; 95% confidence interval [95% CI] 0.93-0.98) and sexual health information and resources (aPR 0.97; 95% CI 0.94-0.99). Stigma from family and friends was associated with increased usage of app-based sexual health reminders (aPR 1.14; 95% CI 1.02-1.28) and sexual health information and resources (aPR 1.16; 95% CI 1.04-1.31). Stigma experience of MSM should be considered in optimizing app-based sexual health interventions.
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Affiliation(s)
- Haisu Zhang
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Travis Sanchez
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA.
| | - Maria Zlotorzynska
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Stefan Baral
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21215, USA
| | - Jen Hecht
- Building Healthy Online Communities, Springboard Health Lab, Richmond, USA
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7
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Agterberg S, Weinberger AH, Stanton CA, Shuter J. Perceived racial/ethnic discrimination and cigarette smoking behaviors among a sample of people with HIV. J Behav Med 2023; 46:801-811. [PMID: 36864228 DOI: 10.1007/s10865-023-00401-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/09/2023] [Indexed: 03/04/2023]
Abstract
This study was a secondary analysis of baseline data from a clinical trial of an intensive group-based smoking cessation treatment for people with HIV (PWH) who smoke. It examined the cross-sectional relationship between perceived ethnic discrimination (PED) and cigarette smoking variables (i.e., nicotine dependence, motivation to quit smoking, self-efficacy to quit smoking) among PWH and explored whether depressive symptoms mediated the relationship between PED and smoking variables. Participants (N = 442; Mage = 50.6; 52.8% Male; 56.3% Black, non-Hispanic; 6.3% White, non-Hispanic; 13.3% Hispanic; 87.7% unemployed; 81.6% single) completed measures of demographics, cigarette smoking, depressive symptoms, and PED. Greater PED was related to lower self-efficacy to quit smoking, greater perceived stress, and greater depressive symptoms. In addition, depressive symptoms mediated the relationship between PED and two cigarette smoking variables (i.e., nicotine dependence, self-efficacy to quit smoking). Findings highlight the need for smoking interventions to target PED, self-efficacy, and depressive symptoms to improve smoking cessation variables among PWH.
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Affiliation(s)
- Silvana Agterberg
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cassandra A Stanton
- Westat, Rockville, MD, USA
- Georgetown University Medical Center, Washington, DC, USA
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Masters RK, Tilstra AM, Simon DH, Coleman-Minahan K. Differences in Determinants: Racialized Obstetric Care and Increases in U.S. State Labor Induction Rates. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:174-191. [PMID: 37098856 PMCID: PMC10848243 DOI: 10.1177/00221465231165284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Induction of labor (IOL) rates in the United States have nearly tripled since 1990. We examine official U.S. birth records to document increases in states' IOL rates among pregnancies to Black, Latina, and White women. We test if the increases are associated with changes in demographic characteristics and risk factors among states' racial-ethnic childbearing populations. Among pregnancies to White women, increases in state IOL rates are strongly associated with changes in risk factors among White childbearing populations. However, the rising IOL rates among pregnancies to Black and Latina women are not due to changing factors in their own populations but are instead driven by changing factors among states' White childbearing populations. The results suggest systemic racism may be shaping U.S. obstetric care whereby care is not "centered at the margins" but is instead responsive to characteristics in states' White populations.
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Affiliation(s)
- Ryan K. Masters
- University of Colorado Boulder, Boulder, CO, USA
- University of Colorado Population Center, Boulder, CO, USA
| | - Andrea M. Tilstra
- University of Colorado Population Center, Boulder, CO, USA
- Oxford University, Oxford, UK
| | - Daniel H. Simon
- University of Colorado Boulder, Boulder, CO, USA
- University of Colorado Population Center, Boulder, CO, USA
| | - Kate Coleman-Minahan
- University of Colorado Population Center, Boulder, CO, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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9
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Burton KL, Ritchwood TD, Metzger IW. Structural Racism and Racial Trauma Among African Americans at Elevated Risk for HIV Infection. Am J Public Health 2023; 113:S102-S106. [PMID: 37339423 PMCID: PMC10282852 DOI: 10.2105/ajph.2023.307223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Kelsey L Burton
- Kelsey L. Burton and Tiarney D. Ritchwood are with the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC. Tiarney D. Ritchwood is also a guest editor of this special issue. Isha W. Metzger is with the Department of Psychology, Georgia State University, Atlanta
| | - Tiarney D Ritchwood
- Kelsey L. Burton and Tiarney D. Ritchwood are with the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC. Tiarney D. Ritchwood is also a guest editor of this special issue. Isha W. Metzger is with the Department of Psychology, Georgia State University, Atlanta
| | - Isha W Metzger
- Kelsey L. Burton and Tiarney D. Ritchwood are with the Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC. Tiarney D. Ritchwood is also a guest editor of this special issue. Isha W. Metzger is with the Department of Psychology, Georgia State University, Atlanta
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10
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Dale SK, Nelson CM, Wright IA, Etienne K, Lazarus K, Gardner N, Bolden R, Adeojo L, Patrick J, Wallen C, Liu J, Ironson G, Alcaide ML, Safren S, Feaster D. Structural equation model of intersectional microaggressions, discrimination, resilience, and mental health among black women with hiv. Health Psychol 2023; 42:299-313. [PMID: 37141016 PMCID: PMC10167554 DOI: 10.1037/hea0001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Compared to non-Black women, Black women in the United States are more likely to be diagnosed with HIV, living with HIV, and have suboptimal HIV outcomes, disparities largely linked to structural and psychosocial factors that may impact mental health. METHOD 151 Black women living with HIV (BWLWH) enrolled in a longitudinal cohort study completed baseline assessments between October 2019 and January 2020 in the Southeastern United States. Measures captured microaggressions (gendered-racial, HIV, and Lesbian/Gay/Bisexual/Transgender/Queer), "macro" discrimination acts (gender, race, HIV, sexual orientation), resilience factors (self-efficacy, trait resilience, posttraumatic growth, positive religious coping, and social support), and mental health (depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic cognitions). Four structural equation models were estimated with latent discrimination (LD), latent microaggression (LM), and latent resilience (LR) as predictors and depressive symptoms, PTSD symptoms, posttraumatic cognitions, and latent mental health (LH) as outcomes. Indirect pathways from LD and LM via LR and LR as a moderator were estimated. RESULTS Models fit well based on indices. There were significant direct pathways from LM and LR to depressive symptoms, posttraumatic cognitions, and LH and a significant direct pathway from LM to PTSD symptoms, but not from LD to any mental health outcome. Indirect pathways were not significant. However, LR moderated the relationships between both LM and LD with PTSD symptoms. CONCLUSION Intersectional microaggressions and resilience factors may play key roles in BWLWH's mental health. Research is needed to examine these pathways overtime and provide opportunities to improve mental health and HIV outcomes among BWLWH. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sannisha K. Dale
- Department of Psychology, University of Miami
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - C. Mindy Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Ian A. Wright
- Department of Economics, University of Miami School of Business
| | | | | | | | | | | | | | | | | | | | - Maria L Alcaide
- Department of Medicine (Infectious Diseases), OB/GYN and Public Health, University of Miami Miller School of Medicine
| | | | - Daniel Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
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11
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Gelaude D, Denson D. "Why You Putting This Drug in Your Body to Fight off Something that You Don't Have?" Perceptions About PrEP Use Among Black and Latino Men Who Have Sex with Men in the U.S. South. JOURNAL OF HOMOSEXUALITY 2023; 70:900-916. [PMID: 34851803 DOI: 10.1080/00918369.2021.2005998] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PrEP use has steadily increased since its introduction, yet uptake remains slow among MSM of color in the U.S. South. Findings presented are from a qualitative study conducted in 2016 exploring factors related to remaining HIV negative among Black (n = 99) and Latino (n = 51) MSM in Atlanta, Baton Rouge, New Orleans, Jackson, and Miami. One-hour in-depth interviews were analyzed using a qualitative content analysis approach. MSM perceived PrEP as providing relief from fear and as an insurance policy against HIV infection but were likely to consider themselves at low risk for HIV. Identified factors influencing PrEP use included side effects, medical mistrust, and stigma. Cost and access were not seen as major barriers. Findings suggest MSM of color in the South may view PrEP as too risky for their HIV prevention needs. PrEP providers can address medical mistrust, discuss side effects, and emphasize positive aspects of PrEP use to increase uptake. (150 words).
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Affiliation(s)
- Deborah Gelaude
- Division of Hiv/aids Prevention, Centers for Disease Control and Prevention, National Center for Hiv/aids, Viral Hepatitis, Std, and Tb Prevention, Atlanta, Georgia, USA
| | - Damian Denson
- Division of Hiv/aids Prevention, Centers for Disease Control and Prevention, National Center for Hiv/aids, Viral Hepatitis, Std, and Tb Prevention, Atlanta, Georgia, USA
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12
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Sharma R, Dale SK. Using Network Analysis to Assess the Effects of Trauma, Psychosocial, and Socioeconomic Factors on Health Outcomes Among Black Women Living with HIV. AIDS Behav 2023; 27:400-415. [PMID: 35927538 PMCID: PMC10712664 DOI: 10.1007/s10461-022-03774-7] [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] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Black women living with HIV (BWLWH) face intersectional adversities impacting their wellbeing. This study utilized network analysis to assess the associations among adversities linked to racism, sexism, HIV stigma, and socioeconomic status (income, housing, education) and determine which adversities predict mental health outcomes, HIV viral load, and medication adherence more consistently among BWLWH. 119 BWLWH aged 18 years or older completed self-report measures on sociodemographics, adversity factors, and mental health outcomes. Viral load count was obtained through blood draws, and medication adherence was measured via Wisepill adherence monitoring device. Multiple regression analysis was used to assess if the more central factors in the network also predicted health outcomes more consistently than the less central factors. The four most central factors in the network were income, housing, gendered racial microaggression (GRM) frequency, and GRM appraisal. Multiple regression analysis revealed that GRM frequency, GRM appraisal, and the number of traumas contributed uniquely and were positively associated with both depressive symptoms and posttraumatic stress disorder symptoms. HIV-related discrimination contributed uniquely and was positively associated with HIV viral load.
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Affiliation(s)
- Ratanpriya Sharma
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
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Bogart LM, Mutchler MG, Goggin K, Ghosh-Dastidar M, Klein DJ, Saya U, Linnemayr S, Lawrence SJ, Tyagi K, Thomas D, Gizaw M, Bailey J, Wagner GJ. Randomized Controlled Trial of Rise, A Community-Based Culturally Congruent Counseling Intervention to Support Antiretroviral Therapy Adherence Among Black/African American Adults Living with HIV. AIDS Behav 2022; 27:1573-1586. [PMID: 36399252 PMCID: PMC9673878 DOI: 10.1007/s10461-022-03921-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
Structural inequities have led to HIV disparities, including relatively low antiretroviral therapy adherence and viral suppression rates among Black Americans living with HIV. We conducted a randomized controlled trial of Rise, a community-based culturally congruent adherence intervention, from January 2018 to December 2021 with 166 (85 intervention, 81 control) Black adults living with HIV in Los Angeles County, California [M (SD) = 49.0 (12.2) years-old; 76% male]. The intervention included one-on-one counseling sessions using basic Motivational Interviewing style to problem solve about adherence, as well as referrals to address unmet needs for social determinants of health (e.g., housing services, food assistance). Assessments included electronically monitored adherence; HIV viral load; and baseline, 7-month follow-up, and 13-month follow-up surveys of sociodemographic characteristics, HIV stigma, medical mistrust, and HIV-serostatus disclosure. Repeated-measures intention-to-treat regressions indicated that Rise led to significantly (two-fold) higher adherence likelihood, lower HIV stigmatizing beliefs, and reduced HIV-related medical mistrust. Effects on HIV viral suppression, internalized stigma, and disclosure were non-significant. Moreover, Rise was cost-effective based on established standards: The estimated cost per person to reach optimal adherence was $335 per 10% increase in adherence. Interventions like Rise, that are culturally tailored to the needs of Black populations, may be optimal for Black Americans living with HIV (ClinicalTrials.gov #NCT03331978).
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Affiliation(s)
- Laura M. Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Matt G. Mutchler
- APLA Health & Wellness, Los Angeles, CA USA ,California State University Dominguez Hills, Carson, CA USA
| | - Kathy Goggin
- Children’s Mercy Kansas City and University of Missouri-Kansas City Schools of Medicine and Pharmacy, Kansas City, MO USA
| | | | - David J. Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Uzaib Saya
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | - Sebastian Linnemayr
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | | | | | - Damone Thomas
- APLA Health & Wellness, Los Angeles, CA USA ,HEALING with HOPE Corp., Los Angeles, CA USA
| | - Mahlet Gizaw
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
| | | | - Glenn J. Wagner
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 USA
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14
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Barak N, Boyle C. Lessons from +LOVE, Improving HIV Care for Black Men Who Have Sex with Men in New Orleans Using an Integrated Behavioral Health Crisis Support Model of Care. AIDS Patient Care STDS 2022; 36:S65-S73. [PMID: 36178382 DOI: 10.1089/apc.2022.0114] [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: 01/29/2023] Open
Abstract
Black men who have sex with men (BMSM) experience higher rates of HIV infection than other groups. They also face disparities in linkage and retention to HIV care, as well as in viral suppression. To address the needs of the BMSM population living with HIV, we developed a novel intervention program (+LOVE), which integrated case management with behavioral health/crisis support. The intervention consisted of (1) a dedicated therapist; (2) an SMS (text message)-based engagement program, CareSignal that provided medication reminders and administered routine ecological momentary assessments (EMAs); (3) a triage crisis coordinator to respond to alerts generated by the EMA responses; and (4) a case manager. This study assessed the additional impact of the first three components of the intervention (a dedicated therapist, text messaging application, along with a triage crisis coordinator), compared with the fourth component alone, the current standard of care (a case manager) on access to HIV care, antiretroviral therapy (ART) adherence, and viral suppression. Analyzing electronic medical record data, survey data, and EMA response data extracted from CareSignal, we found that those who engaged in the behavioral health therapy had higher odds of remaining in HIV care than those who only engaged with the case manager. We also found that increased engagement with CareSignal led to an increased probability of achieving positive HIV-related health outcomes. Our results suggest that an integrated behavioral health/crisis support model of intervention integrated with case managementincreased positive outcomes over case management alone.
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Affiliation(s)
- Narquis Barak
- Department of Prevention, CrescentCare, New Orleans, Louisiana, USA
| | - Caitlin Boyle
- Department of Prevention, CrescentCare, New Orleans, Louisiana, USA
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15
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Kisler KA, Fletcher JB, Reback CJ. Peer Case Management Promoting Advancement Along the HIV Care Continuum Among Black Men Who Have Sex with Men Living with HIV: Building Brothers Up. AIDS Patient Care STDS 2022; 36:S46-S53. [PMID: 36178380 PMCID: PMC9529306 DOI: 10.1089/apc.2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Black men who have sex with men (BMSM) in the United States are at elevated risk for HIV relative to their heterosexual and/or non-BMSM counterparts, yet on average demonstrate suboptimal HIV care linkage and rates of HIV primary care retention. From October 2019 to December 2020, 69 adult (i.e., aged 18-65) BMSM enrolled in Building Brothers Up (2BU), a 6-session peer case management intervention delivered across 3 months and designed to improve retention in HIV primary care through to full viral suppression. Peer case management sessions included detailed assessment of participants' needs and barriers to treatment, which led to the development of a participant-centered treatment plan. All participants self-identified as Black, about three-quarters self-identified as gay (72.5%), and 46.4% reported an annual income of $5000 or less. A total of 69 participants enrolled in 2BU; however, multiply imputed chained equation logistic regressions were carried out on the final analytical data set (n = 40; 99 imputations) due to a large amount of COVID-19-related missing data. Although analyses of retention and achievement of viral suppression did not reach full significance, the probability of a Type-II hypothesis testing error was high, and viral load results (adjusted odds ratio = 1.56; 95% confidence interval = 0.94-2.60; p = 0.08) suggested that increased attendance to peer case management sessions may be associated with improved odds of achieving full viral suppression among BMSM. The significant impact of national race-related civil unrest and the COVID-19 pandemic on the target population during implementation of 2BU is underscored.
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Affiliation(s)
- Kimberly A. Kisler
- Friends Research Institute, Inc., Los Angeles, California, USA.,Department of Public Health, Rongxiang Xu College of Health & Human Services, California State University, Los Angeles, Los Angeles, California, USA.,Address correspondence to: Kimberly A. Kisler, PhD, MPH, Department of Public Health, Rongxiang Xu College of Health & Human Services, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, USA
| | | | - Cathy J. Reback
- Friends Research Institute, Inc., Los Angeles, California, USA.,Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.,Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California, Los Angeles, Los Angeles, California, USA
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16
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Mutchler MG, Wagner GJ, McDavitt B, Woldetsadik MA, Kegeles SM, El-Khoury C, Nogg KA, Klinger IA, Mokhbat J, Ballan EG. Psychometric Properties of a Scale on Judgmental Communication with Peers About Sex Among YMSM and Their Close Friends in Lebanon. AIDS Behav 2022; 26:3089-3098. [PMID: 35322311 PMCID: PMC10234618 DOI: 10.1007/s10461-022-03640-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
We are not aware of any validated sexual health communication scales for use with young men who have sex with men (YMSM). We used data from an HIV prevention study in Lebanon with 226 YMSM aged 18-29 to assess the psychometric characteristics of our scale, Judgmental Communication with Peers about Sex (JCPS). The construct validity of the JCPS scale was supported by it being negatively correlated with general social support, percentage of alters perceived to be supportive, and the percentage of peers who are perceived to use condoms. The scale was positively correlated with gay-related discrimination, feeling part of the gay community, and gay social integration. These findings reflect a reliable, valid measure to assess judgmental sexual health communication between YMSM.
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Affiliation(s)
- Matt G Mutchler
- Department of Health Science, California State University, Dominguez Hills, 1000 E. Victoria Street, Carson, CA, 90747, USA.
- Community-Based Research, AIDS Project Los Angeles (APLA Health), Los Angeles, USA.
| | | | - Bryce McDavitt
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | | | - Susan M Kegeles
- University of California San Francisco School of Medicine, San Francisco, USA
| | | | | | - Ian A Klinger
- Community-Based Research, AIDS Project Los Angeles (APLA Health), Los Angeles, USA
- Department of Sociology, California State University, Dominguez Hills, Carson, USA
| | | | - Elie G Ballan
- The Arab Foundation for Freedoms and Equality, Beirut, Lebanon
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17
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Crawford TN, Silverstein S, Spaulding T, Cheribin D, Murray T, Rivera J, Wilcher K. Exploring the Impact of Experiences with Everyday and Major Discrimination and HIV-Related Stigma on Engagement in HIV Care Among Older African Americans Living with HIV. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01373-9. [PMID: 35876984 DOI: 10.1007/s40615-022-01373-9] [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: 05/11/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES The purpose of this pilot study was to explore the effect of HIV-related stigma and everyday major experiences of discrimination on medication and clinic visit adherence among older African Americans living with HIV in Ohio. METHODS We collected data from 53 individuals who were living with HIV in Ohio, ≥ 50 years of age, and who identified as Black or African American. We conducted logistic regression models to examine the impact of HIV-related stigma and experiences of discrimination on medication and visit adherence. Each model controlled for age, time since diagnosis, and sexual orientation. RESULTS The average age was 53.6 ± 2.1 years and 94.3% were men. Almost half (49.1%) of the participants reported poor medication adherence and almost a third (31.4%) reported poor visit adherence. HIV-related stigma (adjusted odds ratio (aOR) = 1.39; 95% confidence interval (CI) = 1.02-1.89) and major experiences of discrimination (aOR = 1.70; 95% CI = 1.11-2.60) were associated with a greater odds of poor medication adherence. Additionally, major experiences of discrimination were associated with a threefold increase in the odds of poor visit adherence (aOR = 3.24; 95% CI = 1.38-7.64). CONCLUSIONS HIV-related stigma and major experiences of discrimination impede optimal medication and HIV clinic visit adherence for older African Americans living with HIV. To reduce the impact of stigma and discrimination on HIV care engagement, our first step must be in understanding how intersecting forms of stigma and discrimination impact engagement among older African Americans living with HIV.
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Affiliation(s)
- Timothy N Crawford
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA. .,Wright State University Boonshoft School of Medicine, Population and Public Health Sciences, Dayton, OH, USA. .,Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
| | - Sydney Silverstein
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA.,Wright State University Boonshoft School of Medicine, Population and Public Health Sciences, Dayton, OH, USA
| | - Tiffani Spaulding
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Desby Cheribin
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Tamiel Murray
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Josef Rivera
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Katherine Wilcher
- Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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18
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Friedman MR, Liu Q, Meanley S, Haberlen SA, Brown AL, Turan B, Turan JM, Brennan-Ing M, Stosor V, Mimiaga MJ, Ware D, Egan JE, Plankey MW. Biopsychosocial Health Outcomes and Experienced Intersectional Stigma in a Mixed HIV Serostatus Longitudinal Cohort of Aging Sexual Minority Men, United States, 2008‒2019. Am J Public Health 2022; 112:S452-S462. [PMID: 35763737 PMCID: PMC9241468 DOI: 10.2105/ajph.2022.306735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Objectives. To determine whether intersectional stigma is longitudinally associated with biopsychosocial outcomes. Methods. We measured experienced intersectional stigma (EIS; ≥ 2 identity-related attributions) among sexual minority men (SMM) in the United States participating in the Multicenter AIDS Cohort Study. We assessed longitudinal associations between EIS (2008‒2009) and concurrent and future hypertension, diabetes, dyslipidemia, antiretroviral therapy adherence, HIV viremia, health care underutilization, and depression symptoms (2008‒2019). We conducted causal mediation to assess the contribution of intersectional stigma to the relationship between self-identified Black race and persistently uncontrolled outcomes. Results. The mean age (n = 1806) was 51.8 years (range = 22-84 years). Of participants, 23.1% self-identified as Black; 48.3% were living with HIV. Participants reporting EIS (30.8%) had higher odds of hypertension, dyslipidemia, diabetes, depression symptoms, health care underutilization, and suboptimal antiretroviral therapy adherence compared with participants who did not report EIS. EIS mediated the relationship between self-identified Black race and uncontrolled outcomes. Conclusions. Our findings demonstrate that EIS is a durable driver of biopsychosocial health outcomes over the life course. Public Health Implications. There is a critical need for interventions to reduce intersectional stigma, help SMM cope with intersectional stigma, and enact policies protecting minoritized people from discriminatory acts. (Am J Public Health. 2022;112(S4):S452-S462. https://doi.org/10.2105/AJPH.2022.306735).
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Affiliation(s)
- M Reuel Friedman
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Qimin Liu
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Steven Meanley
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Sabina A Haberlen
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Andre L Brown
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Bulent Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Janet M Turan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Mark Brennan-Ing
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Valentina Stosor
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Matthew J Mimiaga
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Deanna Ware
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - James E Egan
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
| | - Michael W Plankey
- M. Reuel Friedman is with the Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA. Qimin Liu is with the Department of Human Development and Psychology, Vanderbilt University, Nashville, TN. Steven Meanley is with the Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia. Sabina A. Haberlen is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Andre L. Brown and James E. Egan are with the Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh. Bulent Turan is with the Department of Psychology, Koc University, Istanbul, Turkey. Janet M. Turan is with the Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. Mark Brennan-Ing is with the Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY. Valentina Stosor is with the Divisions of Infectious Diseases and Organ Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Matthew J. Mimiaga is with the Department of Epidemiology, Fielding School of Public Health, David Geffen School of Medicine, at the University of California‒Los Angeles. Deanna Ware and Michael W. Plankey are with the Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC
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Karver TS, Atkins K, Fonner VA, Rodriguez-Diaz CE, Sweat MD, Taggart T, Yeh PT, Kennedy CE, Kerrigan D. HIV-Related Intersectional Stigma and Discrimination Measurement: State of the Science. Am J Public Health 2022; 112:S420-S432. [PMID: 35763725 PMCID: PMC9241460 DOI: 10.2105/ajph.2021.306639] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/18/2023]
Abstract
Background. Across settings, individuals from populations that are multiply stigmatized are at increased risk of HIV and experience worse HIV treatment outcomes. As evidence expands on how intersecting stigmatized identities and conditions influence HIV outcomes, researchers have used diverse quantitative approaches to measure HIV-related intersectional stigma and discrimination. To date, no clear consensus exists regarding how to best quantitatively measure and analyze intersectional stigma and discrimination. Objectives. To review and document existing quantitative measures of HIV-related intersectional stigma and discrimination to inform research, programmatic, and policy efforts. Search Methods. We searched 5 electronic databases for relevant studies. References of included articles were screened for possible inclusion. Additional articles were screened on the basis of consultations with experts in the field. Selection Criteria. We included peer-reviewed studies published between January 1, 2010, and May 12, 2021, that were HIV related and presented 1 or more quantitative measures of stigma and discrimination using an intersectional lens in measure design or analysis. Data Collection and Analysis. Systematic methods were used to screen citations and abstract data via a standardized coding form. Data were analyzed by coding categories stratified according to 2 subgroups: (1) studies incorporating a single intersectional measure and (2) studies that examined intersectional stigma through analytical approaches combining multiple measures. Main Results. Sixteen articles met the inclusion criteria, 7 of which explicitly referenced intersectionality. Ten studies were from the United States. All of the studies included participants living with HIV. Among the 4 studies incorporating a single intersectional stigma measure, 3 explored race and gender stigma and 1 explored gender and HIV stigma. Studies involving analytic approaches (n = 12) mostly examined intersectional stigma via interaction terms in multivariate regression models. Three studies employed structural equation modeling to examine interactive effects or latent constructs of intersectional stigma. Conclusions. Research on the measurement of HIV-related intersectional stigma and discrimination is currently concentrated in high-income settings and generally focuses on the intersection of 2 identities (e.g., race and gender). Efforts are needed to expand appropriate application of intersectionality in the development, adaptation, and use of measures of HIV-related intersectional stigma and discrimination. The use of context-, identity-, or condition-adaptable measures should be considered. Researchers should also carefully consider how to meaningfully engage communities in the process of measurement development. Public Health Implications. The measures and analytic approaches presented could significantly enhance public health efforts in assessing the impact of HIV-related intersectional stigma and discrimination on critical health outcomes. (Am J Public Health. 2022;112(S4):S420-S432. https://doi.org/10.2105/AJPH.2021.306639).
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Affiliation(s)
- Tahilin Sanchez Karver
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Kaitlyn Atkins
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Virginia A Fonner
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Carlos E Rodriguez-Diaz
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Michael D Sweat
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Tamara Taggart
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Ping Teresa Yeh
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Caitlin E Kennedy
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Deanna Kerrigan
- Tahilin Sanchez Karver, Carlos E. Rodriguez-Diaz, Tamara Taggart, and Deanna Kerrigan are with the Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Kaitlyn Atkins, Ping Teresa Yeh, and Caitlin E. Kennedy are with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Virginia A. Fonner is with the Global Health, Population, and Nutrition Department, FHI 360, Durham, NC. Michael D. Sweat is with the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Guy AA, Zelaya DG, Surace A, Mastroleo NR, Pantalone DW, Monti PM, Mayer KH, Kahler CW. Discrimination and alcohol problems among heavy drinking HIV-positive men who have sex with men: The buffering effect of a brief Motivational Intervention to reduce alcohol use. Drug Alcohol Depend 2022; 233:109384. [PMID: 35259681 PMCID: PMC8968970 DOI: 10.1016/j.drugalcdep.2022.109384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Heavy alcohol use negatively impacts health outcomes among people with HIV and is especially prevalent among men who have sex with men (MSM). Alcohol problems among MSM with HIV may occur, in part, due to increased stress caused by experiences of identity-based discrimination, such as heterosexism, HIV stigma, and racism. The current study examined (a) whether MSM with HIV who experience greater identity-based discrimination reported higher levels of alcohol problems over time in the absence of alcohol intervention, and (b) whether motivational interviewing (MI) to reduce alcohol use would attenuate the effects of discrimination on alcohol problems. METHODS Data came from a clinical trial in which MSM with HIV were randomized into brief MI for alcohol harm reduction [n = 89] or an HIV treatment as usual assessment only control [TAU; n = 91]. Alcohol use and problems were assessed at baseline, 3, 6, and 12 months. RESULTS Generalized Estimating Equations found a significant interaction between MI and baseline identity-based discrimination, such that in those not receiving MI, discrimination prospectively predicted alcohol problems over time (B = 0.065, SE = 0.018, p < .001, 95% Wald CI [.030- 0.100]). In those receiving MI, discrimination did not have an effect (B = - 0.002, SE = 0.131, p = .987, 95% Wald CI [- 0.258 to 0.254]). CONCLUSIONS Even without explicitly targeting experiences of identity-based discrimination, a person-centered intervention, like MI, appears to mitigate the negative impact of identity-based discrimination on alcohol-related problems.
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Affiliation(s)
- Arryn A Guy
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912, USA; Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - David G Zelaya
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Harvard Medical School, Boston, MA, USA
| | - Anthony Surace
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | | | - David W Pantalone
- University of Massachusetts Boston, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Peter M Monti
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Christopher W Kahler
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912, USA; Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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21
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Armoon B, Fleury MJ, Bayat AH, Fakhri Y, Higgs P, Moghaddam LF, Gonabadi-Nezhad L. HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis. Int J Ment Health Syst 2022; 16:17. [PMID: 35246211 PMCID: PMC8896327 DOI: 10.1186/s13033-022-00527-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 02/17/2022] [Indexed: 12/16/2022] Open
Abstract
Background Stigma is a social phenomenon known to have a negative impact on the lives of people living with HIV (PLWH). However, defining HIV-related stigma (HRS) is difficult because of the intersection it has with structural inequalities, and cultural differences, discrimination by health care providers that measure stigma among PLWH. HIV/AIDS has been characterized as a traumatic experience and PLWH may experience stigma which can cause negative mental health disorders and experiences, including emotional distress, shame, depression, anxiety, suicidal ideation. A systematic review of the evidence on the mental disorders of PLWH is currently lacking. This study aimed to analyze the association between HRS and social support, alcohol use disorders and mental health disorders and experiences (depression, anxiety, and suicidal ideation) among PLWH. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) this study searched PubMed, Scopus, Web of sciences, PsycInfo, SciELO and Cochrane library electronic databases to identify publications between January 1992 and August 2020 that discussed social support, alcohol use disorders, mental health disorders and experiences (i.e., depression and anxiety and suicidal ideation) associated with HRS. Pooled Odds Ratios (ORs) were utilized at a 95% confidence level, and as sampling methods differed between articles pooled estimates used a random effects model. Results Twenty-two studies with 9548 participants met the eligibility criteria. No association was observed between HRS and alcohol use disorders. PLWH who had higher levels of social supports were less likely to report HRS. Participants who had been diagnosed with anxiety were 1.89 times more likely to report HRS, while those diagnosed with depression were 1.61 times more. Respondents who reported suicidal ideation also were 1.83 times more likely to report HRS. Conclusions This meta-analysis supports that HRS has a detrimental association with anxiety, depression and suicidal ideation, but social support protects again HRS in PLWH. Applying interventions which focus on the mental health disorders of PLWH may decrease HRS. Provision of social support by practitioners, combined with mental health treatment and assessments, and designing methods to identify stigma at different stages of illness are warranted.
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Affiliation(s)
- Bahram Armoon
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 33 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.,Department of Psychiatry, McGill University, 33 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Yadollah Fakhri
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Victoria, Australia
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Leila Gonabadi-Nezhad
- Department of Psychiatry, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
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22
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Kalomo EN, Shamrova D, Jun JS, Kaddu MN, Kalb A. Risk and protective factors for depressive symptoms among the youth living with HIV in Namibia. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:65-76. [PMID: 35361060 DOI: 10.2989/16085906.2022.2041054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/01/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND : Namibia has one of the highest HIV prevalence rates among young people living with HIV and AIDS. The study of mental well-being among this vulnerable population is emerging as an important area of public health research. METHODS : This study examined how gender, social support, food insecurity, HIV-related stigma, HIV treatment adherence and HIV transmission knowledge are related to depressive symptoms among young people living with HIV in rural northern Namibia. Data were collected from 188 participants from the Zambezi region. RESULTS : The hierarchical regression analysis revealed that being a female infected with HIV, having perceived food insecurity, experiencing more HIV-related stigma and having low levels of social support can exacerbate the severity of depressive symptoms in this sample of Namibian youth. DISCUSSION : Our findings point to the need to expand social support interventions, enhance socio-economic programmes and reduce HIV-related stigma among young people living with HIV, especially those residing in rural, HIV endemic, resource-limited communities in developing countries.
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Affiliation(s)
| | - Dasha Shamrova
- School of Social Work, Wichita State University, Wichita, USA
| | - Jung Sim Jun
- Department of Sociology, Anthropology, and Social Work, Kansas State University, Manhattan, USA
| | | | - Amy Kalb
- School of Social Work, Wichita State University, Wichita, USA
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23
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Brewer R, Hood KB, Hotton A, Moore M, Spieldenner A, Daunis C, Mukherjee S, Sprague L, Schneider JA, Smith-Davis M, Brown G, Bowen B. Associations Between Experienced HIV Stigma, Resulting Consequences, and the HIV Care Continuum: Moderating Effects of Two Resilience Characteristics Among Persons Living with HIV (PLWH) in Louisiana. J Racial Ethn Health Disparities 2022; 9:9-22. [PMID: 33211250 PMCID: PMC7676401 DOI: 10.1007/s40615-020-00925-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION HIV-related stigma continues to serve as a major barrier to HIV care. HIV stigma reduction interventions are urgently needed to promote and protect the health of persons living with HIV (PLWH). Resilience has been identified as a potential leverage to mitigate the impact of HIV-related stigma among PLWH. METHODS We examined whether two resilience measures (i.e., social support and resilience assets and resources [RAR]) moderated the relationship between experienced HIV stigma and the HIV care continuum as well as how they moderated the relationship between the consequences of experienced HIV stigma (CES) and the HIV care continuum among 300 PLWH in Louisiana. Separate bootstrapping analyses were conducted to test for evidence of moderated moderation. RESULTS Most participants were Black (79%) and had been living with HIV for 10 years or more. A relatively high sample of men who have sex with men (MSM) were enrolled (37%). The most common CES were depression (67%). The most common manifestation of experienced HIV stigma was being gossiped about (53%). Participants reported moderate levels of social support. In terms of RAR, most participants (71%) reported that they knew of groups that could support them in responding to experienced HIV stigma. After adjusting for potential covariates, social support and RAR both significantly moderated the relationship between experienced HIV stigma and length of time since their last HIV care visit, B(SE) = .003(.001), p = .03. At high levels of RAR and high levels of social support, those with higher levels of experienced HIV stigma reported a longer length of time since their last HIV care visit than those who reported lower levels of experienced HIV stigma (B(SE) = .17(.04), p < .001). RAR moderated the relationship between social support and HIV care, B(SE) = .01(.004), p < .001. Those who experienced greater CES reported a longer length of time since their last doctor's visit B(SE) = .04(.02), p < .05. Experienced HIV stigma was not significantly associated with viral load results. However, social support significantly moderated the relationship between experienced stigma and viral load results. At higher levels of social support, those who experienced lower levels of stigma were more likely to report an undetectable viral load than those who had higher levels of stigma, B(SE) = - .13(.03), p < .001. Finally, both RAR and social support moderated the relationship between CES and viral load results. Those who reported higher levels of RAR B(SE) = - .07(.02), p < .001, and social support, B(SE) = - .02(.01), p < .05, also reported having an undetectable viral load at most recent HIV care visit. CES was not significantly related to reporting an undetectable viral load (p = .61). CONCLUSIONS Enrolled PLWH already have some level of resilience which plays an important protective role within the context of the HIV care continuum up to a certain extent. Interventions to enhance the RAR and social support components may be useful especially among MSM and persons who have been living with HIV for a shorter period of time.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL 60637 USA
| | | | - Anna Hotton
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL 60637 USA
| | | | | | | | - Snigdha Mukherjee
- Foundation for Advancement of International Medical Education and Research, Philadelphia, PA USA
| | - Laurel Sprague
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - John A. Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL 60637 USA
| | | | - Gina Brown
- Southern AIDS Coalition, Birmingham, AL USA
| | - Brandi Bowen
- New Orleans Regional AIDS Planning Council, New Orleans, LA USA
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Klein MB, Young J, Ortiz-Paredes D, Wang S, Walmsley S, Wong A, Martel-Laferrière V, Pick N, Conway B, Angel J, Baril JG, Fraser C, Lebouché B, Tan DHS, Sandre R, Trottier S, Peiris H, Jayaraman J, Singer J. Virological Outcomes After Switching to Abacavir/Lamivudine/Dolutegravir Combined with Adherence Support in People Living with HIV with Poor Adherence: A Phase IV, Multicentre Randomized Prospective Open Label Study (TriiADD-CTN 286). Patient Prefer Adherence 2022; 16:3267-3281. [PMID: 36536672 PMCID: PMC9759014 DOI: 10.2147/ppa.s379065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many people living with HIV struggle to consistently adhere to antiretroviral therapy, fail to achieve long-term virologic control and remain at risk for HIV-related disease progression, development of resistance and may transmit HIV infection to others. OBJECTIVE To determine if switching from current multi-tablet (curART) to single-tablet antiretroviral therapy (abacavir/lamivudine/dolutegravir; ABC/3TC/DTG), both combined with individualized adherence support, would improve HIV suppression in non-adherent vulnerable populations. METHODS TriiADD was an investigator-initiated randomized, multicentre, open label study. HIV+ adults with documented non-adherence on curART were randomized in a 1:1 ratio to immediately switch to ABC/3TC/DTG or to continue curART. Both arms received adherence support. The primary outcome was the proportion of participants in each arm with HIV RNA < 50 copies/mL 24 weeks after randomization. RESULTS In total, 50 people were screened and 27 randomized from 11 sites across Canada before the trial was stopped early due to slow recruitment. Participants were predominantly from ethnocultural communities, Indigenous people and/or had a history of injection drug use. The proportion achieving HIV RNA < 50 copies/mL at week 24 was 4/12 (33%) in the curART arm vs 7/13 (54%) in the ABC/3TC/DTG arm; median Bayesian risk difference, 5% (95% CrI, -17 to 28%) higher for those randomized to ABC/3TC/DTG. We encountered difficulties with recruitment of participants without prior drug resistance, retention despite intensive support, reliably measuring adherence and in overcoming entrenched adherence barriers. CONCLUSION Results of our trial are consistent with a slight improvement in viral suppression in a vulnerable population when a single tablet regimen is combined with patient-level adherence support. Beyond treatment simplicity and tolerability, tailored interventions addressing stigma and social determinants of health are still needed. The numerous challenges we encountered illustrate how randomised trials may not be the best approach for assessing adherence interventions in vulnerable populations.
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Affiliation(s)
- Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
- Correspondence: Marina B Klein, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, D02.4110, Montréal, H4A 3J1, Canada, Tel +1-514-843-2090, Fax +1-514-843-2092, Email
| | - Jim Young
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Shouao Wang
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sharon Walmsley
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
- University Health Network, University of Toronto, Toronto, Canada
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Canada
| | - Valérie Martel-Laferrière
- Department of Microbiology and Infectious Diseases, Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, Canada
| | | | - Jean-Guy Baril
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, Canada
| | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Darrell H S Tan
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Roger Sandre
- HAVEN Program, Health Sciences North, Sudbury, Canada
| | - Sylvie Trottier
- Centre de Recherche du CHU de Québec, Department of Microbiology, Infectiology and Immunology, Université Laval, Quebec, Canada
| | - Hansi Peiris
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jayamarx Jayaraman
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
| | - Joel Singer
- Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, Canada
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Lo Hog Tian JM, Watson JR, Ibáñez-Carrasco F, Tran B, Parsons JA, Maunder RG, Card KG, Baral S, Hui C, Boni AR, Ajiboye M, Lindsay JD, Rourke SB. Impact of experienced HIV stigma on health is mediated by internalized stigma and depression: results from the people living with HIV stigma index in Ontario. BMC Public Health 2021; 21:1595. [PMID: 34496825 PMCID: PMC8427956 DOI: 10.1186/s12889-021-11596-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background Experiences of HIV stigma remain prevalent across Canada, causing significant stress and negatively affecting the health and wellbeing of people living with HIV. While studies have consistently demonstrated that stigma negatively impacts health, there has been limited research on the mechanisms behind these effects. This study aims to identify which dimensions of stigma have significant relationships with self-rated health and examine the mechanisms by which those types of stigma impact self-rated health. Methods We recruited 724 participants to complete the People Living with HIV Stigma Index in Ontario, designed by people living with HIV to measure nuanced changes in stigma and discrimination. The present study utilizes data from externally validated measures of stigma and health risks that were included in the survey. First, we conducted multiple regression analyses to examine which variables had a significant impact on self-rated health. Results from the multiple regression guided the mediation analysis. A parallel mediation model was created with enacted stigma as the antecedent, internalized stigma and depression as the mediators, and self-rated health as the outcome. Results In the multiple regression analysis, internalized stigma (coefficient = −0.20, p < 0.01) and depression (coefficient = −0.07, p < 0.01) were both significant and independent predictors of health. Mediation analyses demonstrated that the relationship between enacted stigma and self-rated health is mediated in parallel by both internalized stigma [coefficient = −0.08, se = 0.03, 95% CI (−0.14, −0.02)] and depression [coefficient = −0.16, se = 0.03, 95% CI (−0.22, −0.11)]. Conclusions We developed a mediation model to explain how HIV-related stigma negatively impacts health. We found that that enacted stigma, or experiences of prejudice or discrimination, can lead to internalized stigma, or internalization of negative thoughts regarding one’s HIV status and/or increased depressive symptoms which then may lead to worse overall health. Highlighting the importance of internalized stigma and depression has the potential to shape the development of targeted intervention strategies aimed at reducing the burden of stigma and improving the health and wellbeing of people living with HIV.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | | | - Billy Tran
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Janet A Parsons
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada.,Department of Physical Therapy and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Kiffer G Card
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Faculty of Health Sciences, Simon Frasier University, Burnaby, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - Christian Hui
- Canadian HIV Stigma Index Steering Committee, Toronto, Canada.,Ontario Positive Asians, Toronto, Canada.,Ryerson University, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Monisola Ajiboye
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,International Community of Women Living with HIV, London, UK
| | - Joanne D Lindsay
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada.
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Psychosocial Determinants of HIV Stigma among Men Who Have Sex with Men in San Francisco, California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158031. [PMID: 34360326 PMCID: PMC8345572 DOI: 10.3390/ijerph18158031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Background: Stigma and discrimination are major challenges faced by people living with HIV (PLWH), and stigma continues to be prevalent among PLWH. We conducted a cross-sectional study of 584 men who have sex with men (MSM) living with HIV between July 2018 and December 2020, designed to better understand which demographic and behavioral characteristics of MSM living with HIV in San Francisco, California are associated with experience of stigma, so that programs and initiatives can be tailored appropriately to minimize HIV stigma’s impacts. Methods: This analysis was conducted with data from San Francisco AIDS Foundation (SFAF) encompassing services from multiple different locations in San Francisco. Data about the level of HIV-related stigma experienced were collected through a single question incorporated into programmatic data collection forms at SFAF as part of the client record stored in SFAF’s electronic health record. We performed linear regression to determine the associations between self-reported experiences of HIV stigma and other characteristics among MSM living with HIV. Results: HIV stigma was low overall among MSM living with HIV who are actively engaged in HIV care in San Francisco; however, it was significantly higher for the age groups of 13–29 years (adjusted risk difference (ARD): 0.251, 95% CI: 0.012, 0.489) and 30–49 years (ARD: 0.205, 95% CI: 0.042, 0.367) when compared to the age group of 50 years and older, as well as people who were homeless (ARD: 0.844, 95% CI: 0.120, 1.568), unstably housed (ARD: 0.326, 95% CI: 0.109, 0.543) and/or having mental health concerns (ARD: 0.309, 95% CI: 0.075, 0.544), controlling for race, injection history, and viral load. Conclusions: These findings highlight an opportunity to develop culturally, socially, and racially appropriate interventions to reduce HIV stigma among MSM living with HIV, particularly for younger men and those struggling with housing stability and/or mental health.
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Menza TW, Hixson LK, Lipira L, Drach L. Social Determinants of Health and Care Outcomes Among People With HIV in the United States. Open Forum Infect Dis 2021; 8:ofab330. [PMID: 34307729 PMCID: PMC8297699 DOI: 10.1093/ofid/ofab330] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 12/29/2022] Open
Abstract
Background Fewer than 70% of people with HIV (PWH) in the United States have achieved durable viral suppression. To end the HIV epidemic in the United States, clinicians, researchers, and public health practitioners must devise ways to remove barriers to effective HIV treatment. To identify PWH who experience challenges to accessing health care, we created a simple assessment of social determinants of health (SDOH) among PWH and examined the impact of cumulative social and economic disadvantage on key HIV care outcomes. Methods We used data from the 2015-2019 Medical Monitoring Project, a yearly cross-sectional survey of PWH in the United States (n = 15 964). We created a 10-item index of SDOH and assessed differences in HIV care outcomes of missed medical appointments, medication adherence, and durable viral suppression by SDOH using this index using prevalence ratios with predicted marginal means. Results Eighty-three percent of PWH reported at least 1 SDOH indicator. Compared with PWH who experienced none of the SDOH indicators, people who experienced 1, 2, 3, and 4 or more SDOH indicators were 1.6, 2.1, 2.6, and 3.6 as likely to miss a medical appointment in the prior year; 11%, 17%, 20%, and 31% less likely to report excellent adherence in the prior 30 days; and 2%, 4%, 10%, and 20% less likely to achieve durable viral suppression in the prior year, respectively. Conclusions Among PWH, cumulative exposure to social and economic disadvantage impacts care outcomes in a dose-dependent fashion. A simple index may identify PWH experiencing barriers to HIV care, adherence, and durable viral suppression in need of critical supportive services.
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Affiliation(s)
- Timothy W Menza
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA.,Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Lindsay K Hixson
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Lauren Lipira
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA.,School of Social Work, Regional Research Institute, Portland State University, Portland, Oregon, USA
| | - Linda Drach
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
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28
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Bogart LM, Barreras JL, Gonzalez A, Klein DJ, Marsh T, Agniel D, Pantalone DW. Pilot Randomized Controlled Trial of an Intervention to Improve Coping with Intersectional Stigma and Medication Adherence Among HIV-Positive Latinx Sexual Minority Men. AIDS Behav 2021; 25:1647-1660. [PMID: 33231847 PMCID: PMC8084890 DOI: 10.1007/s10461-020-03081-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
We developed and pilot-tested an eight-session community-based cognitive behavior therapy group intervention to improve coping with intersectional stigma, address medical mistrust, and improve antiretroviral treatment adherence. Seventy-six HIV-positive Latinx sexual minority men (SMM; 38 intervention, 38 wait-list control) completed surveys at baseline, and 4- and 7-months post-baseline. Adherence was electronically monitored. Intention-to-treat, repeated-measures regressions showed improved adherence in the intervention vs. control group from baseline to follow-up [electronically monitored: b (95% CI) 9.24 (- 0.55, 19.03), p = 0.06; self-reported: b (95% CI) 4.50 (0.70, 8.30), p = .02]. Intervention participants showed marginally decreased negative religious coping beliefs in response to stigma [b (95% CI) = - 0.18 (- 0.37, 0.01), p = .06], and significantly lower medical mistrust [b (95% CI) = - 0.47 (- 0.84, - 0.09), p = .02]. Our intervention holds promise for improving HIV outcomes by empowering Latinx SMM to leverage innate resilience resources when faced with stigma.ClinicalTrials.gov ID (TRN): NCT03432819, 01/31/2018.
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA.
| | - Joanna L Barreras
- Bienestar Human Services Inc, Los Angeles, CA, USA
- California State University Long Beach, Long Beach, CA, USA
| | - Ana Gonzalez
- Bienestar Human Services Inc, Los Angeles, CA, USA
| | - David J Klein
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Terry Marsh
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Denis Agniel
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - David W Pantalone
- University of Massachusetts Boston, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
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29
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Starks TJ, Skeen SJ, Jones SS, Millar BM, Gurung S, Ferraris C, Ventuneac A, Parsons JT, Sparks MA. The importance of domain-specific self-efficacy assessment for substance use and HIV care continuum outcomes among adults in an urban HIV clinic network. AIDS Care 2021; 34:670-678. [PMID: 33745409 PMCID: PMC8455718 DOI: 10.1080/09540121.2021.1904501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Despite the prominence of self-efficacy as a predictor of antiretroviral therapy (ART) adherence, relatively little work has examined domain-specific associations with steps in the care continuum or the possibility that substance use may have domain-specific associations with self-efficacy. This study analyzed data from a sample of 174 people living with HIV recruited through three clinics in the New York City metro area. Consistent with hypotheses, path analysis showed that appointments kept and viral load were each predicted only by their respective domain-specific self-efficacy components (i.e., self-efficacy for keeping appointments, B = 0.01, p = .04; and self-efficacy for taking ART medications, B = -0.02, p < .01). Path models also indicated domain-specific associations with substance use. Self-efficacy for keeping appointments was negatively associated with severity of drug use (B = -1.81, p < .01); meanwhile, self-efficacy for taking ART medications was negatively associated with severity of alcohol use (B = -0.52, p < .01). Accordingly, studies assessing barriers to retention in the HIV care continuum should conduct multi-domain assessments of self-efficacy for differential associations with specific behaviors. Furthermore, HIV care providers might consider screening for domain-specific self-efficacy to identify patients at risk of drop-out and tailoring interventions to various care continuum domains.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, New York, NY, USA
| | - Simone J Skeen
- PRIDE Health Research Consortium, Hunter College of CUNY, New York, NY, USA
| | - S Scott Jones
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Brett M Millar
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Sitaji Gurung
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Christopher Ferraris
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Ana Ventuneac
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Martha A Sparks
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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30
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Quinn KG, Spector A, Takahashi L, Voisin DR. Conceptualizing the Effects of Continuous Traumatic Violence on HIV Continuum of Care Outcomes for Young Black Men Who Have Sex with Men in the United States. AIDS Behav 2021; 25:758-772. [PMID: 32944841 PMCID: PMC7886964 DOI: 10.1007/s10461-020-03040-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 01/06/2023]
Abstract
The United States (US) is on track to achieve the 90-90-90 targets set forth by UNAIDS and the National HIV/AIDS strategy, yet significant racial disparities in HIV care outcomes remain, particularly for young Black men who have sex with men (YBMSM). Research has demonstrated that various types of violence are key aspects of syndemics that contribute to disparities in HIV risk. However, little research has looked collectively at cumulative violent experiences and how those might affect HIV treatment and care outcomes. Drawing on extant literature and theoretical underpinnings of syndemics, we provide a conceptual model that highlights how continuous traumatic violence experienced by YBMSM may affect HIV outcomes and contribute to racial disparities in HIV outcomes. The findings of this focused review suggest a need for research on how continuous exposure to various types of violence influence HIV prevention and treatment outcomes for young Black MSM.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA.
| | - Antoinette Spector
- Medical College of Wisconsin, Institute for Health Equity, Milwaukee, USA
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31
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The Effects of Perceived Stress and Cortisol Concentration on Antiretroviral Adherence When Mediated by Psychological Flexibility Among Southern Black Men Living with HIV. AIDS Behav 2021; 25:645-652. [PMID: 32902770 DOI: 10.1007/s10461-020-03016-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This pilot study investigates the correlation between psychological stress and antiretroviral therapy (ART) adherence and plasma HIV RNA (viral load) as mediated by psychological flexibility among Black men in the south. Data were collected from 48 HIV-positive, low income Black men. Results indicate a strong positive correlation between perceived stress and psychological inflexibility (adjusted for age and income rs = 0.67; p < 0.001), a negative correlation between psychological inflexibility and ART adherence (adjusted rs = - 0.32; p = 0.03), a negative correlation between perceived stress and ART adherence (adjusted rs = - 0.45; p = 0.006), and a negative correlation between ART adherence and viral load (adjusted rs = - 0.37; p = 0.04). Our findings suggest stress decreases adherence to ART and viral suppression among Black men living with HIV. However, psychological flexibility did not mediate the relationship between stress and treatment adherence. Hair cortisol concentrations were high (mean of 34.2 pg/mg), but uncorrelated with adherence.
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32
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Hojilla JC, Santiago-Rodriguez EI, Sterling S, Williams EC, Leyden W, Hare CB, Silverberg MJ, Satre DD. HIV Stigma and Its Associations with Longitudinal Health Outcomes Among Persons Living with HIV with a History of Unhealthy Alcohol Use. AIDS Behav 2021; 25:215-224. [PMID: 32632497 PMCID: PMC7785626 DOI: 10.1007/s10461-020-02963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the demographic and clinical correlates of HIV stigma and evaluated how HIV stigma was associated with physical and mental health outcomes one year later in a primary-care based cohort of persons living with HIV (PLHIV; N = 584). HIV stigma was measured using a modified Berger HIV stigma scale, which includes four subscales: (1) personalized stigma; (2) disclosure concerns; (3) negative self-image; and (4) concerns around public attitudes towards PLHIV. Physical and mental health were assessed using the 12-item short form survey (SF-12). Compared to whites, African Americans were more likely to have higher personalized stigma scores (adjusted prevalence ratio [aPR] 1.54 [95% confidence interval 1.10-2.15]), disclosure concerns (aPR 1.40 [1.03-1.92]), and concerns with public attitudes about PLHIV (aPR 1.61 [1.11-2.34]). Hispanic/Latinx participants were more likely to have concerns around public attitudes towards PLHIV (aPR 1.50 [1.11-2.02]) than whites. Compared to men, women were more likely to have higher negative self-image scores (aPR 1.50 [1.08-2.08]). Higher stigma scores were associated with poorer subsequent self-reported physical and mental health functional status. Our findings highlight the substantial need for addressing HIV stigma, particularly among minority subgroups.
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Affiliation(s)
- J Carlo Hojilla
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
| | - Edda I Santiago-Rodriguez
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Williams
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - C Bradley Hare
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | | | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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MacCarthy S, Bogart LM, Galvan FH, Pantalone DW. Inter-Group and Intraminority-Group Discrimination Experiences and the Coping Responses of Latino Sexual Minority Men Living With HIV. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2021; 2:1-21. [PMID: 34017964 PMCID: PMC8130892 DOI: 10.1891/lgbtq-2020-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Discrimination negatively impacts the health of HIV-positive Latino sexual minority men (LSMM+). A growing literature on LSMM+ chronicles associations based on multiple devalued identities and mental health symptoms, HIV medication nonadherence, and sexual behaviors with the potential to transmit HIV. To gain additional insights on identity-based discrimination-as well as the associated coping responses-we conducted 30 qualitative interviews with LSMM+.Participantswereprobedregardingrecentdiscriminationevents(context,details,perpetrator, type) based on their intersecting identities (Latinx ethnicity, residency status, sexual minority orientation, HIV-positive serostatus) and their coping responses. We transcribed and translated the interviews and conducted a content analysis. Participants reported inter-group (i.e., between majority and minority group members) and intraminority-group (i.e., within minority group members) experiences as common. Participants described their intraminority-group experiences with discrimination based on being a Latinx sexual minority person in their families and home communities. Participants reported a range of coping responses to discrimination experiences. However, participants reported only functional (and no dysfunctional) coping strategies, and they endorsed using similar strategies in response to inter-group and intraminority-group discrimination. Coping strategies included strategic avoidance, social support, self-advocacy, and external attribution. Additional coping strategies (spirituality and positive reframing) emerged more strongly in response to inter-group experiences with discrimination. Our results underscore the need to address both inter-group and intraminority-group discrimination experiences. Future interventions can focus on strengthening the effective coping skills that LSMM+ currently employ as potential levers to address LSMM+ health disparities.
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Ortiz-Hernández L, Pérez-Salgado D, Miranda-Quezada IP, Staines-Orozco MG, Compean-Dardón MS. Experiencias de homofobia y adherencia al tratamiento antirretroviral (TAR) en hombres que tienen sexo con hombres (HSH). SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021200235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen El objetivo del estudio fue conocer la relación de las experiencias de homofobia con la adherencia al tratamiento anti-retroviral (TAR) en hombres que tienen sexo con hombres (HSH). Para ello, se realizó una encuesta transversal con una muestra por conveniencia de HSH que vivían con VIH (n=340) atendidos en dos instituciones públicas de salud de la Ciudad de México. La información sobre la adherencia al TAR en el mes previo de los participantes y sus experiencias de violencia, discriminación y homofobia internalizada se recopiló mediante un cuestionario. Entre 14% y 33% de los HSH reportaron alguna experiencia de discriminación y entre 41% y 60% experimentaron violencia. Cuando los HSH habían experimentado ambos tipos de estresores, el riesgo de baja adherencia TAR fue mayor (RP=6.49 para mes previo) que cuando habían experimentado sólo una de ellas (RP=4.36 para violencia y RP=5.67 para discriminación). Los profesionales de la salud deben ser sensibles a cómo el ambiente sociocultural puede afectar las prácticas de autocuidado de HSH, incluyendo la adherencia al TAR.
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35
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Jeffries WL, Flores SA, Rooks-Peck CR, Gelaude DJ, Belcher L, Ricks PM, Millett GA. Experienced Homophobia and HIV Infection Risk Among U.S. Gay, Bisexual, and Other Men Who Have Sex with Men: A Meta-Analysis. LGBT Health 2020; 8:1-10. [PMID: 33372845 DOI: 10.1089/lgbt.2020.0274] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Experienced homophobia-negative treatment and perceptions that gay, bisexual, and other men who have sex with men (MSM) encounter because of their sexual orientations-may promote HIV infection among MSM. We conducted a rapid review and meta-analysis to examine experienced homophobia in relation to HIV infection risk. Methods: We searched Embase, MEDLINE, PsycINFO, and Sociological Abstracts to acquire data from U.S. studies published during 1992-2017. Studies examined experienced homophobia in relation to sexual risk behavior, poor HIV care continuum engagement, and diagnosed HIV infection. Random-effects models yielded summary odds ratios (ORs) and 95% confidence intervals (CIs). Results: Experienced homophobia was associated with having any sexual risk behavior (OR = 1.33, 95% CI = 1.25-1.42, I2 = 89.2%), receptive condomless anal sex (CAS) (OR = 1.33, 95% CI = 1.14-1.56, I2 = 63.6%), HIV-discordant CAS (OR = 1.66, 95% CI = 1.29-2.13, I2 = 85.3%), an increased number of sex partners (OR = 1.16, 95% CI = 1.13-1.19, I2 = 0.0%), diagnosed HIV infection (OR = 1.34, 95% CI = 1.10-1.64, I2 = 86.3%), and poor HIV care continuum engagement among MSM living with HIV (OR = 1.45, 95% CI = 1.02-2.08, I2 = 47.0%). Effect sizes for any sexual risk behavior were larger in samples with ≥50% Black or Latino (vs. White) MSM and for family-based mistreatment and perceived sexual minority stigma (vs. other homophobia types). Conclusion: Experienced homophobia is associated with HIV infection risk among MSM. Its association with sexual risk behavior may be stronger among Black and Latino (vs. White) MSM and for family-based mistreatment and perceived sexual minority stigma (vs. other homophobia types). Research is needed to better understand causality in these relationships and the role of interventions to reduce homophobia.
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Affiliation(s)
- William L Jeffries
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen A Flores
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cherie R Rooks-Peck
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deborah J Gelaude
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Belcher
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip M Ricks
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gregorio A Millett
- amfAR, The Foundation for AIDS Research, Washington, District of Columbia, USA
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36
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Quinn KG, Voisin DR. ART Adherence Among Men Who Have Sex with Men Living with HIV: Key Challenges and Opportunities. Curr HIV/AIDS Rep 2020; 17:290-300. [PMID: 32557117 DOI: 10.1007/s11904-020-00510-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW In the USA, gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. High levels of adherence to antiretroviral therapy (ART) can dramatically improve outcomes for persons living with HIV and reduce the risk of HIV transmission to others. Yet, there are numerous individual, social, and structural barriers to optimal ART adherence. Many of these factors disproportionately impact Black MSM and may contribute to their poorer rates of ART adherence. This review synthesizes the key challenges and intervention opportunities to improve ART adherence among MSM in the USA. RECENT FINDINGS Key challenges to ART adherence include stigma, violence, depression, and substance use. Black MSM are significantly disadvantaged by several of these factors. There are several promising interventions to improve ART adherence among MSM, and there remains an opportunity to culturally tailor these to the needs of Black MSM populations to enhance adherence. Despite high rates of HIV among MSM, there continues to be a paucity of research on the various contributors to poor ART adherence among this population. Similarly, few interventions have been tested that lead to increased and sustained ART adherence among Black MSM.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- Factor-Intwentash School of Social Work, University of Toronto, Toronto, Canada
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Tieu HV, Koblin BA, Latkin C, Curriero FC, Greene ER, Rundle A, Frye V. Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men. J Urban Health 2020; 97:592-608. [PMID: 29845586 PMCID: PMC7560681 DOI: 10.1007/s11524-018-0266-2] [Citation(s) in RCA: 9] [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] [Indexed: 10/16/2022]
Abstract
In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily R Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
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Brewer R, Hood KB, Moore M, Spieldenner A, Daunis C, Mukherjee S, Smith-Davis M, Brown G, Bowen B, Schneider JA. An Exploratory Study of Resilience, HIV-Related Stigma, and HIV Care Outcomes Among Men who have Sex with Men (MSM) Living with HIV in Louisiana. AIDS Behav 2020; 24:2119-2129. [PMID: 31916097 DOI: 10.1007/s10461-020-02778-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The various forms of HIV-related stigma continue to serve as major barriers to HIV care and treatment among men who have sex with men (MSM). The study of resilience within the context of HIV-related stigma among MSM living with HIV represents a promising area of research to inform the development of future HIV interventions for this population. We examined resilience within the context of HIV related stigma among MSM living with HIV in Louisiana with a particular interest in how resilience may be more relevant for Black MSM. We utilized Pearson's correlations and layered chi-square non-parametric tests to examine associations and racial differences in resilience, four HIV-related stigma measures/consequences (i.e., anticipated, internalized, enacted, and consequences of enacted HIV stigma), and HIV care outcomes (i.e., length of time since last HIV care visit, time since last HIV lab result, most recent HIV viral load result) among 110 MSM living with HIV in Louisiana who participated in the Louisiana HIV Stigma Index Project. The majority of MSM participants were Black (75%), lived in New Orleans (52%), and reported limited education (52%) and income (76%). MSM who reported higher levels of enacted HIV stigma, consequences of enacted HIV stigma, and internalized HIV stigma reported poorer HIV care outcomes. Both internalized and anticipated HIV stigma significantly negatively impacted Black MSM perceptions of their overall health compared with White MSM. Compared with White MSM, Black MSM who reported greater consequences of enacted HIV stigma had poorer HIV care outcomes. Resilience was associated with positive HIV care outcomes for both Black and White MSM. However, having higher levels of resilience may have been more protective for Black MSM such that higher levels of resilience were associated with less time since last HIV care visit for Black MSM than for White MSM. The current study provides preliminary information on the potential positive relationship between resilience and HIV care outcomes among MSM, particularly Black MSM. However, these findings need to be confirmed among a more representative sample of Black and White MSM in Louisiana.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.
- Chicago Center for HIV Elimination, Chicago, IL, USA.
| | | | - Mary Moore
- Dillard University, New Orleans, LA, USA
| | | | | | - Snigdha Mukherjee
- Educational Commission for Foreign Medical Graduates, Philadelphia, PA, USA
| | | | - Gina Brown
- Southern AIDS Coalition, New Orleans, LA, USA
| | - Brandi Bowen
- New Orleans Regional AIDS Planning Council, New Orleans, LA, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
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Pasipanodya EC, Montoya JL, Watson CWM, Marquine MJ, Hoenigl M, Garcia R, Kua J, Gant V, Trambley J, Moore DJ. Tailoring a mobile health text-messaging intervention to promote antiretroviral therapy adherence among African Americans: A qualitative study. PLoS One 2020; 15:e0233217. [PMID: 32516317 PMCID: PMC7282643 DOI: 10.1371/journal.pone.0233217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 04/30/2020] [Indexed: 01/14/2023] Open
Abstract
African Americans are disproportionately affected by HIV and socio-structural barriers that impact antiretroviral (ART) adherence. Two-way text-messaging interventions have shown promise in supporting adherence in US studies of mostly White people living with HIV (PLWH). However, culturally-appropriate tailoring is necessary to maximize intervention effectiveness among other racial/ethnic groups. Thus, to refine an existing text-messaging intervention, we examined barriers and facilitators to ART adherence among African Americans and perspectives on features to integrate into the extant intervention. Three focus groups, two with African American PLWH (n = 5 and n = 7) and one with providers of care (n = 11) were conducted; transcripts of audio-recordings were thematically analyzed. Adherence supports operated at individual, interpersonal, and structural/environmental levels (e.g., using reminders and pill organizers, wanting to protect partners from HIV, and positive interactions with providers). Adherence barriers also operated at multiple ecological levels (e.g., poor mental health, fear of disclosure of HIV status, and unstable housing). Participant-suggested features for refinement included: i) matching content to participants’ comfort with receiving messages referencing HIV or medication-taking, ii) culturally-tailoring content for African Americans, iii) tracking adherence, and iv) encouraging adherence interactions between patients and providers. Feedback from both patients and providers is foundational to designing effective ART interventions among African American PLWH.
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Affiliation(s)
| | - Jessica L. Montoya
- University of California-San Diego, San Diego, California, United States of America
| | - Caitlin W.-M. Watson
- University of California-San Diego, San Diego, California, United States of America
- San Diego State University/University of California-San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, United States of America
| | - María J. Marquine
- University of California-San Diego, San Diego, California, United States of America
| | - Martin Hoenigl
- University of California-San Diego, San Diego, California, United States of America
| | - Rogelio Garcia
- Family Health Centers of San Diego, San Diego, California, United States of America
| | - John Kua
- Family Health Centers of San Diego, San Diego, California, United States of America
| | - Verna Gant
- Family Health Centers of San Diego, San Diego, California, United States of America
| | - Joel Trambley
- Universal Health Services Southern California Medical Education Consortium, Temecula, California, United States of America
| | - David J. Moore
- University of California-San Diego, San Diego, California, United States of America
- * E-mail:
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Dale SK, Safren SA. Gendered Racial Microaggressions Associated with Depression Diagnosis among Black Women Living with HIV. J Urban Health 2020; 97:377-386. [PMID: 32291580 PMCID: PMC7305274 DOI: 10.1007/s11524-020-00432-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Black women are disproportionately impacted by HIV and depression has been linked to negative HIV outcomes. Little attention has been given to social/structural factors that may drive depression among Black women living with HIV (BWLWH), including discrimination and gendered racial microaggressions (GRM). One hundred BWLWH completed measures on GRM, race- and HIV-related discrimination, and depressive symptoms, as well as a clinical interview for major depressive episode (MDE). GRM and race- and HIV-related discrimination were significantly associated with depressive symptoms and increased likelihood of MDE, but only GRM contributed uniquely in associations with both. Interventions targeting depression among BWLWH should address GRM and race- and HIV-related discrimination.
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Affiliation(s)
- Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
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Batey DS, Dong X, Rogers RP, Merriweather A, Elopre L, Rana AI, Hall HI, Mugavero MJ. Time From HIV Diagnosis to Viral Suppression: Survival Analysis of Statewide Surveillance Data in Alabama, 2012 to 2014. JMIR Public Health Surveill 2020; 6:e17217. [PMID: 32045344 PMCID: PMC7275256 DOI: 10.2196/17217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Evaluation of the time from HIV diagnosis to viral suppression (VS) captures the collective effectiveness of HIV prevention and treatment activities in a given locale and provides a more global estimate of how effectively the larger HIV care system is working in a given geographic area or jurisdiction. OBJECTIVE This study aimed to evaluate temporal and geographic variability in VS among persons with newly diagnosed HIV infection in Alabama between 2012 and 2014. METHODS With data from the National HIV Surveillance System, we evaluated median time from HIV diagnosis to VS (<200 c/mL) overall and stratified by Alabama public health area (PHA) among persons with HIV diagnosed during 2012 to 2014 using the Kaplan-Meier approach. RESULTS Among 1979 newly diagnosed persons, 1181 (59.67%) achieved VS within 12 months of diagnosis; 52.6% (353/671) in 2012, 59.5% (377/634) in 2013, and 66.9% (451/674) in 2014. Median time from HIV diagnosis to VS was 8 months: 10 months in 2012, 8 months in 2013, and 6 months in 2014. Across 11 PHAs in Alabama, 12-month VS ranged from 45.8% (130/284) to 84% (26/31), and median time from diagnosis to VS ranged from 5 to 13 months. CONCLUSIONS Temporal improvement in persons achieving VS following HIV diagnosis statewide in Alabama is encouraging. However, considerable geographic variability warrants further evaluation to inform public health action. Time from HIV diagnosis to VS represents a meaningful indicator that can be incorporated into public health surveillance and programming.
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Affiliation(s)
- D Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Richard P Rogers
- Division of STD Prevention and Control, Alabama Department of Public Health, Montgomery, AL, United States
| | - Anthony Merriweather
- Division of STD Prevention and Control, Alabama Department of Public Health, Montgomery, AL, United States
| | - Latesha Elopre
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Aadia I Rana
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - H Irene Hall
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Penrose K, Robertson M, Nash D, Harriman G, Irvine M. Social Vulnerabilities and Reported Discrimination in Health Care Among HIV-Positive Medical Case Management Clients in New York City. STIGMA AND HEALTH 2020; 5:179-187. [PMID: 32432165 PMCID: PMC7236577 DOI: 10.1037/sah0000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2024]
Abstract
We aimed to investigate the extent to which social vulnerabilities correlated with lifetime experience of discrimination in healthcare among people with HIV (PWH) receiving services to improve treatment adherence and viral suppression. Individuals (N=687) enrolled in a Ryan White Part A medical case management program were surveyed about discrimination experienced in healthcare settings, reasons for any discrimination faced, and self-reported health. We merged data from the survey with data from the New York City HIV Surveillance Registry and a programmatic database to obtain client sociodemographic and clinical characteristics and reported history of social vulnerabilities. Thirty-nine percent of participants reported lifetime experience of discrimination in healthcare settings; individuals with a history of at least three social vulnerabilities (mental health diagnosis, incarceration, substance use, and/or housing instability) had more than twice the odds of reporting discrimination than individuals who did not report any of these social vulnerabilities (aOR, 2.33 [95% CI, 1.43 - 3.83]). Among individuals who reported discrimination in healthcare, those who cited HIV status or substance use as reasons for discrimination were significantly more likely to report a higher number of social vulnerabilities (p=0.04 and p=0.009, respectively), with discrimination due to HIV status most strongly associated with a mental health diagnosis. These findings underscore the importance of acknowledging life experience and psychosocial barriers in provider interactions with PWH. They also highlight a need for monitoring provider attitudes and behaviors regarding intersectional stigmas related not only to factors such as race and sexual orientation, but also to social vulnerabilities.
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Affiliation(s)
- Katherine Penrose
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Graham Harriman
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY
| | - Mary Irvine
- Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY
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Cressman AE, Howe CJ, Nunn AS, Adimora AA, Williams DR, Kempf MC, Chandran A, Wentz EL, Blackstock OJ, Kassaye SG, Cohen J, Cohen MH, Wingood GM, Metsch LR, Wilson TE. The Relationship Between Discrimination and Missed HIV Care Appointments Among Women Living with HIV. AIDS Behav 2020; 24:151-164. [PMID: 31049811 DOI: 10.1007/s10461-019-02522-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Receiving regular HIV care is crucial for maintaining good health among persons with HIV. However, racial and gender disparities in HIV care receipt exist. Discrimination and its impact may vary by race/ethnicity and gender, contributing to disparities. Data from 1578 women in the Women's Interagency HIV Study ascertained from 10/1/2012 to 9/30/2016 were used to: (1) estimate the relationship between discrimination and missing any scheduled HIV care appointments and (2) assess whether this relationship is effect measure modified by race/ethnicity. Self-reported measures captured discrimination and the primary outcome of missing any HIV care appointments in the last 6 months. Log-binomial models accounting for measured sources of confounding and selection bias were fit. For the primary outcome analyses, women experiencing discrimination typically had a higher prevalence of missing an HIV care appointment. Moreover, there was no statistically significant evidence for effect measure modification by race/ethnicity. Interventions to minimize discrimination or its impact may improve HIV care engagement among women.
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Affiliation(s)
- Andrew E Cressman
- Department of Epidemiology, Centers for Epidemiology and Environmental Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Chanelle J Howe
- Department of Epidemiology, Centers for Epidemiology and Environmental Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
| | - Amy S Nunn
- Department of Behavioral and Social Sciences, Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapelhill, NC, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aruna Chandran
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eryka L Wentz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Oni J Blackstock
- Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Seble G Kassaye
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Mardge H Cohen
- Departments of Medicine, Stroger Hospital and Rush University, Chicago, IL, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Lerner Center for Public Health Promotion, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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Rintamaki L, Kosenko K, Hogan T, Scott AM, Dobmeier C, Tingue E, Peek D. The Role of Stigma Management in HIV Treatment Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5003. [PMID: 31835334 PMCID: PMC6950713 DOI: 10.3390/ijerph16245003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/28/2019] [Accepted: 11/09/2019] [Indexed: 11/17/2022]
Abstract
Social stigma is linked to improper HIV treatment adherence, but how stigma impairs adherence outcomes is poorly understood. This study included 93 people living with HIV in the United States who participated in focus groups or one-on-one interviews regarding how stigma might affect medication management. Latent content analysis and constant comparative techniques of participant responses that were produced three thematic groupings that described how participants (a) orient to HIV stigma, (b) manage HIV stigma in ways that directly impair treatment adherence, and (c) manage HIV stigma in ways that may indirectly impair adherence. These findings illustrate the need to understand how patients orient to HIV stigma when prescribing medications and the complications that are inherent to such assessments. In addition, these findings provide a simple framework for organizing the different ways in which stigma management strategies may disrupt treatment adherence. Conceptually, these findings also offer a paradigm shift to extent theories on disclosure and concealment, in which only disclosure has been cast as an active process. These findings demonstrate how concealment is far from a passive default, often requiring enormous effort. Ultimately, these findings may guide intervention programs that help to entirely eliminate HIV by promoting optimized counseling and subsequent treatment adherence.
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Affiliation(s)
- Lance Rintamaki
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA; (C.D.); (E.T.)
| | - Kami Kosenko
- Department of Communication, North Carolina State University, Raleigh, NC 27695, USA;
| | - Timothy Hogan
- Center for Healthcare Organization & Implementation Research, United States Department of Veterans Affairs, Bedford, MA 01730, USA;
- Department of Population and Data Sciences, University of Texas, Southwestern, Dallas, TX 75390, USA
| | - Allison M. Scott
- Department of Communication, University of Kentucky, Lexington, KY 40506, USA;
| | - Christopher Dobmeier
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA; (C.D.); (E.T.)
| | - Erik Tingue
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA; (C.D.); (E.T.)
| | - David Peek
- Department of Medicine, Pen Bay Medical Center, Rockport, ME 04856, USA;
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Brewer R, Issema R, Moore M, Chrestman S, Mukherjee S, Odlum M, Schneider JA. Correlates of Durable Viral Suppression (DVS) Among Criminal Justice-involved (CJI) Black Men Living with HIV in Louisiana. AIDS Behav 2019; 23:2980-2991. [PMID: 31250229 DOI: 10.1007/s10461-019-02578-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Durable viral suppression (DVS) is needed to reduce HIV transmission risk and prevent new HIV infections. We examined changes in viral suppression and correlates of DVS among 97 criminal justice-involved (CJI) Black men living with HIV in Louisiana enrolled in a linkage, re-engagement, and retention in care intervention. Most participants (75%) were Black men who have sex with men. Forty-four percent (44%) were virally suppressed at baseline and only 20% had achieved DVS over a 12-month period. Multinomial logistic regression analyses showed that compared with DVS participants, those with no viral suppression (NVS) and some viral suppression (SVS) were more likely to have lived with HIV for a longer period of time and were less likely to be adherent at baseline. Medication adherence was critical for DVS among this sample of CJI Black men living with HIV who represent a high priority population for HIV care and treatment interventions.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL, USA.
- Chicago Center for HIV Elimination, Chicago, IL, USA.
| | - Rodal Issema
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Mary Moore
- Dillard University, New Orleans, LA, USA
| | | | - Snigdha Mukherjee
- Educational Commission for Foreign Graduates (ECFG), Philadelphia, PA, USA
| | | | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
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Abstract
Black people living with HIV (BPLWH) are less likely to adhere to antiretroviral treatment than are members of other racial/ethnic groups. Data were combined from two studies of BPLWH (n = 239) to estimate adherence trajectories using a semiparametric, group-based modeling strategy over three time-points (spanning 6 months). Analyses identified three groups of individuals (high-stable, moderately low-stable, low-decreasing). Multinomial logistic regressions were used to predict trajectory membership with multiple levels of socio-ecological factors (structural, institutional/health system, community, interpersonal/network, individual). Older age was associated with being in the high-stable group, whereas substance use, lower perceived treatment effectiveness, and lower quality healthcare ratings were related to being in the moderately low-stable group. In sum, multiple socio-ecological factors contribute to adherence among BPLWH and thus could be targeted in future intervention efforts.
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47
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Mutchler MG, Bogart LM, Klein DJ, Wagner GJ, Klinger IA, Tyagi K, McDavitt B. Age matters: differences in correlates of self-reported HIV antiretroviral treatment adherence between older and younger Black men who have sex with men living with HIV. AIDS Care 2019; 31:965-972. [PMID: 31072114 DOI: 10.1080/09540121.2019.1612020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Black men who have sex with men (BMSM) show lower levels of adherence to antiretroviral therapy (ART) for HIV medications than other racial/ethnic groups in the U.S. Yet, little is known about age differences in factors that predict ART adherence among BMSM. We combined data from two surveys of HIV-positive BMSM, resulting in 209 participants (130 aged 18-50 years; 79 aged 50 years or older). Multivariate linear regressions examined associations between baseline characteristics and adherence to HIV medications as well as interactions of baseline characteristics with age. The associations between trust in healthcare and doctor satisfaction ratings with higher adherence were stronger for older vs younger men (p < .05); the association between problem drinking and lower adherence was stronger among younger men (p < .05). Future research should examine how interventions may address these age-specific factors to improve ART adherence among BMSM living with HIV.
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Affiliation(s)
- Matt G Mutchler
- a Department of Sociology , California State University , Dominguez Hills , Carson , USA.,b Community-Based Research , AIDS Project Los Angeles , Los Angeles , USA
| | | | | | | | - Ian A Klinger
- a Department of Sociology , California State University , Dominguez Hills , Carson , USA
| | - Keshav Tyagi
- b Community-Based Research , AIDS Project Los Angeles , Los Angeles , USA
| | - Bryce McDavitt
- d Department of Psychiatry and Behavioral Sciences , Keck School of Medicine of the University of Southern California , Los Angeles , USA
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Ojikutu BO, Bogart LM, Klein DJ, Galvan FH, Wagner GJ. Neighborhood Crime and Sexual Transmission Risk Behavior among Black Men Living with HIV. J Health Care Poor Underserved 2019; 29:383-399. [PMID: 29503307 DOI: 10.1353/hpu.2018.0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Here, we examined the association of exposure to neighborhood crime with sexual risk-taking behavior among Black men living with HIV. HIV-positive Black men on antiretroviral therapy in California completed an audio computer-assisted self-interview. Crime risk per census block group was derived from the Federal Bureau of Investigation's Uniform Crime Report. Among 193 men, the mean (SD) number of sexual partners among those who were sexually active was 2.7 (3.3). 49% reported condomless sex, and 23% reported sex with an HIV-negative or unknown-serostatus partner. In multivariate analysis, illicit drug use ([IRR=1.86; 95%CI: 1.20-2.89] p=.006), depressive symptoms ([IRR=1.59; 95%CI: 1.03-2.44] p=.03), an undetectable viral load ([IRR=1.91; 95%CI: 1.22-3.00] p=.005), and neighborhood total crime risk ([IRR=1.02; 95%CI: 1.01-1.04] p=.007) remained significant. Among Black men living with HIV, exposure to neighborhood crime is associated with having multiple sexual partners whose HIV status was negative or unknown.
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49
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Associations Between Multiple Forms of Discrimination and Tobacco Use Among People Living With HIV: The Mediating Role of Avoidance Coping. J Acquir Immune Defic Syndr 2019; 78:9-15. [PMID: 29373394 DOI: 10.1097/qai.0000000000001636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND People living with HIV (PLWH) have higher levels of tobacco use compared with the general population, increasing their risk of morbidity and mortality. PLWH also face potential chronic stressors related to the stigma and discrimination associated with HIV and other characteristics (eg, race and sexual orientation). These experiences may be associated with harmful health behaviors, such as tobacco use. The purpose of the current study is to explore the psychosocial context of tobacco use in PLWH, examining avoidance coping as a mediator in the relationship between multiple forms of discrimination and tobacco use. SETTING Participants included 202 PLWH recruited from an HIV primary care clinic in Birmingham, AL, between 2013 and 2015. METHODS Participants responded to parallel items assessing experiences of discrimination related to HIV status, race, and sexual orientation, as well as items assessing avoidance coping. Data on current tobacco use were obtained from participants' clinic records. Mediation models for each form of discrimination (HIV, race and sexual orientation) adjusting for demographic variables and the other forms of discrimination were evaluated. RESULTS The indirect effect of HIV-related discrimination on likelihood of tobacco use through avoidance coping was significant, suggesting that avoidance coping mediates the association between HIV-related discrimination and tobacco use. However, the indirect effects of the other forms of discrimination were not significant. CONCLUSIONS Given the disparity in tobacco use in PLWH, behavioral scientists and interventionists should consider including content specific to coping with experiences of discrimination in tobacco prevention and cessation programs for PLWH.
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Dale SK, Dean T, Sharma R, Reid R, Saunders S, Safren SA. Microaggressions and Discrimination Relate to Barriers to Care Among Black Women Living with HIV. AIDS Patient Care STDS 2019; 33:175-183. [PMID: 30932695 DOI: 10.1089/apc.2018.0258] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
In the United States, black women living with HIV (BWLWH) represent the highest proportion of women living with HIV and dying from HIV-related illnesses when compared with women of other racial/ethnic groups. These disparities may be linked to social and structural factors faced by BWLWH, including race- and HIV-related discrimination, and gendered racial microaggressions (GRMs). GRMs are everyday insults that black women experience due to being both black and female (e.g., comments about their body). Commonly assessed barriers to HIV-related care (e.g., transportation, finance, community stigma) do not include personal experiences of race- and HIV-related discrimination and GRM. We present the cross-sectional associations between racial discrimination, HIV-related discrimination, GRM, and barriers to care. One hundred BWLWH in a large city in the Southeast United States completed baseline assessments as part of an intervention development study. At baseline assessments BWLWH completed measures on racial discrimination, HIV-related discrimination, GRM (frequency and appraisal), and barriers to care. Hierarchical multiple linear regressions controlling for age, education, and income indicated that higher race-related discrimination (β = 0.23, p < 0.05), higher HIV-related discrimination (β = 0.26, p < 0.01), and higher GRM (frequency: β = 0.31, p < 0.01; appraisal: β = 0.21, p < 0.05) significantly predicted higher total barriers to care. When all predictors were entered together GRMs contributed uniquely to total barriers to care and two subscales, while racial discrimination contributed uniquely toward one subscale. These findings further emphasize that for BWLWH interventions and policy efforts need to address racial discrimination, HIV-related discrimination, and GRM concurrently with other barriers to care, with special attention being given to daily GRM.
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Affiliation(s)
- Sannisha K. Dale
- Department of Psychology, University of Miami, Miami, Florida
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Taquesha Dean
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Rachelle Reid
- Department of Psychology, University of Miami, Miami, Florida
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