Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS

In people living with HIV (PLWH), menopause (natural or surgical) contributes to the greater symptom burden in women: results from an online US survey

OBJECTIVE

The majority of people living with HIV in the United States are now over the age of 50, but symptom burden research has seldom included older women or the potential role of menopause. The aim of the study was to examine the influence of menopause as part of sex differences in HIV symptom burden.

METHODS

A cross-sectional study was conducted that included both a sex-based analysis of previously reported HIV symptom characteristics of 1,342 respondents to an online survey (males, n = 957; female, n = 385) and a follow-up online survey of menstrual bleeding patterns (inferred menopause) in eligible females (n = 242) from the respondent pool. Using linear mixed models, we identified predictors of symptom burden scores in female respondents.

RESULTS

For the most troublesome symptoms assessed in the sex-based analysis, depression scores were similar (P > 0.05), but higher (worse) burden scores for fatigue (P = 0.013) and muscle aches/pains (P = 0.004) were exclusively observed in females after adjusting for covariates. Respondents to the female survey (n = 222) were predominantly Black, heterosexual, nonsmokers, and obese, with an HIV diagnosis of approximately 16 years and at least one comorbid condition. Burden scores were higher in women reporting amenorrhea due to natural menopause or hysterectomy (n = 104) versus the menstruating group (n = 118) for muscle aches/pains (P = 0.05), fatigue (P = 0.03), and difficulty falling asleep (P = 0.04), independent of age, HIV duration, and number of HIV-associated non-AIDS conditions.

CONCLUSIONS

Two of the most common symptoms in people living with HIV-fatigue and muscle aches/joint pains-invoke additional burden in women. Independent of aging, symptom burden may be exacerbated after menopause, supporting a shifting paradigm for HIV care management.

Maintaining Harmony: How Religion and Culture are Interwoven in Managing Daily Diabetes Self-Care

The lingering culture among Javanese people cannot be separated from religion, influencing how they perceive any factors that might play a role in managing any health condition. This present study aimed in exploring the perceptions and experiences of religion and culture in performing daily self-care among Javanese Muslim with type 2 diabetes. A qualitative study with thematic content analysis method utilizing in-depth semi-structured interviews was undertaken to explore the perceptions and experiences of Javanese Muslim with diabetes managing their daily self-care activity. Convenient samples of 24 participants were selected to gain a richer understanding of self-care activity. The study identified one main theme of 'maintaining harmony' with comprised of two sub-themes: 'surrender and accept', and 'keep trying and leave the rest to Allah, a concept of tawakkal'. The first sub-theme consists of categories of: nerimo ing pandum, or accepting with sincerity, and tepo seliro, or being tolerance with others. The second sub-theme consists of three categories: being independent, social ties, and embracing Allah. The study also reveals the importance of Pengajian and Persadia as social resources in enhancing the capability to better self-care the condition. Thus, it also reveals the need to further develop diabetes education programmes in collaboration with religious leaders and health professionals to promote self-care to complement religious practice: Tawakkal or 'Keep trying and leave the rest to Allah'.

Health-related quality of life of people living with HIV infection in Spain: a gender perspective

Studies exploring gender differences in health-related quality of life (HRQOL) of people living with HIV/AIDS (PLWHA) are scarce and contradictory. This study evaluated gender differences in HRQOL of 744 PLWHA with median (IQR) age 44 (37-48) years and HIV infection diagnosed 12 (5-20) years earlier. Results showed important differences between genders (p < .05). Better male physical health was related to being employed, not having economic worries, not receiving psychological support, not having injected drugs in past, low negative mood HIV-related, low HIV illness representation and internalized stigma, and high body image satisfaction and health behavior. For women, variables were fewer years since HIV diagnosis and low enacted stigma-personal experience of rejection. Mentally, variables in men were being employed, not having injected drugs, having a stable partner, high health behavior, use of problem-solving coping, personal autonomy and personal meaning. In women, better mental health was related to high CD4 cells, self-esteem and body image satisfaction, and negative mood HIV-related. Men and women coincided in absence of past opportunistic infections being related to better physical and mental health, and absence of side effects for physical health and low HIV-related stress and HIV illness representation for mental health. Our results highlight the need for detailed study of gender differences that identify the bio-psycho-socio inequalities that affect HRQOL.

Racial and socioeconomic disparities in the symptom reporting of persons living with HIV

Persons living with HIV (PLWH) today can survive decades with the disease, making the symptom experience much more relevant to their lifestyle and health outcomes. The goal of the research reported here was to assess the symptom reporting of PLWH in the Unites States (US) in the combined antiretroviral therapy (cART) age of the epidemic. We conducted an anonymous online survey of symptomatic PLWH in the US and asked participants to report the frequency and intensity of 28 frequently occurring symptoms in the past 30 days. The relationship between symptom reporting and demographic factors was investigated using the adaptive least absolute shrinkage and selection operator (LASSO) method. Fatigue was the most frequently reported symptom in our study population. Those with the lowest income were more likely to report more burdensome symptoms. In comparison to other racial and ethnic groups, Black non-Hispanic participants were significantly more likely to report a lower symptom burden score for fatigue, depression, muscle aches, anxiety, difficulties with memory and concentration. There were no racial/ ethnic differences in the burden of the symptoms related to sleep or neuropathy. Findings from this study present new evidence on the symptom reporting of PLWH in the US. Neuropathy continues to be a pervasive neurological symptom with no difference noted between racial/ ethnic groups.

Effect of Prayer on Intensity of Migraine Headache: A Randomized Clinical Trial

BACKGROUND AND AIM

Migraine is a common form of headache that affects patients quality of life negatively. In addition to pharmacologic treatment, there are a variety of nonpharmacologic treatments for migraine headache. In present study, we examined the effect of prayer on intensity of migraine pain.

METHODS

In a prospective, randomized, controlled trial from October 2013 to June 2014, this study has been conducted in Kerman, Iran. We randomly assigned 92 patients in 2 groups to receive either 40 mg of propranolol twice a day for 2 month (group "A") or 40 mg of propranolol twice a day for 2 months with prayer (group "B"). At the beginning of study and 3 months after intervention, patients' pain was measured using the visual analogue scale.

RESULTS

At the beginning of study and before intervention, the mean score of pain in patients in groups A and B were 5.7 ± 1.6 and 6.5 ± 1.9, respectively. According to results of independent t test, mean score of pain intensity at the beginning of study were similar between patients in 2 groups (P > .05). Three month after intervention, mean score of pain intensity decreased in patients in both groups. At this time, the mean scores of pain intensity were 5.4 ± 1.1 and 4.2 ± 2.3 in patients in groups A and B, respectively. This difference between groups was statistically significant (P < .001).

CONCLUSIONS

The present study revealed that prayer can be used as a nonpharmacologic pain coping strategy in addition to pharmacologic intervention for this group of patients.

True Believers? Religion, Physiology, and Perceived Body Weight in Texas

This paper examines relationships between body weight, religion, and gender while controlling for relevant covariates and body mass index (BMI), a measure of physical/biological body type. Using data from the 2004 Survey of Texas Adults (n = 1,504), we present results of ordered logistic regression models which indicate that religious factors work distinctly for men and women when controlling for BMI. While church attendance is associated with lower odds of overweight perceptions among women, it is religious salience that is associated with lower odds of self-reported excess weight in men. Implications for research which associates religious and physiological factors are discussed.

Religious and Psychosocial Covariates of Health-Related Quality of Life in People Living with HIV/AIDS

HIV/AIDS is a chronic, highly stigmatized illness that requires significant lifestyle adjustments, including consistent adherence to Antiretroviral Therapy (ART) in order for People Living With HIV/AIDS (PLWH) to survive and maintain good immune health. PLWH often report poor or moderate Health-Related Quality of Life (HRQoL) that is worse than the general population. This may be related to the psychological and physiological demands of HIV disease and the sociodemographic stressors associated with it. The role of religious coping, religiosity, and social support in the mental and physical dimensions of HRQoL is less known, although recent studies highlight that PLWH rely on spirituality/religion to cope with HIV-associated stressors. This study examined the effects of religious coping, religiosity, depressive symptoms, medication adherence, and social support satisfaction in various dimensions of Health- Related Quality of Life (HRQoL) in a sample of 292 PLWH. Majority of participants were African-American (90.1%) and 56.2% were male. Mean age was 45 years and, on average, participants lived with HIV for nearly 11 years. Descriptive statistics, correlations, Analysis of Variance (ANOVA), and hierarchical multiple linear regression were used to analyze the data. Income, sex (β= .14), age (β= -.14), depressive symptoms (β= -.27), and social support satisfaction (β= .17) significantly predicted physical HRQoL. Results indicate that income (β= .13), sex (β= .14), medication adherence (β= .13), negative religious coping (β= -.18), religious attendance (β= .13), religiousness (β= .16), and social support satisfaction (β= .27) significantly predicted mental HRQoL. Depressive symptoms (β= -.38), positive religious coping (β= .24), and social support satisfaction (β= .16) significantly predicted general HRQoL. Participants, who were female, prayed less than daily, attended religious services less than weekly or who were non/less religious had significantly poorer HRQoL. The findings confirm the importance of religion, mental health, medication adherence and social support in the HRQoL of PLWH, which should all be routinely assessed by clinicians.

Longitudinal spiritual coping with trauma in people with HIV: implications for health care

This 10-year study (N=177) examines how people with HIV use spirituality to cope with life's trauma on top of HIV-related stress (e.g., facing death, stigma, poverty, limited healthcare) usual events. Spirituality, defined as a connection to a higher presence, is independent from religion (institutionalized spirituality). As a dynamic adaptive process, coping requires longitudinal studying. Qualitative content-analysis of interviews/essays yielded a coding of specific aspects and a longitudinal rating of overall spiritual coping. Most participants were rated as spiritual, using spiritual practices, about half experienced comfort, empowerment, growth/transformation, gratitude, less than one-third meaning, community, and positive reframing. Up to one-fifth perceived spiritual conflict, struggle, or anger, triggering post-traumatic stress, which sometimes converted into positive growth/transformation later. Over time, 65% used spiritual coping positively, 7% negatively, and 28% had no significant use. Spirituality was mainly beneficial for women, heterosexuals, and African Americans (p<0.05). Results suggest that spirituality is a major source of positive and occasionally negative coping (e.g., viewing HIV as sin). We discuss how clinicians can recognize and prevent when spirituality is creating distress and barriers to HIV treatment, adding a literature review on ways of effective spiritual assessment. Spirituality may be a beneficial component of coping with trauma, considering socio-cultural contexts.

National trends in prayer use as a coping mechanism for depression: changes from 2002 to 2007

To analyze national trends in the use of prayer among individuals with depression, we adopted a cross-sectional design with data from the adult Alternative Medicine supplement of the National Health Interview Survey 2002 and 2007. Prayer use and depression were combined into 4 categories: (a) prayed in the past 12 months and depressed; (b) prayed in the past 12 months and not depressed; (c) never prayed but depressed; and (d) never prayed and not depressed. Chi-square tests and multinomial logistic regressions were performed to analyze group differences. All analyses were adjusted for the complex sample design and conducted in SAS-callable SUDAAN. Use of prayer for depression was steady at 6.9 % across time; however, general prayer increased significantly between 2002 and 2007 (40.2 vs. 45.7). Women, aged 50-64, unmarried, with high school education were more likely to use prayer while depressed compared to those who were neither depressed nor prayed. Lifestyle behaviors (e.g. alcohol, smoking, exercise) were also associated with prayer use and depression. Prayer use for depression remained steady with unique relationships occurring among those who smoke, use alcohol, and have irregular exercise. Individuals' use of prayer as a potential complementary treatment for depression suggests that it is critical for mental and physical health treatment providers to be aware of the use of prayer as a coping resource.

Prevalence and predictors of drug use among adolescents with HIV infection acquired perinatally or later in life

We examined the prevalence and predictors of drug use among a diverse group of adolescents living with HIV infection acquired perinatally or through sexual risk behaviors ("behaviorally acquired"). Adolescents ages 13-21 (n = 166) who were receiving care at one of five pediatric/adolescent HIV clinics in three US cities (Baltimore MD, Washington DC, and New York NY) and were enrolled in a behavioral intervention were interviewed at baseline regarding lifetime drug use experiences and depression symptoms. A majority of study participants reported using alcohol (57.2%) and marijuana (51.2%); 48.8% reported tobacco/cigarette use. The mean age of onset of use for each type of drug was 14 years or younger. A larger proportion of participants with behaviorally acquired HIV than adolescents with perinatally acquired HIV reported lifetime use of alcohol (76.1 vs. 44.4%), marijuana (73.1 vs. 36.4%), tobacco (70.2 vs. 34.3%), and club drugs (22.4 vs. 3%) (all p < 0.001).

Living with HIV: responses to a mantram intervention using the critical incident research method

OBJECTIVES

The objective of this study was to identify and describe ways that a spiritually based intervention of silently repeating a mantram-sacred word or phrase-was used as a coping strategy for managing human immunodeficiency virus (HIV) disease.

DESIGN

The design was a qualitative research method, the critical incident technique.

SETTINGS/LOCATION

The study was conducted at an academically affiliated Veterans Affairs Hospital in southern California.

SUBJECTS

The subjects were outpatient adults living with HIV (n=32) who were receiving care through HIV clinics, community agencies, and HIV providers.

INTERVENTIONS

Subjects who participated in the intervention arm of a randomized controlled trial that tested the efficacy of a 5-weekly group mantram intervention were interviewed 2 months postintervention. Follow-up telephone interviews were specifically aimed at identifying instances of mantram use, and also participant perceptions of intervention usefulness or nonusefulness.

OUTCOME MEASURES

The outcome measures comprised categorization and comparison of the types and frequency of incidents reported, describing ways that the intervention was "helpful" or "not helpful" in managing stressors of HIV disease.

RESULTS

Participants reported a total of 185 incidents. Analysis and classification of the incidents resulted in eight mutually exclusive categories, including Increasing calm and/or peace, Mastering the technique, Changing my viewpoint, Increasing personal awareness, Adjusting behaviors, Managing physical symptoms, Increasing spirituality, and Enhancing relationships.

CONCLUSIONS

This study shows support for the benefits of the mantram intervention for adults with HIV. Additionally, the spiritually based mantram repetition intervention was found to be more helpful in providing a convenient, portable tool for managing a wide range of situations related to living with HIV disease.

Gender differences in HIV-related coping and depression

Our study examined differences in HIV-related coping in relation to depression in men and women. Ethnically diverse participants (n = 247, 46% women) were recruited in Dallas/Fort Worth and completed medical and demographic information, the Coping with HIV Scale (CHIV), and the Center for Epidemiological Studies-Depression scale (CES-D). Multiple regression analyses revealed that in men, depression was associated with symptoms, higher use of distraction, blame, expression and lower use of positive growth. In women, depression was associated with symptoms and higher use of blame. These results shed light on the ways in which each gender copes with HIV and may help researchers develop interventions tailored to the needs of the HIV-positive population.

Predictors of complementary/alternative medicine use and intensity of use among men with HIV infection from two geographic areas in the United States

This descriptive, cross-sectional study explored the factors associated with frequency and intensity of complementary/alternative medicine (CAM) use in 301 HIV-infected men from southern California (n=75) and northern Florida/southern Georgia (n=226). Logistic regression analysis was conducted to identify which demographic, biomedical, psychosocial, and health behavior variables (risk and health-promoting behaviors) were predictors of CAM use and intensity of use. The majority (69%) of participants reported CAM use. The types of CAM most frequently cited were dietary supplements (71%) and spiritual therapies (66%). Odds of CAM use increased with more depressive symptoms and more health-promoting behaviors. The odds of CAM use intensity increased with greater symptom frequency and more health-promoting behaviors. Living in California was predictive of both use frequency and intensity of CAM use. High levels of CAM use should alert health care providers to assess CAM use and to incorporate CAM-related patient education into their clinical practices.

Symptom experience in HIV-infected adults: a function of demographic and clinical characteristics

Personal characteristics that interact with both HIV diagnosis and its medical management can influence symptom experience. Little is known about how symptoms in populations with chronic illness vary by age, sex, or socioeconomic factors. As part of an ongoing prospective longitudinal study, this report describes symptoms experienced by 317 men and women living with HIV/AIDS. Participants were recruited at HIV clinics and community sites in the San Francisco Bay Area. Measures included the most recent CD4 cell count and viral load from the medical record, demographic and treatment variables, and the 32-item Memorial Symptom Assessment Scale to estimate prevalence, severity, and distress of each symptom and global symptom burden. The median number of symptoms was nine, and symptoms experienced by more than half the sample population included lack of energy (65%), drowsiness (57%), difficulty sleeping (56%), and pain (55%). Global symptom burden was unrelated to age or CD4 cell count. Those with an AIDS diagnosis had significantly higher symptom burden scores, as did those currently receiving antiretroviral therapy. African Americans reported fewer symptoms than Caucasians or Mixed/Other race, and women reported more symptom burden after controlling for AIDS diagnosis and race. Because high symptom burden is more likely to precipitate self-care strategies that may potentially be ineffective, strategies for symptom management would be better guided by tailored interventions from health care providers.

Self-care behaviors of African American women living with HIV: a qualitative perspective

Significant numbers of African American (AA) women have been diagnosed with HIV over the past decade. HIV may be viewed as a chronic condition that can be actively managed through the use of self-care behaviors, yet little is known about how these women define self-care (SC) for themselves, and still less is known about what facilitates and hinders SC behaviors among these women. This article highlights the results of a qualitative research study undertaken with AA women living with HIV in a metropolitan city in the southeastern United States. The objective of this study was to systematically collect data about the SC experiences of these women. Focus group methodology was used. Content analysis of the data was conducted. Two primary domains emerged: do what the doctor says and living healthy. SC activities included seeking social support, managing disclosure, engaging in pampering, taking part in religious customs, and maintaining recovery.

Coping with HIV: Caribbean people in the United Kingdom

Although Caribbean people in the United Kingdom are increasingly being affected by HIV/AIDS, there has been no examination of how they are coping with the illness. We investigate the coping strategies of HIV-positive Caribbean people using in-depth interviews with a purposively selected group of 25 residents of South London. The main coping strategies were more cognitive than behavioral: restricted disclosure, submersion, faith, and positive reappraisal. These strategies were intertwined in complex ways, and most were rooted in contextual factors, particularly cultural ones. Themes of loss, silence, and reinvention suffused respondents' narratives. Interventions should consider the high degree of stigmatization of HIV/AIDS in the Caribbean community, reluctance to disclose, the likelihood of an initial severe reaction to diagnosis, and external stressors. HIV-positive Caribbean people who are coping well could serve as mentors and role models for poor copers and newly diagnosed patients; establishing Caribbean-specific support groups might also assist coping.

Church and Spirituality in the Lives of the African American Community

The African American church is held in the highest esteem by most African Americans. Although the influence of the African American church has been underestimated by physicians and nurses, it could be pivotal in optimizing health status among African Americans. Because of this influence, health care practitioners, including nurses, are now recognizing the important role that the African American church plays in improving the health status of individuals in the African American community. This article illuminates the health and health care concerns of the African American community by considering the traditional lack of equal access for this population and the role that the church can play in not only offering church-based health care services but also improving the health status of church congregations. Future roles of the African American church for improved health status are also suggested.

Male and Female Stimulant Use Among Rural Kentuckians: The Contribution of Spirituality and Religiosity

This study describes gender-specific patterns of drug use among active rural stimulant users and examines religiosity and spirituality as factors that may be related to stimulant use among males and females. The study includes a sample of 225 active rural stimulant users from Kentucky who were recruited using respondent driven sampling and completed face-to-face interviews. Findings suggest gender specific patterns among active rural stimulant users, with females reporting more amphetamine use. In addition, bivariate findings indicate that there is an inverse relationship between spirituality, religiosity, and stimulant use (specifically methamphetamine and amphetamine use), particularly for males. However, when further examining this relationship in multivariate models controlling for age and race, few significant findings were noted for spirituality and religiosity in predicting gender-specific stimulant use patterns. These findings suggest that treatment interventions that incorporate spirituality and religiosity should not only be gender specific, but should also target clients differentially. Findings on the degree of reported spirituality and religiosity also suggest that religious and/or faithbased organizations could be utilized for drug use interventions for rural stimulant users.

Barriers and facilitators to medication adherence in a southern minority population with HIV disease

Adherence to HIV medications has been an important focus over the past decade, but little is known about adherence barriers and facilitators specifically in that part of the United States known as the Deep South. Characteristics of the region may affect factors associated with adherence related to the patient, the patient-provider relationship, and the environment. A total of 20 HIV-infected clients of a large public infectious diseases clinic in the Deep South participated in one of three focus groups; themes were identified by content analysis. Barriers included the perceived burden of extra planning, denial, life stress, difficult characteristics of the medicines, social stigma, and shame. Facilitators included acceptance of the diagnosis, thinking about the consequences of not taking the medicines, prayer and spirituality, improvements in the medicines, and support from family and friends. In the South, faith and prayer may be strong facilitators that need to be considered when adapting existing adherence interventions.

Demographic and illness-related variables associated with HIV-related fatigue

Fatigue is one of the most debilitating symptoms suffered by those with HIV infection, yet little is known about its correlates. The primary aims of this study were to describe the degree to which fatigue affects daily functioning and the demographic and illness-related predictors of fatigue. The sample (n = 128) was composed of primarily poor, unemployed people of color. Fatigue most often interfered with the ability to think quickly, perform household chores, exercise, work, engage in recreational activities, walk, plan activities, and think clearly. The consequences of fatigue were highest for lowered motivation, difficulty concentrating, increased drowsiness, losing patience, and interference with work, family, and social life. Multiple linear regression analyses showed statistically significant associations of employment status, monthly income, current antidepressant use, and number of years living with HIV infection as predictors of fatigue. These must be better understood to develop interventions to successfully ameliorate HIV-related fatigue.

Beliefs about HIV disease and medication adherence in persons living with HIV/AIDS in rural southeastern North Carolina

The purpose of this study was to assess personal beliefs about the causes and meaning of having HIV disease and personal beliefs about medication adherence in persons living in rural southeastern North Carolina. Of the total sample of 34 participants, 29 (85%) were African American. The sample included 21 men (62%) and 13 women (38%), with a self-reported mean CD4 count of 499.38 (SD = 377.69) and a mean duration of HIV of 8.0 years. The majority of participants held beliefs that HIV was a serious and chronic condition and that the disease could be controlled by HIV therapies. Participants offered disparate views about whether or not the course of HIV disease was amenable to personal control. The persons who held the belief that the cause of HIV/AIDS was because of chance/bad luck (p = .03) or God's will (p < .001) were also most likely to believe that the progression of their HIV disease depended on chance or fate. The respondents currently taking HIV medication were also more likely to believe that HIV was caused by chance or bad luck (p = .038) or God's will (p = .016). The results reflect the important role of spirituality on self- regulation of illness and treatment in the rural southern culture.

Depression: the 'invisible grey fog' influencing the midlife health of African Canadian women

Depression is a topic that is often avoided in discussions among Black women for a myriad of reasons. The purpose of this study was to investigate the midlife health of Black women living in the province of Nova Scotia, Canada. This paper will present one of the key findings of this research; midlife depression. It will examine the factors associated with depression among mid-life African Canadian women and how these women deal with depression. A triangulation of qualitative and quantitative methods guided by the principles of participatory action research (PAR) was used in the study. Data collection methods included 50 in-depth interviews of mid-life African Canadian women aged 40-65, focus groups, and workshops as well as the CES-D structured instrument. Purposive sampling method was the primary recruitment strategy and 113 people participated in the study. Although the women rarely openly discussed depression, they described depression as emotional feelings that range from "feeling blue" to being clinically depressed. Women viewed midlife depression as the consequence of a complex set of circumstances and stressors that they face. At midlife, Black women frequently recognize the importance of greater self-care and the need to pay more attention to their health, but they are reluctant to do so because they have to be "strong" in order to deal with their daily experiences of racism. Racism, among other things, leads to accumulated stress and undermines Black women's ability to cope and make healthy life choices. This signifies the implications of these research findings for clinical practice.