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Moore ED, Caiola C, Cary M, Humphreys J. A Qualitative Study of the Social Relationship Experiences Across the Life Course Among Black/African American Women Aging With HIV in the South. J Assoc Nurses AIDS Care 2024; 35:122-134. [PMID: 38261540 DOI: 10.1097/jnc.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
ABSTRACT Black/African American women continue to be disproportionately affected by HIV, facing multiple intersecting challenges that influence how they age and effectively manage their health. Supportive social relationships have been shown to help mitigate challenges and improve health in women with HIV, but little is known about Black/African American women's perceptions of social relationships. Guided by Life Course Theory, in-depth life history interviews were conducted with 18 Black/African American women aged 50+ years. In older adulthood, most important relationships among Black/African American women were with their adult children and grandchildren, intimate partners, God, and friends from the community. Factors that influenced relationships over time included: (a) a desire to build a community; (b) a need to empower oneself and give back; (c) yearning to engage the younger generation; and (d) battling HIV stigma. Older Black/African American women with HIV played a critical role in the education of the younger generation.
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Affiliation(s)
- Elizabeth D Moore
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
| | - Courtney Caiola
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
| | - Michael Cary
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
| | - Janice Humphreys
- Elizabeth D. Moore, PhD, MSc, FNP-BC, ACRN, was a doctoral student in the School of Nursing, Duke University, Durham, North Carolina, at the time the research was completed. She is now an Instructor, Department of Medicine, at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Courtney Caiola, PhD, MPH, RN, CNE, is an Assistant Professor, Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
- Michael Cary, PhD, RN, FAAN is an Associate Professor in the School of Nursing, Duke University, Durham, North Carolina, USA
- Janice Humphreys, PhD, RN, FAAN, is a Professor Emerita in the School of Nursing, Duke University, Durham, North Carolina, USA
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Mwangala PN, Wagner RG, Newton CR, Abubakar A. Strategies for improving mental health and wellbeing used by adults ageing with HIV from the Kenyan coast: a qualitative exploration. Wellcome Open Res 2023; 7:221. [PMID: 37415804 PMCID: PMC10320323 DOI: 10.12688/wellcomeopenres.18212.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
Background: Physical and mental health problems are common among older adults living with HIV (OALWH). Adaptive coping strategies play a vital role in improving these adults' mental health and well-being despite the deleterious effects of HIV and ageing. However, in sub-Saharan Africa, limited evidence exists on the commonly utilized coping strategies in this population. We explore the coping strategies used by Kenyan OALWH to improve their mental health and wellbeing. Methods: Semi-structured in-depth interviews were conducted between October and December 2019 with 56 participants: 34 OALWH (53% female), 11 healthcare providers (63% female) and 11 primary caregivers (73% female) in Kilifi County. All interviews were audio-recorded and transcribed verbatim. We used the framework approach to synthesize the qualitative data. Results: Five major themes emerged from the analysis of participants' narratives, including self-care practices, religion and spirituality, relational living (social connectedness), generativity, identity, and mastery. Our study further revealed maladaptive coping strategies, including reliance on over-the-counter medications, self-isolation, waiting to see if symptoms would subside despite doing nothing, and HIV treatment interruptions during prolonged periods of prayer and fasting. Conclusions: Our findings provide an initial understanding of the coping strategies used by OALWH to confront HIV and ageing challenges in a low-literacy, low socio-economic Kenyan setting. Our results suggest that interventions designed to enhance personal capacity, social support, positive religiosity and spirituality, and intergenerational connections may be beneficial in improving the mental health and well-being of OALWH.
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Affiliation(s)
- Patrick N. Mwangala
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, P O Box 230-80108, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, 27 St Andrews Road, Parktown 2193, South Africa
- Institute for Human Development, Aga Khan University, Nairobi, P.O. BOX 30270-00100, Kenya
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Charles R. Newton
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, P O Box 230-80108, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, P.O. BOX 30270-00100, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Oxford, OX3 7JX, UK
- Department of Public Health, Pwani University, Kilifi, P.O. BOX 195-80108, Kenya
| | - Amina Abubakar
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, P O Box 230-80108, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, P.O. BOX 30270-00100, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Oxford, OX3 7JX, UK
- Department of Public Health, Pwani University, Kilifi, P.O. BOX 195-80108, Kenya
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de Monteynard S, Bihan H, Campagné L, Crozet C, Cailhol J. Perceptions of multiple chronic conditions and coping strategies among migrants from Sub-Saharan Africa living in France with diabetes mellitus and HIV: An interview-based qualitative study. PLoS One 2023; 18:e0284688. [PMID: 37267406 DOI: 10.1371/journal.pone.0284688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/05/2023] [Indexed: 06/04/2023] Open
Abstract
Although diabetes is common among people living with HIV/AIDS (PLWHA), few data exists on how migrants from Sub-Saharan Africa (SSA) experience living with these two coexisting conditions in France. The objective of this study was to analyze perception of polypathology among PLWHA from SSA with type 2 diabetes and identify barriers and facilitators to their self-management. A qualitative study was conducted using semi-structured interviews from November 2019 to April 2020 with participants selected from a cohort of PLWHA and diabetes at Avicenne University Hospital. A total of 12 semi-structured interviews were conducted and analyzed using thematic analysis with inductive approach. Stigma remained a major issue in self-managing HIV, and some participants did not consider themselves as having a polypathology, as HIV has always been considered as a distinct condition. In general, emotion-based resources (e.g spirituality, trust in the medical discourse) and social support were mobilized more than problem-solving resources (e.g perception of medication as life-saving). Participants used the same main resource in self-management of HIV and diabetes, and resources used differed from participant to participant. This study highlighted challenges in self-management of diabetes and HIV in this population and complexity related to the socioeconomic and cultural specificities. Self-management could be more successful if patients and carers move in the same direction, having identified the individual coping resources to reach objectives.
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Affiliation(s)
- Soline de Monteynard
- Department of Infectious and Tropical Diseases, Avicenne University Hospital, Bobigny, France
| | - Hélène Bihan
- Endocrinology-Diabetology Department, Avicenne University Hospital, Bobigny, France
- LEPS UR 3412, Sorbonne Paris Nord University, Bobigny, France
| | - Lucie Campagné
- Department of General Medicine, Sorbonne Paris Nord University, Bobigny, France
| | - Cyril Crozet
- LEPS UR 3412, Sorbonne Paris Nord University, Bobigny, France
| | - Johann Cailhol
- Department of Infectious and Tropical Diseases, Avicenne University Hospital, Bobigny, France
- LEPS UR 3412, Sorbonne Paris Nord University, Bobigny, France
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4
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Mwangala PN, Wagner RG, Newton CR, Abubakar A. Strategies for improving mental health and wellbeing used by adults ageing with HIV: a qualitative exploration. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18212.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Physical and mental health problems are common among older adults living with HIV (OALWH). Adaptive coping strategies play a vital role in improving these adults' mental health and well-being despite the deleterious effects of HIV and ageing. However, in sub-Saharan Africa, limited evidence exists on the commonly utilized coping strategies in this population. We explore the coping strategies used by Kenyan OALWH to improve their mental health and wellbeing. Methods: Semi-structured in-depth interviews were conducted between October and December 2019 with 56 participants: 34 OALWH (53% female), 11 healthcare providers (63% female) and 11 primary caregivers (73% female) in Kilifi County. All interviews were audio-recorded and transcribed verbatim. We used the framework approach to synthesize the qualitative data. Results: Five major themes emerged from the analysis of participants’ narratives, including self-care practices, religion and spirituality, relational living (social connectedness), generativity, identity, and mastery. Our study further revealed maladaptive coping strategies, including reliance on over-the-counter medications, self-isolation, waiting to see if symptoms would subside despite doing nothing, and HIV treatment interruptions during prolonged periods of prayer and fasting. Conclusions: Our findings provide an initial understanding of the coping strategies used by OALWH to confront HIV and ageing challenges in a low-literacy, low socio-economic Kenyan setting. Our results suggest that interventions designed to enhance personal capacity, social support, positive religiosity and spirituality, and intergenerational connections may be beneficial in improving the mental health and well-being of OALWH.
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5
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Skeen SJ, Jones SS, Cruse CM, Horvath KJ. Integrating Natural Language Processing and Interpretive Thematic Analyses to Gain Human-Centered Design Insights on HIV Mobile Health: Proof-of-Concept Analysis. JMIR Hum Factors 2022; 9:e37350. [PMID: 35862171 PMCID: PMC9353680 DOI: 10.2196/37350] [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: 02/16/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV mobile health (mHealth) interventions often incorporate interactive peer-to-peer features. The user-generated content (UGC) created by these features can offer valuable design insights by revealing what topics and life events are most salient for participants, which can serve as targets for subsequent interventions. However, unstructured, textual UGC can be difficult to analyze. Interpretive thematic analyses can preserve rich narratives and latent themes but are labor-intensive and therefore scale poorly. Natural language processing (NLP) methods scale more readily but often produce only coarse descriptive results. Recent calls to advance the field have emphasized the untapped potential of combined NLP and qualitative analyses toward advancing user attunement in next-generation mHealth. OBJECTIVE In this proof-of-concept analysis, we gain human-centered design insights by applying hybrid consecutive NLP-qualitative methods to UGC from an HIV mHealth forum. METHODS UGC was extracted from Thrive With Me, a web app intervention for men living with HIV that includes an unstructured peer-to-peer support forum. In Python, topics were modeled by latent Dirichlet allocation. Rule-based sentiment analysis scored interactions by emotional valence. Using a novel ranking standard, the experientially richest and most emotionally polarized segments of UGC were condensed and then analyzed thematically in Dedoose. Design insights were then distilled from these themes. RESULTS The refined topic model detected K=3 topics: A: disease coping; B: social adversities; C: salutations and check-ins. Strong intratopic themes included HIV medication adherence, survivorship, and relationship challenges. Negative UGC often involved strong negative reactions to external media events. Positive UGC often focused on gratitude for survival, well-being, and fellow users' support. CONCLUSIONS With routinization, hybrid NLP-qualitative methods may be viable to rapidly characterize UGC in mHealth environments. Design principles point toward opportunities to align mHealth intervention features with the organically occurring uses captured in these analyses, for example, by foregrounding inspiring personal narratives and expressions of gratitude, or de-emphasizing anger-inducing media.
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Affiliation(s)
- Simone J Skeen
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States.,Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Stephen Scott Jones
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Carolyn Marie Cruse
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
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Jaspal R, Eriksson P, Nynäs P. Identity, Threat and Coping among Gay Men Living with HIV in Finland. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2021.1878980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Rusi Jaspal
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Panda Eriksson
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
| | - Peter Nynäs
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Turku, Finland
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7
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Allen A, Zaviryukha I, Kiriazova T, Shenoi S, Rozanova J. The Lived Experience of a Newly Diagnosed Older Person With HIV in Ukraine. QUALITATIVE HEALTH RESEARCH 2021; 31:2290-2303. [PMID: 34414837 PMCID: PMC8930274 DOI: 10.1177/10497323211026914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Low- and middle-income countries are home to 80% of older people with HIV (OPWH). Ukrainian OPWH experience higher mortality and decreased antiretroviral therapy (ART) initiation than younger patients, but there is little data examining OPWH's perspectives around new diagnosis and impact on care. In this study, we examined accounts of 30 newly diagnosed OPWH in Ukraine, exploring challenges faced in the peri-diagnosis period. Themes emerged representing the longitudinal coping process: OPWH (1) viewed themselves as low risk before diagnosis; (2) experienced HIV diagnosis as a traumatic event challenging their self-image; (3) used disclosure to seek support among a small circle of family, friends, or health care providers; (4) avoided disclosure to outsiders including primary care providers for fears of stigma and breaches in confidentiality; (5) viewed age as an asset; and (6) used HIV diagnosis as starting point for growth. These findings highlight the need for age-specific programming to increase HIV knowledge and coping, increase screening, and improve long-term planning.
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Affiliation(s)
- Amy Allen
- State University of New York Downstate Medical Center, Brooklyn, New York, USA
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Statz M, Ware D, Perry N, Huebner D, Cox C, Brown A, Meanley S, Haberlen S, Egan J, Brennan M, Teplin LA, Bolan R, Friedman MR, Plankey M. Primary and secondary supportive partnerships among HIV-positive and HIV-negative middle-aged and older gay men. PLoS One 2021; 16:e0245863. [PMID: 33596240 PMCID: PMC7888601 DOI: 10.1371/journal.pone.0245863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/08/2021] [Indexed: 11/18/2022] Open
Abstract
This study describes the primary and secondary partnerships of aging gay men participating in the Understanding Patterns of Healthy Aging Among Men Who Have Sex with Men substudy of the Multicenter AIDS Cohort Study and examines differences in the prevalence of these relationship structures by HIV status while adjusting for age, education, and race/ethnicity. Relationships were compared within the following structural categories: “only a primary partnership”, “only a secondary partnership”, “both a primary and secondary relationship”, or “neither a primary nor secondary relationship”. There were 1,054 participants (51.9% HIV negative/48.1% HIV positive) included in the study. Participants had a median age of 62.0 years (interquartile range: 56.0–67.0) and most reported being non-Hispanic white (74.6%) and college educated (88.0%). Of the 1,004 participants with available partnership status data, 384 (38.2%) reported no primary or secondary partnerships, 108 (10.8%) reported secondary-only partnership, 385 (38.3%) reported primary-only partnership, and 127 (12.6%) reported both primary and secondary partnerships. Of participants who reported primary partnerships only, the prevalence rates (PRs) were lower among those 62 years and older, HIV positive, black non-Hispanic and Hispanics. Of participants who reported only having a secondary partnership, the PRs were higher among those 62 years and older and HIV positive. Of participants who did not report having either a primary or secondary partnership, the PRs were higher among those 62 years and older, HIV positive, and black non-Hispanic compared with their respective referent groups. There was no significant difference in PRs of having both primary and secondary partnerships by age category, HIV status, race/ethnicity, and education. This study aimed to fill a knowledge gap in the literature regarding both primary and secondary supportive partnerships among aging HIV-positive and HIV-negative gay men.
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Affiliation(s)
- Matthew Statz
- Georgetown University School of Medicine, Washington, DC, United States of America
| | - Deanna Ware
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, United States of America
- * E-mail:
| | - Nicholas Perry
- Warren Alpert Medical School, Brown University, Providence, RI, United States of America
- Rhode Island Hospital, Providence, RI, United States of America
| | - David Huebner
- Department of Prevention and Community Health, Milken Institute of Public Health, George Washington University, Washington, DC, United States of America
| | - Christopher Cox
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Andre Brown
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, United States of America
| | - Sabina Haberlen
- Warren Alpert Medical School, Brown University, Providence, RI, United States of America
| | - James Egan
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Mark Brennan
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, United States of America
| | - Linda A. Teplin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Robert Bolan
- Los Angeles LGBT Center, Los Angeles, CA, United States of America
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, United States of America
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9
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My Whole World Changed: A Qualitative Exploration of the Coping Experiences of Transgender Women After an HIV Diagnosis. J Assoc Nurses AIDS Care 2020; 31:654-668. [PMID: 33060378 DOI: 10.1097/jnc.0000000000000200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this study was to generate a theoretical stage model that describes transgender women's coping strategies and responses after a new HIV diagnosis. The sample included 18 transgender women living with HIV in a large metropolitan city in central Indiana. Semi-structured interviews were conducted, digitally recorded, transcribed verbatim, and analyzed using grounded theory methods. Participants commonly described the experience of being newly diagnosed with HIV as, having the world change. Four stages through which attempts at coping occurred were identified: having the world come crashing down; shutting out the world; living in a dark world; and reconstructing the world. This model advances our understanding of the social and behavioral factors that influence how transgender women cope with a new HIV diagnosis and how their coping responses influence entry and engagement in the HIV care continuum.
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Freeman R, Gwadz M, Wilton L, Collins LM, Dorsen C, Hawkins RL, Silverman E, Martinez BY, Leonard NR, Applegate A, Cluesman S. Understanding long-term HIV survivorship among African American/Black and Latinx persons living with HIV in the United States: a qualitative exploration through the lens of symbolic violence. Int J Equity Health 2020; 19:146. [PMID: 32859191 PMCID: PMC7453370 DOI: 10.1186/s12939-020-01253-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/05/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Persons living with HIV (PLWH) are living longer, although racial/ethnic and socioeconomic status (SES) disparities persist. Yet, little is known about the experience of living with and managing HIV over decades. The present study took a qualitative approach and used the lens of symbolic violence, a type of internalized, non-physical violence manifested in the power differential between social groups. We focused on adult African American/Black and Latinx (AABL) PLWH from low-SES backgrounds. METHODS Data were drawn from two studies with AABL PLWH in New York City (N = 59). After providing signed informed consent, participants engaged in in-depth semi-structured interviews on aspects of HIV management. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. RESULTS Participants in the two studies were comparable on sociodemographic and background characteristics. They had lived with HIV for 20 years, on average (range 3-33 years). All were from low-SES backgrounds and most were African American/Black and men. Participants experienced a convergence of multiple social exclusions, harms, and stigmas, consistent with symbolic violence, which contributed to disengagement from HIV care and discontinuation of HIV medications. We organized results into five sub-themes: (1) participants were "ground down" over time by material, social, and emotional challenges and this diminished self-worth and, at times, the will to live; (2) social isolation and self-isolation, based in part on feeling devalued and dehumanized, served as stigma-avoidance strategies and mechanisms of social exclusion; (3) stigmatizing aspects of patient-provider interactions, both experienced and anticipated, along with (4) restricted autonomy in HIV care and other settings (e.g., parole) reduced engagement; and (5) poor HIV management was internalized as a personal failure. Importantly, resilience was evident throughout the five sub-themes. CONCLUSIONS Symbolic violence is a useful framework for understanding long-term HIV management and survivorship among AABL PLWH from low-SES backgrounds. Indeed, forms of symbolic violence are internalized over time (e.g., experiencing devaluation, dehumanization, loss of self-worth, and anticipated stigma), thereby impeding successful HIV management, in part because avoiding HIV care and discontinuing HIV medications are primary coping strategies. Results have implications for interventions in community and health care settings.
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Affiliation(s)
- Robert Freeman
- Independent Consultant, 205 Clinton Avenue, Brooklyn, NY, 11205, USA
| | - Marya Gwadz
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA.
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA
- Faculty of Humanities, University of Johannesburg, PO Box 524, Auckland Park, Johannesburg, 2006, South Africa
| | - Linda M Collins
- Department of Human Development and Family Studies, The Methodology Center, The Pennsylvania State University, 435 Health and Human Development Building, University Park, PA, 16802, USA
| | - Caroline Dorsen
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY, 10012, USA
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY, 10010, USA
| | - Robert L Hawkins
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Elizabeth Silverman
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Belkis Y Martinez
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Noelle R Leonard
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY, 10012, USA
| | - Amanda Applegate
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 314 Biobehavioral Health Building, University Park, PA, 16802, USA
| | - Sabrina Cluesman
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
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11
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Halpin SN, Ge L, Mehta CC, Gustafson D, Robertson KR, Rubin LH, Sharma A, Vance D, Valcour V, Waldrop-Valverde D, Ofotokun I. Psychosocial Resources and Emotions in Women Living With HIV Who Have Cognitive Impairment: Applying the Socio-Emotional Adaptation Theory. Res Theory Nurs Pract 2020; 34:49-64. [PMID: 31937636 PMCID: PMC8062986 DOI: 10.1891/1541-6577.34.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Decreased cognitive function is related to undesirable psychological outcomes such as greater emotional distress and lower quality of life, particularly among women living with HIV who experience cognitive impairment (WLWH-CI). Yet, few studies have examined the psychosocial resources that may attenuate these negative emotional outcomes. The current study sought to identify the interrelated contributions of social relationships and psychological resources in 399 WLWH-CI by applying Socio-Emotional Adaptation (SEA) theory using data from the Women's Interagency HIV Study (WIHS). Cognitive impairment (CI) was defined as impairment on two or more cognitive domains. Logistic regression models were used to estimate the odds of experiencing specific emotions due to a combination of four psychosocial resources. Emotions (i.e., depression, apathy, fear, anger, and acceptance) were related to a combination of binary (positive/negative) psychosocial resources including relationship with an informal support partner, relationship with a formal caregiver, coping, and perceived control. Understanding the conditions that may influence emotions in WLWH-CI is important for identifying and appropriately addressing the needs of this population. As CI increases, these individuals experience increasing challenges with articulating their care needs and having their needs met. As such, it becomes increasingly important to identify possible triggers for emotional responses to best address these underlying challenges.
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Affiliation(s)
| | - Lin Ge
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Christina C Mehta
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | | | - Kevin R Robertson
- AIDS Neurological Center, Department of Neurology.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leah H Rubin
- Departments of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Anjali Sharma
- Albert Einstein College of Medicine, Yeshiva University, New York, NY
| | - David Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Victor Valcour
- Global Brain Health Institute, San Franscisco, CA.,Department of Neurology, University of California San Fransisco, San Fransisco, CA
| | | | - Igho Ofotokun
- Emory University School of Medicine, Division of Infectious Disease, Atlanta, GA
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12
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Solomon P, O'Brien KK, Nixon S, Letts L, Baxter L, Gervais N. Trajectories of Episodic Disability in People Aging with HIV: A Longitudinal Qualitative Study. J Int Assoc Provid AIDS Care 2019; 17:2325958218759210. [PMID: 29464973 PMCID: PMC6748469 DOI: 10.1177/2325958218759210] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
People living with HIV may experience disability which is episodic in nature, characterized by periods of wellness and illness. The purpose of this longitudinal qualitative study was to understand how the episodic nature of HIV and the associated uncertainty shape the disability experience of older adults living with HIV over time. Fourteen men and 10 women who were HIV positive and over 50 years (mean age: 57 years; range: 50-73) participated in 4 interviews over 20 months. Longitudinal analyses of the transcribed interviews identified 4 phenotypes of episodic disability over time: decreasing, increasing, stable, or significant fluctuations. Although all participants experienced uncertainty, acceptance and optimism were hallmarks of those whose phenotypes were stable or improved over time. Understanding a person's episodic trajectory may help to tailor interventions to promote stability, mitigate an upward trajectory of increasing disability, and increase the time between episodes of illness.
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Affiliation(s)
- Patricia Solomon
- 1 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Stephanie Nixon
- 2 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lori Letts
- 1 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Larry Baxter
- 3 Community HIV Volunteer, Halifax, Nova Scotia, Canada
| | - Nicole Gervais
- 1 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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13
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‘The own’ and ‘the wise’ as social support for older people living with HIV in the United Kingdom. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractAs the HIV population ages, how the ageing and HIV experiences intersect to shape the lives of older people living with HIV (PLWH) becomes an increasingly pressing question. This multi-method study investigated social support, mental health and quality of life among 100 older PLWH in the United Kingdom. Drawing on data from three focus groups and 74 life-history interviews with older (aged 50+) White men who have sex with men (MSM), and Black African and White heterosexual men and women, living with HIV, we explore participants’ distinctions between, evaluations of and access to sources of social support. Participants distinguished between support from the HIV-negative (Goffman's ‘the own’) and experientially based support from other PLWH (Goffman's ‘the wise’), and viewed the former, while valuable, as needing to be supplemented by the latter. Furthermore, access to experientially based support varied across participant groups, whose communities had different histories with HIV/AIDS and thus different degrees of knowledge about HIV and avenues for connecting to other PLWH. Thus, social support among older PLWH cannot be neatly divided into ‘formal’ and ‘informal’ domains, or fully appreciated by applying traditional social support measures, including, in the context of health conditions, ‘peer support’ created through formal service organisations. Rather, older PLWH's own distinctions and evaluations better illuminate the complexities of social support in the context of ageing with HIV.
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14
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Krentz HB, John Gill M. Long-term HIV/AIDS survivors: Patients living with HIV infection retained in care for over 20 years. What have we learned? Int J STD AIDS 2018; 29:1098-1105. [PMID: 29933720 DOI: 10.1177/0956462418778705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals diagnosed with HIV before 1996 had poor prognoses. Few HIV care centers can track patients continuously from the 1980s to present. We determined the sociodemographic, clinical, and health care utilization characteristics of patients diagnosed and followed for >20 years (i.e. long-term HIV/AIDS survivors) to understand what factors contributed to survival. All HIV-positive patients diagnosed before 1996 were categorized as active, moved/lost, or died as of 1 January 2016. Baseline sociodemographic, clinical characteristics, antiretroviral therapy (ART) usage, retention, HIV care costs, and health status were analyzed. Of 876 patients, 49.5% died, 30.3% moved or left, 20.3% remained active in care for a median of 23.4 years. At diagnosis, continuously-followed patients were younger with a higher CD4 cell count, attended regular clinic visits at higher frequencies, and had received more ART than patients who moved or died. As of 1 January 2016, their median age was 57 years (interquartile range 53-62), 15% were aged >65 years, median CD4 cell count was 591 cells/mm3 (475-863) with 68% >500 cells/mm3. Sixty-two percent remained employed. The total cost of HIV care was $32,251,030 (Cdn$); median cost per patient per year $15,418 ($13,697-$18,392). Individuals diagnosed prior to 1996 benefited from early diagnosis and engagement to care, regular follow-ups, and timely initiation of ART, strongly supporting the modern guidelines of care.
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Affiliation(s)
- Hartmut B Krentz
- 1 Southern Alberta Clinic, Calgary, Canada.,2 Department of Medicine, University of Calgary, Calgary, Canada
| | - M John Gill
- 1 Southern Alberta Clinic, Calgary, Canada.,2 Department of Medicine, University of Calgary, Calgary, Canada
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15
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Porter KE, Brennan-Ing M, Burr JA, Dugan E, Karpiak SE. Stigma and Psychological Well-being Among Older Adults With HIV: The Impact of Spirituality and Integrative Health Approaches. THE GERONTOLOGIST 2017; 57:219-228. [PMID: 26329318 DOI: 10.1093/geront/gnv128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/16/2015] [Indexed: 11/12/2022] Open
Abstract
Purpose of the Study The National Institutes of Health calls for research that explores what it means to age optimally with HIV/AIDS as half of the U.S. people with HIV are aged 50 or older. This study applied the stress process model to examine the association between HIV stigma and psychological well-being and mediating resources (i.e., spirituality and complementary and integrative health [CIH]) approaches) in older adults with HIV. Design and Methods Using data from the Research on Older Adults with HIV (ROAH) study, structural equation modeling was used to estimate these relationships within a latent variable model. Namely, a direct negative association between HIV stigma and psychological well-being was hypothesized that would be mediated by spirituality and/or CIH use. Results The analyses showed that the model fits the data well [χ2 (137, N = 914) = 561.44, p = .000; comparative fit index = .964; root mean square error of approximation = .058, 95% confidence interval = .053 to .063]. All observed variables significantly loaded on their latent factor, and all paths were significant. Results indicated that spirituality and CIH use significantly mediated the negative association between HIV stigma and psychological well-being. Implications Findings highlight the importance of spiritual and CIH interventions for older adults with HIV/AIDS. Practice recommendations are provided at the micro- and mesolevel.
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Affiliation(s)
- Kristen E Porter
- ACRIA, Center on HIV and Aging, New York.,Department of Gerontology, University of Massachusetts, Boston
| | - Mark Brennan-Ing
- ACRIA, Center on HIV and Aging, New York.,New York University College of Nursing
| | - Jeffrey A Burr
- Department of Gerontology, University of Massachusetts, Boston
| | - Elizabeth Dugan
- Department of Gerontology, University of Massachusetts, Boston
| | - Stephen E Karpiak
- ACRIA, Center on HIV and Aging, New York.,New York University College of Nursing
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16
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Frazier EL, Sutton MY, Tie Y, Collison M, Do A. Clinical Characteristics and Outcomes Among Older Women with HIV. J Womens Health (Larchmt) 2017; 27:6-13. [PMID: 28836885 DOI: 10.1089/jwh.2017.6380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To inform the development of HIV care strategies for older women with HIV infection, an understudied group, we compared the psychosocial, behavioral, and clinical characteristics of HIV-positive women aged ≥50 (older women) with those aged 18-49 (younger women). METHODS We examined factors among HIV-positive women in care using data from the 2009 through 2013 cycles of a nationally representative sample of HIV-positive adults in care (Medical Monitoring Project). We compared psychosocial, clinical, and behavioral factors among women aged ≥50 years at interview versus those aged <50 years. We calculated weighted frequency estimates and performed logistic regression to compute adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) for the comparison of characteristics among women aged ≥50 versus <50 years. RESULTS Of 22,145 participants, 6186 were women; 40.7% (CI 39.1-42.3) were ≥50 years, and 32.7% of older women reported being sexually active. Compared with women <50 years, women aged ≥50 years were more likely to be dose adherent (aPR = 1.19; CI 1.07-1.33), prescribed antiretroviral therapy and have sustained viral load suppression (aPR = 1.03; CI 1.00-1.18), and were less likely to report any depression (aPR = 0.92; CI 0.86-0.99), to report condomless sex with a negative or unknown partner if sexually active (aPR = 0.56; CI 0.48-0.67), and to have received HIV/sexually transmitted infection (STI) prevention counseling from a healthcare provider (aPR = 0.82; CI 0.76-0.88). CONCLUSIONS These data suggest that older women in HIV care have more favorable outcomes in some clinical areas, but may warrant increased HIV/STI prevention counseling from their care providers, especially if sexually active.
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Affiliation(s)
- Emma L Frazier
- 1 Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Madeline Y Sutton
- 1 Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Yunfeng Tie
- 1 Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia .,2 ICF International , Atlanta, Georgia
| | - Maggie Collison
- 3 Internal Medicine Residency Program, Boston Medical Center , Boston, Massachusetts
| | - Ann Do
- 1 Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
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17
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Multimorbidity With HIV: Views of Community-Based People Living With HIV and Other Chronic Conditions. J Assoc Nurses AIDS Care 2017; 28:603-611. [PMID: 28495366 DOI: 10.1016/j.jana.2017.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 04/04/2017] [Indexed: 12/17/2022]
Abstract
People living with HIV (PLWH) experience an increase in chronic conditions with aging, but little is known about experiences of living with multimorbidity with HIV. Because early palliative care services may improve well-being for individuals with multimorbidity, we planned to test an intervention to provide these services to community-dwelling PLWH with other chronic conditions. To tailor our intervention to the target population, we conducted four focus groups (n = 22) that elicited health-related needs, experiences, and views regarding palliative and other health services. We identified four themes related to patients' needs and experiences: views of HIV as background to other chronic conditions, challenges managing medications and provider interactions, concerns about coping with future health needs, and persistence of HIV stigma. In addressing multimorbidity with HIV, providers and patients may benefit from enhanced attention to communication when crossing specialty areas and from additional support to decrease stressors associated with HIV stigma.
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18
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Zeligman M, Wood AW. Conceptualizing an HIV Diagnosis Through a Model of Grief and Bereavement. ADULTSPAN JOURNAL 2017. [DOI: 10.1002/adsp.12031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Melissa Zeligman
- Department of Counseling and Psychological Services; Georgia State University
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19
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Pierre S, Riviera V, Jean CP, Louis MJJ, Reif LK, Severe P, Rouzier V, Johnson WD, Pape JW, Fitzgerald DW, McNairy ML, Boutin-Foster C. Live with the Disease Like You Used to Before You Knew You Were Infected: A Qualitative Study Among 10-Year Survivors Living with HIV in Haiti. AIDS Patient Care STDS 2017; 31:145-151. [PMID: 28282245 DOI: 10.1089/apc.2016.0192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2003, the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), a nonprofit organization, began administering antiretroviral therapy (ART) to its patients. This practice transformed HIV from a fatal disease to a more manageable chronic condition. However, relatively few studies focus on the experiences of survivors. This study provided a unique opportunity to interview patients who survived at least 10 years after being treated with ART at GHESKIO. The goal of the study was to elicit from patients their perspectives on what enabled them to survive with AIDS. Grounded Theory, a qualitative research method was used to guide data collection, coding, and analysis. Individual interviews were conducted, audio-taped, transcribed and analyzed in Creole, and translated into English. Data saturation was reached at 25 participants. Of which, 64% were women, the mean age was 49, range of 43-55 years, 24% were married, 44% had not completed elementary school, and 72% had no income, the remaining participants had incomes ranging from $1000 to $5000 annually. Qualitative analysis resulted in 681 codes, which were grouped into six categories: being spiritually grounded, having supportive interactions with providers, caring for children, setting personal goals, persevering and living life as usual, and maintaining strict medication adherence practices. The overarching theory was that having a reason to live despite one's circumstances and living life as usual enabled one to survive. Having a strong spiritual foundation coupled with supportive family and providers motivated participants to live and adhere to their ART. As the number of patients who are living longer with HIV in Haiti increases, results from this study will be important in helping tailor interventions that enhance their overall quality of life.
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Affiliation(s)
- Samuel Pierre
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Vanessa Riviera
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Circee Phara Jean
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Marie Jude Jean Louis
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Lindsey K. Reif
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Patrice Severe
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
| | - Warren D. Johnson
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Jean W. Pape
- Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections, GHESKIO, Port-au-Prince, Haiti
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | | | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medical College, New York, New York
- Division of General Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Carla Boutin-Foster
- Brooklyn Health Disparities Center, SUNY Downstate Medical Center, New York, New York
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20
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Fumaz CR, Ayestaran A, Perez-Alvarez N, Muñoz-Moreno JA, Moltó J, Ferrer MJ, Clotet B. Resilience, ageing, and quality of life in long-term diagnosed HIV-infected patients. AIDS Care 2016; 27:1396-403. [PMID: 26679268 DOI: 10.1080/09540121.2015.1114989] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Resilience is a predictor of emotional well-being and psychological adjustment in people living with HIV infection. We report the results of a cross-sectional study in which we evaluated resilience and its association with perception of ageing, coping strategies, quality of life, and emotional status in a group of long-term diagnosed HIV-infected patients. The analysis included 151 consecutive participants (57.6% men). Resilience was moderately high to high in 65 (43%) participants, moderately low to moderate in 57 (37.7%), and very low in 29 (19.2%). Univariate and multivariate analyses were performed. Two factors of perception of ageing (good cognitive self-concept and good subjective perception of social relationships), the use of positive reframing as a coping strategy and better emotional status remained associated with high resilience. Our findings suggest that successful ageing is possible in people living with HIV infection. Resilience seems to play a key role in the ageing process.
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Affiliation(s)
- Carmina R Fumaz
- a Universitat Autònoma de Barcelona , Bellaterra , Barcelona , Spain.,b HIV Unit , Germans Trias i Pujol University Hospital , Badalona , Barcelona , Spain.,c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain
| | - Aintzane Ayestaran
- c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain.,d Statistics and Operations Research Department - Universitat Politècnica de Barcelona , Barcelona , Spain
| | - Nuria Perez-Alvarez
- c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain.,d Statistics and Operations Research Department - Universitat Politècnica de Barcelona , Barcelona , Spain
| | - Jose A Muñoz-Moreno
- a Universitat Autònoma de Barcelona , Bellaterra , Barcelona , Spain.,c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain
| | - Jose Moltó
- a Universitat Autònoma de Barcelona , Bellaterra , Barcelona , Spain.,b HIV Unit , Germans Trias i Pujol University Hospital , Badalona , Barcelona , Spain.,c Lluita contra la Sida Foundation , Badalona , Barcelona , Spain
| | - Maria Jose Ferrer
- b HIV Unit , Germans Trias i Pujol University Hospital , Badalona , Barcelona , Spain
| | - Bonaventura Clotet
- e AIDS Research Institute IrsiCaixa-HIVACAT , Badalona , Barcelona , Spain
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21
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Ezeamama AE, Woolfork MN, Guwatudde D, Bagenda D, Manabe YC, Fawzi WW, Smith Fawzi MC. Depressive and Anxiety Symptoms Predict Sustained Quality of Life Deficits in HIV-Positive Ugandan Adults Despite Antiretroviral Therapy: A Prospective Cohort Study. Medicine (Baltimore) 2016; 95:e2525. [PMID: 26945347 PMCID: PMC4782831 DOI: 10.1097/md.0000000000002525] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The impact of psychosocial status at onset of antiretroviral therapy on changes in quality of life (QOL) and subjectively rated health (SRH) among adults on highly active antiretroviral therapy (HAART) in resource-limited settings is poorly understood. Therefore, we evaluate the association between stigma, anxiety, depression, and social support and change in QOL and SRH in HIV-infected Ugandan adults during an 18-month period. Psychosocial indicators were assessed at enrollment using structured questionnaires. QOL and SRH measures were assessed at months 0, 6, 12, and 18 using the Medical Outcomes Survey-HIV. Linear mixed models determined risk estimated differences in QOL and SRH in relation to quartiles of each psychosocial status indicator. Repeated measures generalized estimating equations modeling was implemented to assess differences in likelihood of improved versus nonimproved SRH during follow-up.QOL scores and SRH improved significantly for all participants over 18 months (P < 0.0001). The gain in QOL increased dose-dependently as baseline depressive symptoms (time*depression P < 0.001) and anxiety levels (time*anxiety P < 0.001) declined. Lower social support was associated with worse QOL at baseline (P = 0.0005) but QOL improvement during follow-up was not dependent on baseline level of social support (time*social support P = 0.8943) or number of stigmatizing experiences (time*stigma P = 0.8662). Psychosocial determinants did not predict changes in SRH in this study. High levels of depression and anxiety symptoms at HAART initiation predicts lower gains in QOL for HIV-positive patients for as long as 18 months. Long-term QOL improvements in HIV-infected adults may be enhanced by implementation of psychosocial interventions to reduce depression and anxiety in HIV-infected adults.
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Affiliation(s)
- Amara E Ezeamama
- From the Department of Epidemiology and Biostatistics (AEE), Department of Health Promotion and Behaviour, The University of Georgia, Athens, GA, USA (MNW); School of Public Health (DG, DB); Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda (YCM); Division of Infectious Diseases, Department of Medicine, John Hopkins University, Baltimore, MD (YCM); Department of Epidemiology (WWF); Department of Global Health and Population (DB, WWF); Department of Nutrition, Harvard School of Public Health (WWF); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (MCSF); and Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA (DB)
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22
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High perceived social standing is associated with better health in HIV-infected Ugandan adults on highly active antiretroviral therapy. J Behav Med 2016; 39:453-64. [PMID: 26733010 DOI: 10.1007/s10865-015-9710-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
Perceived social standing (PSS) was evaluated as a determinant of differences in health outcomes among Ugandan HIV-infected adults from Kampala using cross-sectional study design. PSS was defined using the MacArthur scale of subjective social status translated and adapted for the study setting. Socio-demographic and psychosocial correlates of PSS ranking at enrollment were determined using linear regression models. High versus low PSS was defined based on the median PSS score and evaluated as a determinant of body mass index, hemoglobin, quality of life (QOL) and frailty-related phenotype via linear regression. A log-binomial regression model estimated the relative-risk of good, very good or excellent versus fair or poor self-rated health (SRH) in relation to PSS. Older age, increasing social support and material wealth were correlated with high PSS ranking, whereas female sex, experience of multiple stigmas and multiple depressive symptoms were correlated with low PSS ranking. High PSS participants were on average 1.1 kg/m(2) heavier, had 4.7 % lower frailty scores and 3.6 % higher QOL scores compared to low PSS patients (all p < 0.05); they were also more likely to self-classify as high SRH (RR 1.4, 95 % confidence interval 1.1, 1.7) but had comparable hemoglobin levels (p = 0.634). Low PSS correlated with poor physical and psychosocial wellbeing in HIV-positive Ugandan adults. The assessment of PSS as part of clinical management, combined with efforts to reduce stigma and improve social support, may identify and possibly reduce PSS-associated health inequality in Ugandan adults with HIV.
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23
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Lin C, Li L, Ji G, Jie W. Emotional social support and access to care among older people living with HIV in rural China. Int J Geriatr Psychiatry 2015; 30:1041-7. [PMID: 25663571 PMCID: PMC4527961 DOI: 10.1002/gps.4260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/16/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Globally, the number of older people living with HIV (PLH) is growing. Additionally, older PLH are facing particular challenges related to accessing health care. The objective of this study is to investigate the older PLH's access to care and its relationship to emotional and tangible social support. METHODS A cross-sectional study was conducted among 225 PLH who were 50 years of age or older in Anhui, China. A computer-assisted personal interview was used to collect the participants' demographic characteristics, perceived health status, and access to care. The following two dimensions of social support were measured: emotional support and tangible support. The association between emotional/tangible support and access to care was calculated using Pearson's/point-biserial correlations and with multiple linear regression. RESULTS Higher tangible support was reported by the participants who were married or living with a partner, those who had higher annual income levels, and those with better perceived health status. Emotional support was correlated with higher education, higher income, and better perceived health status. Multiple regression analyses showed that access to care was significantly associated with emotional support (β = 0.2807, p < 0.0001) but not with tangible support (β = -0.0183, p = 0.7922). CONCLUSIONS The study findings point to the importance of providing emotional support for older PLH. It is suggested that emotional support should be provided for older PLH in addition to tangible assistance, in order to engage them in treatment and care.
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Affiliation(s)
- Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Guoping Ji
- Anhui Provincial Center for Women and Children’s Health, Hefei, China
| | - Wu Jie
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
- Epidemiology Department, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
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24
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Abstract
Spirituality and religion are important to many people living with HIV (PLWH). Recent research has focused on special populations (ethnic-minorities, women, and youth), spirituality/religion measurement, mediating/moderating mechanisms, and individual and community-level interventions. Spirituality/religion in PLWH has been refined as a multidimensional phenomenon, which improves health/quality of life directly and through mediating factors (healthy behaviors, optimism, social support). Spirituality/religion helps people to cope with stressors, especially stigma/discrimination. Spiritual interventions utilizing the power of prayer and meditation and addressing spiritual struggle are under way. Faith-based community interventions have focused on stigma and could improve individual outcomes through access to spiritual/social support and care/treatment for PLWA. Community engagement is necessary to design/implement effective and sustainable programs. Future efforts should focus on vulnerable populations; utilize state-of-the-art methods (randomized clinical trials, community-based participatory research); and, address population-specific interventions at individual and community levels. Clinical and policy implications across geographic settings also need attention.
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Affiliation(s)
- Magdalena Szaflarski
- Department of Sociology, University of Alabama at Birmingham, HHB 460Q, 1720 2nd Ave S, Birmingham, AL, 35294-1152, USA,
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