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Hutchinson J, Neesgard B, Kowalska J, Grabmeier-Pfistershammer K, Johnson M, Kusejko K, De Wit S, Wit F, Mussini C, Castagna A, Stecher M, Pradier C, Domingo P, Carlander C, Wasmuth J, Chkhartishvili N, Uzdaviniene V, Haberl A, d'Arminio Monforte A, Garges H, Gallant J, Said M, Schmied B, van der Valk M, Konopnicki D, Jaschinski N, Mocroft A, Greenberg L, Burns F, Ryom L, Petoumenos K. Clinical characteristics of women with HIV in the RESPOND cohort: A descriptive analysis and comparison to men. HIV Med 2024. [PMID: 38840507 DOI: 10.1111/hiv.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/02/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Women with HIV are globally underrepresented in clinical research. Existing studies often focus on reproductive outcomes, seldom focus on older women, and are often underpowered to assess sex/gender differences. We describe CD4, HIV viral load (VL), clinical characteristics, comorbidity burden, and use of antiretroviral therapy (ART) among women with HIV in the RESPOND study and compare them with those of the men in RESPOND. METHODS RESPOND is a prospective, multi-cohort collaboration including over 34 000 people with HIV from across Europe and Australia. Demographic and clinical characteristics, including CD4/VL, comorbidity burden, and ART are presented at baseline, defined as the latter of 1 January 2012 or enrolment into the local cohort, stratified by age and sex/gender. We further stratify men by reported mode of HIV acquisition, men who have sex with men (MSM) and non-MSM. RESULTS Women account for 26.0% (n = 9019) of the cohort, with a median age of 42.2 years (interquartile range [IQR] 34.7-49.1). The majority (59.3%) of women were white, followed by 30.3% Black. Most women (75.8%) had acquired HIV heterosexually and 15.9% via injecting drug use. Nearly half (44.8%) were receiving a boosted protease inhibitor, 31.4% a non-nucleoside reverse transcriptase inhibitor, and 7.8% an integrase strand transfer inhibitor. The baseline year was 2012 for 73.2% of women and >2019 for 4.2%. Median CD4 was 523 (IQR 350-722) cells/μl, and 73.6% of women had a VL <200 copies/mL. Among the ART-naïve population, women were more likely than MSM but less likely than non-MSM (p < 0.001) to have CD4 <200 cells/μL and less likely than both MSM and non-MSM (p < 0.001) to have VL ≥100 000 copies/mL. Women were also more likely to be free of comorbidity than were both MSM and non-MSM (p < 0.0001). CONCLUSION RESPOND women are diverse in age, ethnicity/race, CD4/VL, and comorbidity burden, with important differences relative to men. This work highlights the importance of stratification by sex/gender for future research that may help improve screening and management guidelines specifically for women with HIV.
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Grants
- U01 AI069907 NIAID NIH HHS
- The International Cohort Consortium of Infectious Disease (RESPOND) is supported by The CHU St Pierre Brussels HIV Cohort, The Austrian HIV Cohort Study, The Australian HIV Observational Database, The AIDS Therapy Evaluation in the Netherlands National Observational HIV cohort, The EuroSIDA cohort, The Frankfurt HIV Cohort Study, The Georgian National AIDS Health Information System, The Nice HIV Cohort, The ICONA Foundation, The Modena HIV Cohort, The PISCIS Cohort Study, The Swiss HIV Cohort Study, The Swedish InfCare HIV Cohort, The Royal Free HIV Cohort Study, The San Raffaele Scientific Institute, The University Hospital Bonn HIV Cohort, The University of Cologne HIV Cohort, The Brighton HIV Cohort and The National Croatian HIV cohort. RESPOND is further financially supported by ViiV Healthcare, Merck Life Sciences, Gilead Sciences, Centre of Excellence for Health, Immunity and Infections (CHIP) and the AHOD cohort by grant No. U01-AI069907 from the U.S. National Institutes of Health, and GNT2023845 of the National Health and Medical Research Council, Australia.
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Affiliation(s)
- J Hutchinson
- The Australian HIV Observational Database (AHOD), The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - B Neesgard
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Kowalska
- Medical University of Warsaw, Warsaw, Poland
| | - K Grabmeier-Pfistershammer
- Austrian HIV Cohort Study (AHIVCOS), Department Of Dermatology, Medical University of Vienna, Vienna, Austria
| | - M Johnson
- Department of Infectious Diseases and Hospital Epidemiology, Royal Free London NHS Foundation Trust, London, UK
| | - K Kusejko
- University Hospital Zurich; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - S De Wit
- Saint-Pierre University Hospital, Infectious Diseases Department, Université Libre de Bruxelles, Brussels, Belgium
| | - F Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) Cohort, HIV Monitoring Foundation, Amsterdam, the Netherlands
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - C Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
- Italian Cohort Naive Antiretrovirals (ICONA), Milan, Italy
| | - A Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milan, Italy
| | - M Stecher
- University Hospital Cologne, Cologne, Germany
| | - C Pradier
- Nice HIV Cohort, Université Côte d'Azur et Centre Hospitalier Universitaire, Nice, France
| | - P Domingo
- Sant Pau and Santa Creu Hospital, Barcelona, Spain
| | - C Carlander
- Swedish InfCareHIV, Karolinska University Hospital, Solna, Sweden
| | - J Wasmuth
- University Hospital Bonn, Bonn, Germany
| | - N Chkhartishvili
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - V Uzdaviniene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - A Haberl
- Medical Center, Infectious Diseases Unit, Goethe-University Hospital, Frankfurt, Germany
| | | | - H Garges
- ViiV Healthcare, RTP, Research Triangle Park, North Carolina, USA
| | - J Gallant
- Gilead Sciences, Foster City, California, USA
| | - M Said
- European AIDS Treatment Group (EATG), Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - B Schmied
- Austrian HIV Cohort Study (AHIVCOS), Department Of Dermatology, Medical University of Vienna, Vienna, Austria
| | - M van der Valk
- AIDS Therapy Evaluation in the Netherlands (ATHENA) Cohort, HIV Monitoring Foundation, Amsterdam, the Netherlands
- Division of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - D Konopnicki
- Saint-Pierre University Hospital, Infectious Diseases Department, Université Libre de Bruxelles, Brussels, Belgium
| | - N Jaschinski
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Mocroft
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Institute for Global Health, University College London, London, UK
| | - L Greenberg
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F Burns
- Department of Infectious Diseases and Hospital Epidemiology, Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, University College London, London, UK
| | - L Ryom
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Disease 144, Hvidovre University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - K Petoumenos
- The Australian HIV Observational Database (AHOD), The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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2
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Guise A. Stigma power in practice: Exploring the contribution of Bourdieu's theory to stigma, discrimination and health research. Soc Sci Med 2024; 347:116774. [PMID: 38537331 DOI: 10.1016/j.socscimed.2024.116774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/08/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
Stigma and discrimination are increasingly understood as shaping health, and in turn conceptualised as social processes shaped by power and structural inequities. A challenge to analysis and implementing interventions is developing theory that can integrate analysis of structure, agency and power. One theoretical framework already promoted by prominent scholars as supporting this need is Bourdieu's social practice theory. This paper explores the application to date of Bourdieu's theory on stigma, discrimination and health. The paper describes how existing health literature has used concepts of symbolic violence, fields, capitals and habitus to develop insight into stigma power. The discussion explores how this theoretical framework is though underutilised and there has been little consideration of new programmatic approaches based on this theory. Directions for future research include the need for integrated approaches to analysis, especially using habitus to explore stigma power, and addressing processes of change. Directions for conceptualising interventions address how a mismatch of field and habitus could foster change and then the role for prophets in fostering symbolic revolutions. All these potential directions must in turn be integrated within the vast scholarship on stigma. In conclusion, further application and development of Bourdieu's social practice theory could help address the theoretical challenges facing the field of stigma, discrimination and health research.
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Affiliation(s)
- Andy Guise
- King's College London, 5(t,h) Floor, Addison House, Guy's Campus, London, SE1 3UL, UK.
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3
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Hartmann M, Nyblade L, Otticha S, Marton T, Agot K, Roberts ST. The development of a conceptual framework on PrEP stigma among adolescent girls and young women in sub-Saharan Africa. J Int AIDS Soc 2024; 27:e26213. [PMID: 38379129 PMCID: PMC10879468 DOI: 10.1002/jia2.26213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Stigma is a well-known barrier to HIV testing and treatment and is an emerging barrier to pre-exposure prophylaxis (PrEP) use. To guide future research, measurement and interventions, we developed a conceptual framework for PrEP stigma among adolescent girls and young women (AGYW) in sub-Saharan Africa, a priority population for PrEP. METHODS A literature review, expert consultations and focus group discussions (FGDs) were conducted to adapt the Health Stigma and Discrimination Framework, describing the stigmatization process nested within the socio-ecological framework. We reviewed all articles on PrEP stigma and on HIV, contraceptive or sexuality stigma among AGYW from 2009 to 2019. Expert consultations were conducted with 10 stigma or PrEP researchers and two Kenyan youth advisory boards to revise the framework. Finally, FGDs were conducted with AGYW PrEP users (4 FGDs; n = 20) and key influencers (14 FGDs; n = 72) in Kenya with the help of a Youth Research Team who aided in FGD conduct and results interpretation. Results from each phase were reviewed and the framework was updated to incorporate new and divergent findings. This was validated against an updated literature search from 2020 to 2023. RESULTS The conceptual framework identifies potential drivers, facilitators and manifestations of PrEP stigma, its outcomes and health impacts, and relevant intersecting stigmas. The main findings include: (1) PrEP stigma is driven by HIV, gender and sexuality stigmas, and low PrEP community awareness. (2) Stigma is facilitated by factors at multiple levels: policy (e.g. targeting of PrEP to high-risk populations), health systems (e.g. youth-friendly service availability), community (e.g. social capital) and individual (e.g. empowerment). (3) Similar to other stigmas, manifestations include labelling, violence and shame. (4) PrEP stigma results in decreased access to and acceptability of PrEP, limited social support and community resistance, which can impact mental health and decrease PrEP uptake and adherence. (5) Stigma may engender resilience by motivating AGYW to think of PrEP as an exercise in personal agency. CONCLUSIONS Our PrEP stigma conceptual framework highlights potential intervention targets at multiple levels in the stigmatization process. Its adoption would enable researchers to develop standardized measures and compare stigma across timepoints and populations as well as design and evaluate interventions.
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Affiliation(s)
- Miriam Hartmann
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Laura Nyblade
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| | | | - Tozoe Marton
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
| | - Kawango Agot
- Impact Research Development OrganizationKisumuKenya
| | - Sarah T. Roberts
- Women's Global Health ImperativeRTI InternationalBerkeleyCaliforniaUSA
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4
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Goldstein MH, Moore S, Mohamed M, Byrd R, Curtis MG, Rice WS, Camacho-Gonzalez A, Zanoni BC, Hussen SA. A qualitative analysis examining intersectional stigma among young adults living with HIV in Atlanta, Georgia. PLoS One 2023; 18:e0289821. [PMID: 37561729 PMCID: PMC10414665 DOI: 10.1371/journal.pone.0289821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
HIV-related stigma is a barrier to engagement in care for young adults living with HIV. Other intersecting forms of stigma (e.g., racism, sexism, homophobia), may worsen HIV-related stigma and impact engagement in care. From November 2020 to February 2021, we conducted 20 in-depth qualitative interviews among young adults living with HIV attending a large, comprehensive HIV care center in Atlanta, Georgia. Semi-structured interview guides based on Earnshaw and Chaudoir's HIV Stigma Framework and the theory of intersectionality facilitated discussion around experiences with various forms of stigma and its possible influence on healthcare engagement. Using the social-ecological model, we used thematic analysis to contextualize how young adults living with HIV experienced intersectional stigma and enacted, anticipated, and internalized HIV stigma in both healthcare and non-healthcare settings. Most participants identified as male, Black/African American, and gay. Participants described stigma at intrapersonal, interpersonal, clinic, and community levels. Intrapersonal stigma was associated with delayed care seeking, isolation, and fear of disclosure. Interpersonal stigma included discrimination from family and friends and avoidance of close relationships to elude disclosure. At the clinic level, stigma included negative experiences with staff in HIV and non-HIV healthcare settings, which contributed to decreased engagement in care. Stigma in the community included differential treatment from employers, community leaders, and religious community and was associated with feelings of helplessness related to current societal inequalities. Coping/motivating mechanisms for stigma included prioritizing health, eliciting support from the medical care team and peers. Our findings show different intersecting stigmas are barriers to healthcare at multiple levels for young adults living with HIV, potentially exacerbating existing health and social disparities. To improve engagement in care among young adults living with HIV, future interventions should address the different mechanisms of stigma at community, clinic, interpersonal and intrapersonal levels by enhancing social support and improving healthcare structural competency.
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Affiliation(s)
- Madeleine H. Goldstein
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Shamia Moore
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Munira Mohamed
- College of Arts and Sciences, Emory University, Atlanta, GA, United States of America
| | - Rosalind Byrd
- School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Michael G. Curtis
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Andres Camacho-Gonzalez
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Brian C. Zanoni
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Sophia A. Hussen
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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5
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Yu F, Hsiao YH, Park S, Kambara K, Allan B, Brough G, Hwang TF, Dang N, Young B, Patel R, Maldonado A, Okoli C. The Influence of Anticipated HIV Stigma on Health-related Behaviors, Self-rated Health, and Treatment Preferences Among People Living with HIV in East Asia. AIDS Behav 2023; 27:1287-1303. [PMID: 36348191 PMCID: PMC10036452 DOI: 10.1007/s10461-022-03865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
Abstract
Long-acting injectable regimens for HIV treatment have been developed which are less frequent, more discreet, and more desirable for some people living with HIV (PLHIV) and may help reduce stigma-related barriers to HIV treatment. However, there is little information on the relationship between reported stigma and preference for these newer treatments. We characterized anticipated, experienced, and internalized HIV stigma and examined the associations with treatment preferences among an international sample of PLHIV. Data came from the international, web-based, cross-sectional study called "Positive Perspectives" conducted among PLHIV aged ≥ 18 years in 25 geographic locations during 2019 (n = 2389). Descriptive analyses were stratified among East Asian (n = 230) vs. non-Asian (n = 2159) participants. Results showed that prevalence of anticipated stigma was significantly higher among East Asian than non-Asian participants (72.2%[166/230] vs. 63.8%[1377/2159], p = 0.011). A significantly higher percentage of East Asian (68.7%[158/230]) than non-Asian participants (43.3%[935/2159] indicated that someone finding their HIV pills would cause them much "stress or anxiety" (p < 0.001). Actions taken by some PLHIV to prevent unwanted disclosure included restricting who they shared their HIV status with, hiding their HIV pills, or even skipping a dose altogether because of privacy concerns. Overall, 50.0%[115/230] East Asian participants believed HIV would reduce their lifespan and 43.0%[99/230] no longer planned for their old age because of HIV. Anticipated stigma was strongly associated with receptivity to non-daily regimens. Concerted efforts to reduce stigma and deliver flexible treatment options that address the unmet treatment needs of PLHIV, including confidentiality concerns, may improve their health-related quality of life.
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Affiliation(s)
- Fei Yu
- Danlan Beijing Media Limited, Beijing, China
| | | | | | - Keita Kambara
- Japanese Network of People living with HIV/AIDS, Tokyo, Japan
| | - Brent Allan
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia
- International Council of AIDS Service Organizations (ICASO), Toronto, Canada
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6
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Yu B, Feng C, Yang X, Wang Z, Zou H, Jia P, Yang S. Roles of Social Capital in the Association Between Internalized Homophobia and Condomless Sex Among Men Who Have Sex With Men in Southwest China: A Four-Way Decomposition. Int J Public Health 2023; 68:1605202. [PMID: 36743343 PMCID: PMC9894890 DOI: 10.3389/ijph.2023.1605202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Objectives: This study examined whether social capital (SC) mediated the association between internalized homophobia (IH) and condomless sex among men who have sex with men (MSM), with the interaction of SC and IH considered. Methods: A cross-sectional study was conducted between November 2018 and April 2019 in Sichuan Province, China. A total of 540 participants were recruited to investigate their IH, SC, and condomless sex. A four-way decomposition of causal mediation analysis was used to test SC's roles in the association between IH and condomless sex. Results: Condomless sex was prevalent (46.7%) among the participants, which was significantly associated with IH [odds ratio (OR) = 1.70] and SC (OR = 0.55). A direct effect [excess risk ratio (RR = 0.32)] and an indirect effect (excess RR = 0.16) of SC were found to be significant in the association between IH and condomless sex. Heterogeneities in effects were observed when taking the SC's domains (e.g., individual and family-based SC) as mediators. SC's effects were significant only in the homosexual subgroup. Conclusion: IH-based intervention with consideration of SC can be tailored to MSM to decrease condomless sex and curb the spread of HIV, especially for the homosexual subgroup.
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Affiliation(s)
- Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,Sichuan Research Center of Sexual Sociology and Sex Education, Chengdu, China
| | - Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, China,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xue Yang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zixin Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China,International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China,Department of Health Management Center, Clinical Medical College and Affiliated Hospital, Chengdu University, Chengdu, China,*Correspondence: Shujuan Yang,
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7
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Age and Mental Health Symptoms Among Chinese Persons With HIV: The Mediating and Moderating Role of Perceived Discrimination. J Assoc Nurses AIDS Care 2023; 34:105-112. [PMID: 36656094 DOI: 10.1097/jnc.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
ABSTRACT The association between age and mental health symptoms among persons with HIV (PWH) is inconsistent, and little is known about the mediators and moderators of this association. This study aimed to examine the association between age and mental health symptoms, as well as the mediators and moderators of perceived discrimination. Data were from 1,304 PWH who completed a cross-sectional survey in five areas of China. Multiple linear regressions showed that younger age was significantly associated with more severe mental health symptoms and that perceived discrimination moderated this relationship. The Sobel test showed that perceived discrimination also mediated the association between age and mental health symptoms. Our study indicates that perceived discrimination shapes the association between age and mental health symptoms among PWH and highlights the importance of designing age-tailored mental health intervention strategies for perceived discrimination among young PWH. Interventions addressing discrimination are necessary to help improve mental health, especially for young PWH.
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8
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Yu Y, Wang X, Wu Y, Weng W, Zhang M, Li J, Huang X, Gao Y. The benefits of psychosocial interventions for mental health in men who have sex with men living with HIV: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:440. [PMID: 35768860 PMCID: PMC9241196 DOI: 10.1186/s12888-022-04072-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Men who have sex with men (MSM) living with HIV are more likely to suffer from mental health problems. They should be given adequate attention to treat and improve their mental health disorders. This meta-analysis aimed to assess whether psychosocial interventions reliably improve psychological well-being among MSM living with HIV. METHOD Cochrane Library, EMBASE, PsycINFO, and PubMed were searched for psychosocial intervention randomized controlled trials evaluating mental health (e.g., depression, anxiety, self-efficacy). The effect size was pooled using the random-effects model, and continuous outcomes were reported using standardized mean difference (SMD) values . RESULTS A total of 12 studies including 1782 participants were included in the meta-analysis. Psychosocial interventions in contrast to control groups significantly reduced depression (SMD, - 0.28; 95% CI - 0.52 - - 0.03) at the follow-up assessment and improved quality of life (SMD 0.43, 95% CI 0.23-0.63) after treatment. Psychosocial interventions also had a significant effect on measures of self-efficacy (SMD 2.22, 95% CI 0.24-4.20), and this effect was sustained until long-term follow-up (SMD 0.55, 95% CI 0.02-1.08). Subgroup analyses revealed that improvements in depression were more significant when participants possessed higher education and treatment providers used cognitive behavioral therapy (CBT). CONCLUSIONS The findings of this study indicate that psychosocial interventions benefit the mental health of MSM living with HIV. It is necessary to conduct more research to explore characteristics that may affect treatment outcomes in the future. TRIAL REGISTRATION This research was prospectively registered in PROSPERO ( CRD42021262567 ).
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Affiliation(s)
- Yan Yu
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xinyu Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yaxin Wu
- grid.24696.3f0000 0004 0369 153XCenter for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wenjia Weng
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ming Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Juan Li
- grid.24696.3f0000 0004 0369 153XDepartment of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.
| | - Yanqing Gao
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China. .,Candidate Branch of National Clinical Research Center for Skin Diseases, Beijing, China.
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9
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Wanjala SW, Too EK, Luchters S, Abubakar A. Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13074. [PMID: 34948690 PMCID: PMC8701211 DOI: 10.3390/ijerph182413074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
Addressing HIV-related stigma requires the use of psychometrically sound measures. However, despite the Berger HIV stigma scale (HSS) being among the most widely used measures for assessing HIV-related stigma, no study has systematically summarised its psychometric properties. This review investigated the psychometric properties of the HSS. A systematic review of articles published between 2001 and August 2021 was undertaken (CRD42020220305) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, we searched the grey literature and screened the reference lists of the included studies. Of the total 1241 studies that were screened, 166 were included in the review, of which 24 were development and/or validation studies. The rest were observational or experimental studies. All the studies except two reported some aspect of the scale's reliability. The reported internal consistency ranged from acceptable to excellent (Cronbach's alpha ≥ 0.70) in 93.2% of the studies. Only eight studies reported test-retest reliability, and the reported reliability was adequate, except for one study. Only 36 studies assessed and established the HSS's validity. The HSS appears to be a reliable and valid measure of HIV-related stigma. However, the validity evidence came from only 36 studies, most of which were conducted in North America and Europe. Consequently, more validation work is necessary for more precise insights.
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Affiliation(s)
- Stanley W. Wanjala
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Department of Social Sciences, Pwani University, Kilifi P.O. Box 195-80108, Kenya
| | - Ezra K. Too
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
| | - Stanley Luchters
- Department of Public Health and Primary Care, Campus UZ-Ghent, Ghent University, 9000 Ghent, Belgium
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi P.O. Box 30270-00100, Kenya; (E.K.T.); (A.A.)
- Department of Public Health, Pwani University, Kilifi P.O. Box 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi P.O. Box 230-80108, Kenya
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Shamsaei F, Tahour N, Sadeghian E. Effect of Stress Management Training on Stigma and Social Phobia in HIV-Positive Women. J Int Assoc Provid AIDS Care 2021; 19:2325958220918953. [PMID: 32274969 PMCID: PMC7153174 DOI: 10.1177/2325958220918953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to investigate the effect of stress management training on stigma and social phobia among HIV-positive women. This quasi-experimental pre- and posttest study was performed on a single group of 55 HIV-positive females Hamadan city, Iran, in 2018. The samples were taken through a convenience sampling method and the data collection tool were Berger HIV Stigma and Connor Social Phobia Scale. The mean scores of the stigma were 119.98 ± 21.15 and 94.78 ± 16.34 and social phobia were 24 ± 17.4 and 11.2 ± 9.68 before and after the intervention, respectively. The results of the paired sample t test indicated a significant difference in the stigma and social phobia mean scores before and after the intervention in HIV-positive women (P < .05). The results of the study revealed that stigma and social phobia are big challenges for HIV-positive women since these people are always judged by others and are subjected to labeling and rejection.
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Affiliation(s)
- Farshid Shamsaei
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Neda Tahour
- Department of Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Efat Sadeghian
- Chronic Diseases (Home Care) Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran
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Abstract
The concept of social capital appears in the literature of multiple disciplines as a social determinant of health, an important aspect of human interaction, and a means to support population health capacity. Little is known about the use of social capital within the context of nursing. This article's aim provides insight into the concept of social capital and nursing. Avant and Walker methodology was used to analyze a sample of 78 articles. Along with a variety of articles and content themes, findings from this concept analysis include critical attributes, an operational definition, and reflections regarding future use.
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12
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Griswold MK, Pagano-Therrien J. Women Living With HIV in High Income Countries and the Deeper Meaning of Breastfeeding Avoidance: A Metasynthesis. J Hum Lact 2020; 36:44-52. [PMID: 31895603 DOI: 10.1177/0890334419886565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recommendations to avoid breastfeeding for women living with HIV in high income countries has resulted in a gap in the literature on how healthcare professionals can provide the highest standard of lactation counseling. RESEARCH AIMS (1) Describe social and emotional experiences of infant feeding for women living with HIV in high income countries; (2) raise ethical considerations surrounding the clinical recommendation in high income countries to avoid breastfeeding. METHODS A systematic literature search was conducted between January 1, 2008 and June 20, 2019. A total of 900 papers were screened and six met the inclusion criteria: (a) the sample was drawn from a high-income country regardless of the nativity of participants; (b) some or all participants were women living with HIV. Metasynthesis, according to Noblit and Hare (1988), was used to synthesize the experiences of women living with HIV in high-income countries and their experiences in infant feeding decisions. RESULTS Participants in this sample suffered a substantial emotional burden associated with infant feeding experiences potentially leading to risk of internalized stigma, suggesting that infant feeding considerations may contribute to HIV stigma in unique ways. Four overarching themes were identified expressing the meaning of avoidance of breastfeeding: maternal self-worth, deculturalization, surveillance, and intersectionality. CONCLUSION Women in high-income countries living with HIV deserve the highest standard of lactation care and counseling available. Healthcare professionals in high-income countries are ethically obligated to provide evidenced-based lactation care and counseling to women living with HIV.
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Affiliation(s)
- Michele K Griswold
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jesica Pagano-Therrien
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
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13
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Martawinarti RTSN, Sari PI, Berhimpong VM. Life Experience of Human Immunodeficiency Virus (HIV) Sufferers: A Qualitative Systematic Review. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: HIV is a chronic disease that continues to increase from year to year, with many symptoms or obstacles encountered by HIV sufferers when going about their day. The experience of HIV sufferers is important to know in order to find out what they have experienced for as long as they have had the disease. The objective of this qualitative systematic review is to describe the experiences of people living with HIV.Methods: The method used was searching for journals using the pre-determined keywords of ‘experience’, ‘living with HIV’ and ‘coping’ through the databases of Scopus, ProQuest, PubMed and Sage between 2014 and 2019.Results: The study results showed that there was still discrimination against people with HIV. They also experienced health problems due to the effects of the therapy, unpreparedness in accepting their conditions and the prevention of transmission to their family members.Conclusion: Understanding the role of uncertainty, stigma and resilience is important, since these factors may very well contribute to the patient’s mental health.
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Khumsaen N, Stephenson R. Feasibility and Acceptability of an HIV/AIDS Self-Management Education Program for HIV-Positive Men Who Have Sex With Men in Thailand. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:553-566. [PMID: 31815528 PMCID: PMC7075033 DOI: 10.1521/aeap.2019.31.6.553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This pilot study examined the feasibility and acceptability of the HIV/AIDS self-management education program-Thai (HASMEP-T) for HIV-positive Thai men who have sex with men (MSM). HASMEP-T is a group-based adaptation of the evidence-based intervention, HASMEP. Participants were 40 Thai MSM living with HIV aged 18 years or older, recruited from an HIV clinic housed in a hospital in Thailand. Results support the feasibility of recruitment, screening, eligibility, and retention methods. The majority of the participants reported that the intervention was acceptable and met their initial expectations. Furthermore, all recruited participants in the intervention group (n = 20) completed HASMEP-T. Overall, intervention group participants demonstrated significant increases in all aspects of HIV self-management (p < .05), as well as improvement in quality of life in the psychological domain (p < .05). Our findings provide preliminary support for the large-scale, randomized-controlled trial of the efficacy of HASMEPT to promote self-management behaviors among HIV-positive Thai MSM.
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Affiliation(s)
- Natawan Khumsaen
- Boromarajonani College of Nursing, Suphanburi, Praboromarajchanok Institute of Health Workforce Development, Thailand
- Corresponding author’s
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48104, USA
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI 48104, USA
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15
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Wang W, Yang N, Li X, Xiao H, Gao M, Yan H, Li S. A pathway analysis of exploring how HIV-related stigma affects social capital among people living with HIV/AIDS in China. PSYCHOL HEALTH MED 2019; 24:1100-1110. [PMID: 30892925 DOI: 10.1080/13548506.2019.1595677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV-related stigma is the most common and serious social problem which people living with HIV/AIDS (PLWHA) have to face. However, the impact of HIV stigma on social capital is not yet clear. Therefore, this study aims to understand the relationship between HIV stigma and social capital, and explore the mechanism of how HIV stigma influences social capital among Chinese PLWHA on this basis. An institutional based cross-sectional study was conducted from Nov 2015 to Jan 2016 in Wuhan, China, using a self-reporting questionnaire. A total of 552 PLWHA participated, and 520 valid questionnaires were included. Multiple linear regression analysis showed that lower education level, lower monthly income, higher internalized stigma, and anticipated stigma were significantly associated with lower social capital. Results of path analysis showed that although perceived community stigma has no direct effect on social capital, but it can affect social capital through internalized stigma and anticipated stigma. In conclusion, increased HIV stigma and reduced social capital are frequent among PLWHA in China. Perceived community stigma may cause PLWHA to internalize stigma and anticipate stigmatizing experiences, resulting in the reduction of social capital. These findings suggest that perceived community stigma should become the target of stigma intervention strategy among Chinese PLWHA.
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Affiliation(s)
- Wei Wang
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china.,b Department of Epidemiology , University of Florida , Gainesville , FL , USA
| | - Ningxi Yang
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Xiaoyan Li
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Han Xiao
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Mengting Gao
- c Information Center , Renmin Hospital of Wuhan University , Wuhan , P.R. China
| | - Hong Yan
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
| | - Shiyue Li
- a School of Health Sciences , Wuhan University , Wuhan , P.R. china
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16
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Andu E, Wagenaar BH, Kemp CG, Nevin PE, Simoni JM, Andrasik M, Cohn SE, French AL, Rao D. Risk and protective factors of posttraumatic stress disorder among African American women living with HIV. AIDS Care 2018; 30:1393-1399. [PMID: 29695184 DOI: 10.1080/09540121.2018.1466981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We sought to examine risk and protective factors for Posttraumatic Stress Disorder (PTSD) among African American women living with HIV. This is a cross-sectional analysis of baseline data from a randomized trial of an HIV stigma reduction intervention. We examined data from two-hundred and thirty-nine African American women living with HIV. We examined whether age, marital status, level of education, internalized HIV-related stigma, and social support as potential protective and risk factors for PTSD symptoms using logistic regression. We analyzed bi-variate associations between each variable and PTSD symptoms, and constructed a multivariate logistic regression model adjusting for all variables. We found 67% reported clinically significant PTSD symptoms at baseline. Our results suggest that age, education, and internalized stigma were found to be associated with PTSD symptoms (p < 0.001), with older age and more education as protective factors and stigma as a risk factor for PTSD. Therefore, understanding this relationship may help improve assessment and treatment through evidence- based and trauma-informed strategies.
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Affiliation(s)
- Eaden Andu
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Brad H Wagenaar
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Chris G Kemp
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Paul E Nevin
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Jane M Simoni
- b Department of Psychology , University of Washington , Seattle , WA , USA
| | | | - Susan E Cohn
- d Department of Infectious Diseases , Northwestern University , Chicago , IL , USA
| | | | - Deepa Rao
- f Department of Global Health/Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , WA , USA
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Gao M, Xiao C, Zhang X, Li S, Yan H. Social capital and PTSD among PLWHA in China: the mediating role of resilience and internalized stigma. PSYCHOL HEALTH MED 2018; 23:698-706. [PMID: 29334231 DOI: 10.1080/13548506.2018.1426869] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Post-traumatic Stress Disorder (PTSD) is frequent among people living with HIV/AIDS (PLWHA). Few studies have investigated social-psychological predictors of PTSD in China. This study aimed to examine relationships between social capital, stigma, resilience and PTSD among PLWHA in China, and to provide effective suggestions for PTSD intervention. A cross-sectional study of 520 PLWHA was conducted from November 2015 to January 2016. Survey data were collected using anonymous self-reported questionnaire. Multivariable analyses were used to examine related factors of PTSD, and causal mediation analyses were conducted to assess whether stigma and resilience were mediators. Results indicated that higher risk of PTSD was independent associated with stronger stigma, decreasing social capital and lower resilience. There was an indirect relationship of social capital on PTSD mediated through resilience and HIV-related stigma. Therefore, PTSD intervention programs should not only pay attention to the role of social capital on PTSD, but also attach importance to stigma and resilience on PTSD symptoms.
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Affiliation(s)
- Mengting Gao
- a Information Center , Renmin Hospital of Wuhan University , Wuhan , China.,b School of Health Science , Wuhan University , Wuhan , China
| | - Chenchang Xiao
- b School of Health Science , Wuhan University , Wuhan , China
| | - Xuan Zhang
- c Department of nosocomial infection management , The Second People's Hospital of Shanxi Province , Taiyuan , China
| | - Shiyue Li
- b School of Health Science , Wuhan University , Wuhan , China
| | - Hong Yan
- b School of Health Science , Wuhan University , Wuhan , China
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