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Diaz JE, Ghanooni D, Atkins L, Sam SS, Kantor R, Miller-Perusse M, Chuku CC, Valentin O, Balise RR, Davis-Ewart L, Tisler A, Horvath KJ, Carrico AW, Hirshfield S. Challenges and Opportunities with at-Home Blood Collection for HIV-1 Viral Load Monitoring among Sexual Minoritized Men who use Stimulants. AIDS Behav 2024:10.1007/s10461-024-04453-5. [PMID: 39126558 DOI: 10.1007/s10461-024-04453-5] [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: 07/20/2024] [Indexed: 08/12/2024]
Abstract
Sexually minoritized men (SMM) with HIV who use stimulants experience difficulties achieving and maintaining an undetectable viral load (VL). Home-based VL monitoring could augment HIV care by supporting interim, early identification of detectable VL. We describe implementation challenges associated with a home-collection device for laboratory-based VL testing among SMM with HIV who use stimulants. From March-May 2022, cisgender SMM with HIV reporting moderate-to-severe stimulant use disorder and suboptimal (< 90%) past-month antiretroviral therapy (ART) adherence were recruited via a consent-to-contact participant registry. Eligible men completed teleconference-based informed consent and were mailed a HemaSpot-HD blood collection device (volume capacity 160 µL; lower limit of detection 839 copies/mL) with detailed instructions for home blood self-collection and return shipment. Implementation process measures included estimated blood volume and VL quantification. Among 24 participants, 21 (88%) returned specimens with a median duration of 23 days (range: 10-71 days) between sending devices to participants and receiving specimens. Of these, 13/21 (62%) included enough blood (≥ 40 µL) for confidence in detectable/undetectable results; 10/13 (77%) had detectable VL, with 4/10 (40%) were quantifiable at ≥ 839 copies/mL. The remaining 8/21 had low blood volume (< 40 µL), but 3/8 (38%) still had detectable VL, with 1/3 (33%) quantifiable at ≥ 839 copies/mL. Home blood collection of ≥ 40 µL using HemaSpot-HD was feasible among this high-priority population, with > 50% having a VL detected. However, interim VL monitoring using HemaSpot-HD among those experiencing difficulties with ART adherence may be strengthened by building rapport via teleconferencing and providing detailed instructions to achieve adequate sample volume.
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Affiliation(s)
- José E Diaz
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Delaram Ghanooni
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Lindsay Atkins
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Soya S Sam
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI, USA
| | - Rami Kantor
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI, USA
| | - Michael Miller-Perusse
- San Diego State University/University of California Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Chika C Chuku
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Omar Valentin
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Raymond R Balise
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Leah Davis-Ewart
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Anna Tisler
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Adam W Carrico
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Sabina Hirshfield
- Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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2
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De Torres RQ, Operario D. Characterizing the "HIV Care Adherence Journey" for Persons With HIV in the Philippines: Conceptual Foundation for Person-Centered Intervention. J Assoc Nurses AIDS Care 2024; 35:325-338. [PMID: 38563452 PMCID: PMC11209816 DOI: 10.1097/jnc.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
ABSTRACT Promoting adherence to HIV care among persons with HIV (PWH) is a key component to addressing the rising HIV epidemic in the Philippines. HIV care adherence is a complex process that may change throughout an individual's life course or "journey" living with HIV. This qualitative study aimed to explore the HIV care adherence journey of PWH. Maximum variation sampling was used to select 12 PWH and 3 health care providers for in-depth online interviews, which were analyzed using thematic analysis. The four themes that emerged to describe the HIV care adherence journey are integration, relation, navigation, and manifestation. Each theme corresponds to a unique set of activities and goals related to PWH's lived experiences as they initiate, practice, and maintain care adherence. This study provides a preliminary framework to characterize the HIV care adherence journey as a dynamic, complex, and multifaceted phenomenon, which can help to inform holistic interventions to support PWH.
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Affiliation(s)
- Ryan Q. De Torres
- College of Nursing, University of the Philippines Manila, Philippines and a Volunteer HIV Educator and Counselor, The LoveYourself Inc., Philippines
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
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3
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Tang J, Ren J, Wang H, Shi M, Jia X, Zhang L. Real experience of caregivers of patients with HIV/AIDS from the perspective of iceberg theory: a qualitative research. BMJ Open 2024; 14:e079474. [PMID: 38719298 PMCID: PMC11086469 DOI: 10.1136/bmjopen-2023-079474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the caregiving behaviours and supportive needs of caregivers of patients with HIV/AIDS and provide a basis for healthcare institutions to carry out caregiver interventions. DESIGN A purposive sampling method was used to select 11 caregivers of patients with HIV/AIDS in the Infectious Disease Department of a tertiary hospital in Nanjing, China, to conduct semistructured interviews. Colaizzi analysis was used to collate and analyse the interview data. SETTING All interviews were conducted at a tertiary hospital specialising in infectious diseases in Nanjing, Jiangsu Province. PARTICIPANTS We purposively sampled 11 caregivers of people with HIV/AIDS, including nine women and two men. RESULTS Analysing the results from the perspective of iceberg theory, three thematic layers were identified: behavioural, value and belief. The behavioural layer includes a lack of awareness of the disease, physical and mental coping disorders, and an increased sense of stigma; the values layer includes a heightened sense of responsibility, the constraints of traditional gender norms, the influence of strong family values and the oppression of public opinion and morality and the belief layer includes the faith of standing together through storms and stress. CONCLUSION Healthcare professionals should value the experiences of caregivers of patients with HIV/AIDS and provide professional support to improve their quality of life.
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Affiliation(s)
- Jie Tang
- School of Nursing, Nanjing University of Chinese Medicine, Lianyungang, Jiangsu, China
| | - Jingxia Ren
- School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, Anyang, Henan, China
| | - Huiqun Wang
- Department of Infectious Disease, The Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Min Shi
- School of Nursing, Nanjing University of Chinese Medicine, Lianyungang, Jiangsu, China
| | - Xiaofeng Jia
- School of Nursing, Nanjing University of Chinese Medicine, Yantai, Shandong, China
| | - Liman Zhang
- Department of Infectious Disease, The Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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4
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Ferguson L, Anderson ME, Satchi K, Capron AM, Kaplan CD, Redfield P, Gruskin S. The ubiquity of 'self-care' in health: Why specificity matters. Glob Public Health 2024; 19:2296970. [PMID: 38214311 DOI: 10.1080/17441692.2023.2296970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
Despite increased interest in self-care for health, little consensus exists around its definition and scope. The World Health Organization has published several definitions of self-care, including in a 2019 Global Guideline rooted in sexual and reproductive health and rights (SRHR), later expanded to encompass health more generally. To establish a robust understanding of self-care, this exploratory study inventorises, consolidates, presents and analyses definitions of self-care beyond the SRHR field. A pragmatic review identified definitions and conceptualisations of self-care from peer-reviewed and grey literature published between 2009 and 2021. The search identified 91 definitions of self-care from 116 relevant publications. Data extraction informed analysis to identify recurring themes and approaches, revealing three key areas of variation: self-care being: (1) defined directly or descriptively; (2) situated within individual, interpersonal or structural contexts; (3) defined broadly or topic-specifically. A multilevel conceptualisation can guide a more broadly applicable understanding of self-care: first, as an aspect of healthcare; second, as a concept operating at individual, interpersonal and institutional levels; third, as a concept that impacts specific health fields and contexts differently. A comprehensive but adaptable framework works in service of improving health and wellbeing for all, acknowledging the linkages between self-care and health-related human rights.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle E Anderson
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Krishni Satchi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander M Capron
- Gould School of Law, University of Southern California, Los Angeles, CA, USA
| | - Charles D Kaplan
- Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Peter Redfield
- Department of Anthropology, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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5
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Batchelder AW, Heo M, Foley JD, Sullivan MC, Lum P, Pericot Valverde I, Taylor LE, Mehta SH, Kim AY, Norton B, Tsui JI, Feinberg J, Page K, Litwin AH. Shame and stigma in association with the HCV cascade to cure among people who inject drugs. Drug Alcohol Depend 2023; 253:111013. [PMID: 37951006 DOI: 10.1016/j.drugalcdep.2023.111013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/26/2023] [Accepted: 10/22/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Psycho-social experiences including shame and experienced and internalized stigma have been associated with substance use, HCV infection, and reluctance to disclose HCV status and pursue treatment. These psycho-social barriers have been examined independently for many chronic diseases, including HCV, but to our knowledge have not been quantitatively explored in a large multi-site US-based sample of people who inject drugs (PWID) in HCV treatment. METHODS We examine baseline relationships with HCV-stigma and engagement across the HCV treatment cascade as well as baseline and longitudinal relationships between shame and engagement across the HCV treatment cascade including treatment initiation, adherence, completion, and sustained virologic response (SVR) among a multi-site sample of PWID with HCV, where N=755 were randomized to the pragmatic trial comparing HCV treatment outcomes in modified directly observed treatment (mDOT) or patient navigation, and N=623 initiated treatment. RESULTS While cross-sectional assessments of shame and HCV-stigma were not associated with engagement across the HCV treatment cascade, those whose shame scores decreased compared to those who reported consistently high and increasing levels of shame were significantly more likely to complete HCV treatment (aOR=5.29; 95%CI: 1.56,18.00) and achieve SVR (aOR=6.32; 95%CI: 1.61, 24.87). CONCLUSION Results underscore the relationships between lower levels of shame and health-related behavior and treatment outcomes among PWID and suggest SVR achievement may contribute to reductions in shame or that reductions in shame may contribute to continued treatment and thus SVR.
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Affiliation(s)
- Abigail W Batchelder
- Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA.
| | - Moonseong Heo
- Department of Public Health, College of Behavioral, Social, and Health Sciences, Clemson University, 116 Edwards Hall, Clemson, SC 29634, USA
| | - Jacklyn D Foley
- Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA
| | - Matthew C Sullivan
- Behavioral Medicine Program, Psychiatry Department, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA 02114, USA
| | - Paula Lum
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Lynn E Taylor
- College of Pharmacy, University of Rhode Island, Providence, RI, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arthur Y Kim
- Department of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brianna Norton
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Judith Feinberg
- Department of Behavioral Medicine & Psychiatry and Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Kim Page
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Alain H Litwin
- Department of Medicine, Clemson University, Clemson, SC, 29634 USA; Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA; Department of Medicine, Prisma Health, Greenville, SC, USA.
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Restall G, Ukoli P, Mehta P, Hydesmith E, Payne M. Resisting and disrupting HIV-related stigma: a photovoice study. BMC Public Health 2023; 23:2062. [PMID: 37864144 PMCID: PMC10590010 DOI: 10.1186/s12889-023-16741-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/12/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The stigma associated with human immunodeficiency virus (HIV) is a significant global public health concern. Health care providers and policy makers continue to struggle with understanding and implementing strategies to reduce HIV-related stigma in particular contexts and at the intersections of additional oppressions. Perspectives and direction from people living with HIV are imperative. METHODS In this project we amplified the voices of people living with HIV about their experiences of HIV-related stigma in Manitoba, Canada. We used an arts-based qualitative case study research design using photovoice and narrative interviews. Adults living with HIV participated by taking pictures that represented their stigma experiences. The photos were a catalyst for conversations about HIV and stigma during follow-up individual narrative interviews. Journaling provided opportunities for participants to reflect on their experiences of, and resistance to, stigma. Interviews were audio recorded and transcribed. Photos, journals, and transcribed interviews were analyzed using inductive qualitative methods RESULTS: Through pictures and dialogue, participants (N = 11; 64% women) expressed the emotional and social impacts of stigmas that were created and supported by oppressive structures and interpersonal attitudes and behaviours. These experiences were compounded by intersecting forms of oppression including racism, sexism, and homophobia. Participants also relayed stories of their personal strategies and transitions toward confronting stigma. Strategies were themed as caring for oneself, caring for children and pets, reconstituting social support networks, and resisting and disrupting stigma. Participants made important recommendations for system and policy change. CONCLUSIONS These stories of oppression and resistance can inspire action to reduce HIV-related stigma. People living with HIV can consider the strategies to confront stigma that were shared in these stories. Health care providers and policy makers can take concerted actions to support peoples' transitions to resisting stigmas. They can facilitate supportive and anti-oppressive health and social service systems that address medical care as well as basic needs for food, shelter, income, and positive social and community connections.
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Affiliation(s)
- Gayle Restall
- Department of Occupational Therapy, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada.
| | - Patricia Ukoli
- Faculty of Social Work, University of Manitoba, Winnipeg, MB, Canada
| | - Punam Mehta
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Elizabeth Hydesmith
- Department of Anthropology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Mike Payne
- Nine Circles Community Health Centre, Winnipeg, MB, Canada
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Maiorana A, Zamudio-Haas S, Santiago-Rodríguez EI, Sauceda JA, Rodríguez-Díaz CE, Brooks RA, Myers JJ. HIV Disclosure Practices to Family Among Mexican and Puerto Rican Sexual Minority Men with HIV in the Continental USA: Intersections of Sexual Orientation and HIV Stigma. JOURNAL OF HOMOSEXUALITY 2023; 70:1911-1935. [PMID: 35225747 DOI: 10.1080/00918369.2022.2043731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Disclosing a seropositive HIV status still is a complex process of assessing the risks, benefits, and potential personal and interpersonal outcomes associated with disclosure, such as stigma, rejection, or emotional support. We examined HIV disclosure practices to family and intersectional stigma related to HIV and sexual orientation among Latino sexual minority men (LSMM) of Mexican and Puerto Rican origin with HIV in the continental USA. Guided by Framework Analysis, we present data from 54 interviews with 33 LSMM participants in HIV care engagement interventions, and 21 project staff implementing the interventions. LSMM disclosed their HIV status to family seeking support. They applied stigma management techniques to manage the information communicated to family about their HIV status, including selective disclosure to some family members, conveying strategic information about the significance of having HIV, non-disclosure, or partial disclosure, silence and deceptions. LSMM HIV disclosure practices to family encompassed appraisals of intersectional stigma related to their sexual orientation and HIV, assessing the potential outcomes of disclosure, and the preservation of family ties.
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Affiliation(s)
- Andres Maiorana
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
| | - Sophia Zamudio-Haas
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
| | - Edda I Santiago-Rodríguez
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
| | - John A Sauceda
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
| | - Carlos E Rodríguez-Díaz
- Department of Prevention and Community Health, The George Washington University, Milken Institute School of Public Health, Washington, DC, USA
| | - Ronald A Brooks
- Department of Family Medicine, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Janet J Myers
- Department of Prevention Science, University of California at San Francisco, Center for Aids Prevention Studies, San Francisco, California, USA
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8
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Zhang H. Intersectional stigma and coping strategies of single mothers living with HIV in Thailand. CULTURE, HEALTH & SEXUALITY 2023; 25:336-351. [PMID: 35209801 DOI: 10.1080/13691058.2022.2042393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Stigma and discrimination are barriers to the prevention and treatment of HIV, and have serious biomedical, psycho-social and socio-cultural consequences, especially for marginalised groups such as sex workers, transgender people and sexual minorities. There has been little research to date on single mothers living with HIV to situate the stigma they experience within the context of gender, class, ethnicity and other intersecting social inequalities. Drawing on participant observation and in-depth interviews with 28 single mothers living with HIV in Thailand in 2020-21, this article finds that single mothers living with HIV experience intersectional stigma based on their class, ethnicity, religious status and gender, which manifests at the self, family, community and societal levels. In response to this stigmatisation, single mothers have developed four different coping strategies: self-presentation, identity talk, self-exclusion (through distancing and selective association), and empowerment. Findings from the research indicate that an intersectional approach is needed if academics, health workers, policy makers - and even the individuals concerned - are to understand and respond effectively to the HIV-related stigma experienced by specific socio-demographic groups.
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Affiliation(s)
- Herbary Zhang
- Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong
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9
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Tao Y, Xiao X, Ma J, Wang H. The relationship between HIV-related stigma and HIV self-management among men who have sex with men: The chain mediating role of social support and self-efficacy. Front Psychol 2022; 13:1094575. [PMID: 36600713 PMCID: PMC9807034 DOI: 10.3389/fpsyg.2022.1094575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
HIV infection becomes a manageable disease, and self-management is one of the key indicators of achieving optimal health outcomes. Men who have sex with men (MSM) living with HIV face many psychosocial challenges when managing HIV infection, such as sexual minority pressure and HIV-related stigma. Higher perceived HIV-related stigma had been related to low self-management. However, the mechanisms underlying the association between HIV-related stigma and HIV self-management are unclear. Two possible mediators include social support and self-efficacy. This study aimed to examine the relationship between HIV-related stigma and HIV self-management among MSM living with HIV and to explore the single mediating effect of social support and self-efficacy and the chain mediating effect of these two variables on this relationship in China. Convenience sampling was used to recruit participants from the Center for Disease Control (CDC) in Changsha City, Hunan province, China. A total of 459 MSM living with HIV completed questionnaires regarding sociodemographic and disease-related information, HIV-related stigma, social support, self-efficacy, and HIV self-management. Descriptive statistics analysis, one-way ANOVA, independent t-tests, Pearson's bivariate correlation, and multiple regression were conducted using the SPSS v24.0. Process macro in SPSS was used to analyze the single and chain mediating effect among variables. Our findings showed that the indirect and total effect of HIV-related stigma on HIV self-management was significant, while the direct effect was not statistically significant. Social support and self-efficacy mediated the relationship between HIV-related stigma and HIV self-management, respectively. Moreover, the chain mediating model confirmed that the association between HIV-related stigma and HIV self-management was mediated by social support and self-efficacy sequentially. Future interventions focusing on improving HIV self-management among MSM living with HIV should consider a multi-faced approach.
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Batchelder AW, Hagan MJ. The Clinical Relevance of a Socioecological Conceptualization of Self-Worth. REVIEW OF GENERAL PSYCHOLOGY 2022. [DOI: 10.1177/10892680221109201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low self-worth pervades discussions of psychopathology, is a central feature of many psychiatric disorders, and appears in conceptions of psychological distress in a range of cultural contexts . Explication of this aspect of self-evaluation offers clinical utility especially when adequate attention is paid to social and cultural aspects of the self. In this paper, we propose that refining the conceptualization of self-worth as felt perceptions of one’s mattering and deservingness of equity and psychological, social, and material resources offers a unique clinical utility. We present an argument for this definition of self-worth, building on existing literature, as a relativistic construct informed and reinforced by dynamic feedback from intrapersonal, interpersonal, sociocultural, and structural socioecological levels. To highlight that self-worth has been an implied but under-examined concept, we follow with a selective review of psychological and sociological perspectives of self-esteem and related constructs. We conclude with a discussion of our conceptualization’s implications for measurement and treatment, including the potential transdiagnostic utility of self-worth.
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Affiliation(s)
- Abigail W. Batchelder
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Melissa J. Hagan
- Department of Psychology, San Francisco State University, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
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11
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Meyers-Pantele SA, Sullivan P, Mansergh G, Hirshfield S, Stephenson R, Horvath KJ. Race-Based Medical Mistrust, HIV-Related Stigma, and ART Adherence in a Diverse Sample of Men Who Have Sex with Men with HIV. AIDS Behav 2022; 26:1456-1466. [PMID: 34669061 PMCID: PMC9007843 DOI: 10.1007/s10461-021-03500-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
Disparities in antiretroviral treatment (ART) access by race for men who have sex with men (MSM) with HIV persist. We assessed whether race-based medical mistrust and HIV stigma impact ART adherence among MSM with HIV. Longitudinal data were drawn from a RCT of a messaging intervention to promote sexual health among MSM. Regression models tested associations between baseline race-based medical mistrust, HIV stigma, and ART adherence at follow-up. In multivariable models with the overall sample of MSM with HIV (n = 383), baseline medical mistrust was negatively associated with ART adherence 3-months post-baseline. Among participants of color (i.e., Black/African American, Hispanic/Latino, or another race; n = 301), HIV stigma was negatively associated with optimal ART adherence 6-months post-baseline. Medical mistrust was longitudinally associated with reduced ART adherence among racially and ethnically diverse MSM with HIV. HIV-related services might prioritize patients reporting medical mistrust for additional supports.
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Affiliation(s)
- Stephanie A Meyers-Pantele
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gordon Mansergh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Rob Stephenson
- The Center for Sexuality and Health Disparities and the School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
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12
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Nardell MF, Hedt-Gauthier B, Earnshaw VA, Bogart LM, Dietrich JJ, Courtney I, Tshabalala G, Bor J, Orrell C, Gray G, Bangsberg DR, Katz IT. Understanding Repeat Positive HIV Testing in South Africa Under Changing Treatment Guidelines. AIDS Behav 2022; 26:1366-1376. [PMID: 34705150 PMCID: PMC9007825 DOI: 10.1007/s10461-021-03493-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/06/2023]
Abstract
Some people with HIV (PWH) test positive multiple times without initiating antiretroviral therapy (ART). We surveyed 496 ART-eligible PWH following routine HIV testing at three clinics in Soweto and Gugulethu, South Africa in 2014-2015. Among repeat positive testers (RPTs) in this cohort, we compared rates of treatment initiation by prior treatment eligibility and assessed psychosocial predictors of treatment initiation in logistic regression models. RPTs represented 33.8% of PWH in this cohort. Less than half of those who reported eligibility for ART on prior testing started treatment upon retesting, in contrast to two thirds of RPTs who were previously ineligible for treatment who started treatment once they learned of their eligibility. Those who reported coping through substance use were more likely to decline treatment versus those not using substances. PWH who test repeatedly represent a vulnerable population at risk for ART non-initiation who may benefit from interventions addressing individualized coping strategies.
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Affiliation(s)
- Maria F Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Thorn Building 14th Floor, Boston, MA, 02120, USA.
- Harvard Medical School, Boston, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, USA.
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Massachusetts General Hospital Center for Global Health, Boston, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, USA
| | | | - Janan J Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Western Cape, South Africa
| | - Ingrid Courtney
- Desmond Tutu Health Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - Gugulethu Tshabalala
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Catherine Orrell
- Desmond Tutu Health Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Western Cape, South Africa
| | - David R Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, USA
| | - Ingrid T Katz
- Harvard Medical School, Boston, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, USA
- Massachusetts General Hospital Center for Global Health, Boston, USA
- Harvard Global Health Institute, Cambridge, USA
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13
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Regenauer KS, Kleinman MB, Belus JM, Myers B, Joska JA, Magidson JF. Effects of intersecting internalized stigmas and avoidance on HIV and alcohol-related outcomes among people living with HIV in South Africa. Drug Alcohol Depend 2022; 233:109364. [PMID: 35219998 PMCID: PMC8978067 DOI: 10.1016/j.drugalcdep.2022.109364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite HIV and problematic drinking often co-occurring in South Africa (SA), limited research has examined how HIV stigma relates to alcohol outcomes, how alcohol stigma relates to HIV outcomes, and moderators of these associations. This study examined the intersection of HIV and alcohol stigmas on HIV and alcohol outcomes, and the role of avoidant behavior in moderating these relationships in SA. METHODS We assessed biomarker-verified measures of antiretroviral therapy (ART) adherence, HIV viral load (VL), and alcohol consumption, and self-reported measures of internalized HIV/alcohol stigmas, avoidant behavior, ART adherence, and problematic drinking-alcohol use that will likely lead to health or other problems-cross-sectionally among people with HIV (PWH) and problematic drinking (N = 64). We conducted regression analyses with interaction terms. FINDINGS A significant relationship was found between internalized alcohol stigma and VL suppression, with higher levels of alcohol stigma associated with a lower likelihood of suppression (OR=1.68, 95%CI[1.11-2.65], p = .02). Avoidance significantly moderated the relationship between internalized HIV stigma and problematic drinking; higher HIV stigma was associated with lower problematic drinking only at low levels of avoidance (b(SE)= -1.92(.85), p = .03). CONCLUSIONS This study is the first to examine associations between HIV and alcohol stigmas, avoidance, and both HIV and alcohol outcomes in SA. Findings contribute to our understanding of how alcohol stigma relates to biological HIV outcomes, and the role of avoidance in the relationship between internalized HIV stigma and problematic drinking. Findings may inform future clinical interventions aiming to address the impact of stigma on HIV treatment outcomes and alcohol use among PWH in SA.
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Affiliation(s)
- Kristen S Regenauer
- Department of Psychology, University of Maryland, College Park, Maryland, United States.
| | - Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, Maryland, United States
| | - Jennifer M Belus
- Department of Psychology, University of Maryland, College Park, Maryland, United States; Swiss Tropical and Public Health Institute, Department of Medicine, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia; Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, Tygerberg, South Africa; Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, College Park, Maryland, United States
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14
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Stanton AM, Wirtz MR, Perlson JE, Batchelder AW. "It's how we get to know each other": Substance use, connectedness, and sexual activity among men who have sex with men who are living with HIV. BMC Public Health 2022; 22:425. [PMID: 35241029 PMCID: PMC8895830 DOI: 10.1186/s12889-022-12778-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among MSM, substance use increases risk for acquiring HIV and is associated with sub-optimal engagement in HIV-related care. Most research related to substance use and sexual activity among MSM focuses on identifying and reducing risk of HIV acquisition and transmission rather than pleasure and agency. However, substance use may also facilitate sexual pleasure and build community, which could be particularly meaningful for individuals who cope with intersecting stigmas related to the disease, sexual identity, and drug use. METHODS To explore the ways in which substance use both promotes and hinders positive sexual expression and healthy sexual relationships, we conducted a secondary analysis of 33 semi-structured qualitative interviews with MSM living with HIV who were poorly engaged in care and reported recent substance use. RESULTS Thematic analysis revealed that substance use was perceived as: (1) a potential pathway to intimacy and enhanced sexual experiences; (2) a tool to help access partners and gain entry to a community; and (3) a source of empowerment, though some noted that it sometimes came at the cost of sexual disempowerment and unbalanced relationships. CONCLUSIONS Clinically, our results suggest that the complex motivations for substance use during sexual activity need to be carefully considered and discussed with patients, especially when attempting to decrease problematic use as a pathway to improved HIV self-care.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,The Fenway Health Institute, Fenway Health, Boston, MA, USA
| | - Megan R Wirtz
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
| | - Jacob E Perlson
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,The Fenway Health Institute, Fenway Health, Boston, MA, USA.
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15
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Liang Z, Huang YT. Intersecting Stigma and HIV/AIDS Community Participation Among Young Chinese Men Who Have Sex with Men Living with HIV. AIDS Patient Care STDS 2022; 36:73-82. [PMID: 35049339 DOI: 10.1089/apc.2021.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Community participation is vital for the recovery and empowerment of men who have sex with men (MSM) living with HIV. Intersectionality also provides an important lens that inequalities operate in an intersectional manner and pose compound challenges to the lives of minority individuals. However, the association between intersecting stigma toward HIV-positive MSM and their community participation is underexplored. The study drew on a sample of young Chinese MSM living with HIV from a community-based online survey that recruited respondents using nonprobability purposive sampling (n = 1004). Structural equation modeling was performed to investigate the associations among perceived stigma against sexual minorities and people living with HIV, HIV-related self-stigma, and HIV/AIDS community participation. The indirect effect of self-stigma and the statistical interaction between perceived homosexual stigma and perceived HIV-related stigma were further examined. Results show that total direct effect was significant [B (SE) = 0.859 (0.233); confidence interval (95% CI) = 0.402-1.316]. Perceived HIV-related stigma was positively correlated with HIV/AIDS community participation, while HIV-related self-stigma was negatively correlated. The mediating role of HIV-related self-stigma was significant in both types of perceived stigma [total indirect effect: B (SE) = -0.935 (0.175); 95% CI = -1.277 to -0.593]. The interaction effect was also significant and negative [B (SE) = -0.117 (0.056), p < 0.001], showing that perceived homosexual stigma could offset the effect of perceived HIV-related stigma on HIV-related self-stigma. The findings illustrate how intersecting stigma is involved in HIV-related self-stigma and community participation and highlight the importance of applying an intersectionality perspective to investigate stigma toward MSM living with HIV and their community participation.
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Affiliation(s)
- Zurong Liang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yu-Te Huang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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16
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Batchelder AW, Burgess C, Perlson J, O’Cleirigh C. Age and Year of HIV Diagnosis are Associated with Perceptions of Discrimination and Internalized Stigma Among Sexual Minority Men Who Use Substances. AIDS Behav 2022; 26:125-137. [PMID: 34117966 PMCID: PMC8665940 DOI: 10.1007/s10461-021-03333-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 01/03/2023]
Abstract
Discrimination and internalized stigma are barriers to engagement in HIV self-care among men who have sex with men (MSM) living with HIV. However, differences in perceptions of discrimination and internalized stigmas by age, year of HIV-diagnosis, and race are poorly understood. We assessed differences in reported discrimination related to HIV, race, sexual orientation, and substance use and internalized stigmas among 202 MSM living with HIV who use substances. Younger participants reported higher levels of all types of discrimination and internalized stigmas (p-values < 0.001-0.030). Those diagnosed after the advent of antiretrovirals reported higher levels of discrimination related to HIV, sexual orientation, and substance use, as well as internalized stigma related to HIV and substance use (p-values 0.001-0.049). We explored perceived community HIV stigma, which accounted for associations involving age and year of diagnosis. Age, year of diagnosis, and race should be considered when assessing and intervening with stigma.
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Affiliation(s)
- Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,The Fenway Health Institute, Fenway Health, Boston, MA,Corresponding Author: Abigail Batchelder, Ph.D., M.P.H., One Bowdoin Square, 7th Floor, Boston, MA 02114; Phone: 617-643-0387; Fax: 617-536-8602;
| | - Claire Burgess
- Department of Psychiatry, Harvard Medical School, Boston, MA,VA Boston Healthcare System, Boston, MA
| | - Jacob Perlson
- The Fenway Health Institute, Fenway Health, Boston, MA,Geisel School of Medicine at Dartmouth College, Hanover, NH
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,The Fenway Health Institute, Fenway Health, Boston, MA
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