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Pelletier J, Bergeron D, Rouleau G, Guillaumie L. Nurses' clinical practices reducing the impact of HIV-related stigmatisation in non-HIV-specialised healthcare settings: a protocol for a realist synthesis. BMJ Open 2022; 12:e062569. [PMID: 36385029 PMCID: PMC9670922 DOI: 10.1136/bmjopen-2022-062569] [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] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite tremendous progress in care, people living with HIV (PLHIV) continue to experience HIV-related stigmatisation by nurses in non-HIV-specialised healthcare settings. This has consequences for the health of PLHIV and the spread of the virus. In the province of Quebec (Canada), only four interventions aimed at reducing the impact of HIV-related stigmatisation by nurses have been implemented since the beginning of the HIV pandemic. While mentoring and persuasion could be promising strategies, expression of fears of HIV could have deleterious effects on nurses' attitudes towards PLHIV. In literature reviews on stigma reduction interventions, the contextual elements in which these interventions have been implemented is not considered. In order to develop new interventions, we need to understand how the mechanisms (M) by which interventions (I) interact with contexts (C) produce their outcomes (O). METHODS AND ANALYSIS Realist synthesis (RS) was selected to formulate a programme theory that will rely on CIMO configuration to describe (1) nursing practices that may influence stigmatisation experiences by PLHIV in non-HIV-specialised healthcare settings, and (2) interventions that may promote the adoption of such practices by nurses. The RS will draw on the steps recommended by Pawson: clarify the scope of the review; search for evidence; appraise primary studies and extract data; synthesise evidence and draw conclusions. To allow an acute interpretation of the disparities between HIV-related stigmatisation experiences depending on people's serological status, an initial version of the programme theory will be formulated from data gathered from scientific and grey literature, and then consolidated through realist interviews with various stakeholders (PLHIV, nurses, community workers and researchers). ETHICS AND DISSEMINATION Ethical approval for realist interviews will be sought following the initial programme theory design. We intend to share the final programme theory with intervention developers via scientific publications and recommendations to community organisations that counter HIV-related stigmatisation.
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Affiliation(s)
- Jérôme Pelletier
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
- Faculty of Nursing Sciences, Université Laval, Quebec, Quebec, Canada
| | - Dave Bergeron
- Department of Health Sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Geneviève Rouleau
- Women's College Hospital, Toronto, Ontario, Canada
- Research Chair in Innovative Nursing Practices, Centre de recherche du CHUM, Montréal, Quebec, Canada
| | - Laurence Guillaumie
- Faculty of Nursing Sciences, Université Laval, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
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Herron LM, Mutch A, Lui CW, Kruizinga L, Howard C, Fitzgerald L. Enduring stigma and precarity: A review of qualitative research examining the experiences of women living with HIV in high income countries over two decades. Health Care Women Int 2021; 43:313-344. [PMID: 34534051 DOI: 10.1080/07399332.2021.1959589] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The lived experience of HIV for women remains poorly understood. In particular, there has been little attention to the consequences for women living with HIV (WLHIV) of changing social, epidemiological, biomedical and policy contexts, or to the implications of long-term treatment and aging for the current generation of HIV-positive women. We reviewed qualitative research with WLHIV in selected high-income countries (Australia, Canada, New Zealand, the UK and the USA) to identify the most prevalent experiences of HIV for women and trends over time. Our synthesis highlights the relative consistency of experiences of a diverse sample of WLHIV, particularly the enduring prevalence of gendered HIV-related stigma, sociostructural barriers to healthcare and support, and negative encounters with health professionals. We also identified gaps in knowledge. Understanding women's experiences, particularly their changing needs and strategies for coping as they live long-term with HIV, is key to effective support and services for WLHIV.
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Affiliation(s)
- Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Allyson Mutch
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Chi-Wai Lui
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lara Kruizinga
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People, Brisbane, Queensland, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Mkumba L, Muiruri C, Garg K, Watt MH, Okeke NL. Perspectives of Chronic Disease Management Among Persons with HIV: A Qualitative Study. Patient Prefer Adherence 2021; 15:49-55. [PMID: 33469274 PMCID: PMC7812046 DOI: 10.2147/ppa.s287325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Persons with HIV (PWH) are living to advanced age as a result of ART. These epidemiological changes highlight the importance of innovating chronic care delivery of PWH, but there is limited research regarding patient preferences for chronic care delivery. METHODS We conducted in-depth interviews of 20 PWH who receive care at the Duke Infectious Diseases Clinic. Manuscript was coded and we used thematic analysis to identify emerging themes from interviewees' responses. RESULTS Insights of the interviews revealed a strong affinity of PWH with their HIV providers and a reliance on them for primary care as a result. Participants also expressed a strong preference for receiving NCD care from a single provider, regardless of their current chronic disease care configuration. Participants also stated a willingness to embrace new roles of non-provider HIV clinic staff in their chronic disease care. CONCLUSION Overall, persons living with HIV prefer consolidation and co-location of their care, and are willing to endure minor inconveniences to accommodate this preference. Efforts towards promoting primary care integration into HIV clinics are warranted.
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Affiliation(s)
| | - Charles Muiruri
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Keva Garg
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Nwora Lance Okeke
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
- Correspondence: Nwora Lance Okeke Duke University Medical Center, 315 Trent Drive, Rm. 178, Durham, NC27707, USATel +1 919 684 2579Fax + 1 919 681 7494 Email
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Kusuma MTPL, Kidd T, Muturi N, Procter SB, Yarrow L, Hsu WW. HIV knowledge and stigma among dietetic students in Indonesia: implications for the nutrition education system. BMC Infect Dis 2020; 20:663. [PMID: 32907539 PMCID: PMC7487527 DOI: 10.1186/s12879-020-05379-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have demonstrated that health care students and practitioners are not immune to stigma towards people living with HIV (PLHIV). This attitude could lead to poor quality of care if it remains uncorrected. However, little is known about dietetic students' acceptance of PLHIV despite their substantial role in treatment. This study aimed to measure the extent of knowledge and stigma towards PLHIV among dietetic students and to determine the associated factors using the attribution theory. METHODS Students from three dietetics schools in Indonesia (n = 516) were recruited to participate in this cross-sectional study. Survey questions covered demographic information, interaction with PLHIV, access to information sources, cultural values, and beliefs as predictor variables. The outcome variables were comprehensive knowledge of HIV, HIV and nutrition-specific knowledge, and attitudes. Analyses with linear regression and the stepwise selection were performed to determine factors related to the outcome. RESULTS The levels of HIV comprehensive knowledge and HIV-nutrition specific knowledge among dietetic students were low, as indicated by the average score of 19.9 ± 0.19 (maximum score = 35) and 8.0 ± 0.11 (maximum score = 15), respectively. The level of negative attitudes towards PLHIV was high, with 99.6% of participants reported having a high stigma score. Types of university affiliation (public or private), beliefs and values, exposure to HIV discourse, access to printed media, and years of study were significantly related to HIV comprehensive knowledge (p < 0.05). Nutrition-specific knowledge was also correlated with university affiliation, beliefs and values, participation in HIV discussion, and years of study (p < 0.05). HIV comprehensive knowledge, university affiliation, discussion participation, and ethnicities were associated with attitudes (p < 0.05). CONCLUSIONS Awareness and acceptance of PLHIV must be further improved throughout dietetic training to ensure patients' quality of care since students represent future dietary care providers. Considering the consistent findings that affiliation to education institution correlates with HIV knowledge and attitude, some examinations concerning the curriculum and teaching conduct might be necessary.
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Affiliation(s)
- Mutiara Tirta Prabandari Lintang Kusuma
- Department of Nutrition and Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. .,Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA.
| | - Tandalayo Kidd
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Nancy Muturi
- A.Q. Miller School of Journalism and Mass Communications, College of Arts and Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Sandra B Procter
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Linda Yarrow
- Department of Food, Nutrition, Dietetics, and Health, College of Health and Human Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Wei-Wen Hsu
- Department of Statistics, College of Arts and Sciences, Kansas State University, Manhattan, Kansas, USA
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Ion A, Greene S, Sinding C, Grace D. Risk and preventing perinatal HIV transmission: uncovering the social organisation of prenatal care for women living with HIV in Ontario, Canada. HEALTH, RISK & SOCIETY 2020. [DOI: 10.1080/13698575.2020.1760217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Allyson Ion
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Christina Sinding
- School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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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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Abstract
Palm Springs, CA, is a retirement community with the highest prevalence of gay men living with HIV older than 50 years in the United States. Through a community-academic partnership, we explored the major health issues, resiliencies, and priority research topics related to HIV and aging. We conducted five community facilitated focus groups with different stakeholders, including two focus groups with older adults living with HIV, one with their caregivers, one with HIV-focused community-based organizations, and a joint focus group with researchers and HIV care providers. Using the rigorous and accelerated data reduction technique, five major themes emerged, which included long-term side effects of medication, social determinants of health, mental health, resiliencies, and involving community in research. These data are important for developing effective interventions, conducting useful and impactful research, and providing health care providers with the tools and knowledge to provide optimal care.
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Loutfy M, Kennedy VL, Poliquin V, Dzineku F, Dean NL, Margolese S, Symington A, Money DM, Hamilton S, Conway T, Khan S, Yudin MH. No. 354-Canadian HIV Pregnancy Planning Guidelines. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:94-114. [PMID: 29274714 DOI: 10.1016/j.jogc.2017.06.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist Canadians affected by HIV with their fertility, preconception, and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible and take into account diverse and intersecting local/population needs based on the social determinants of health. INTENDED OUTCOMES EVIDENCE: Literature searches were conducted by a librarian using the Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases for published articles in English and French related to HIV and pregnancy and HIV and pregnancy planning for each section of the guidelines. The full search strategy is available upon request. VALUES The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines. BENEFITS, HARMS, AND COSTS Guideline implementation should assist the practitioner in developing an evidence-based approach for the prevention of unplanned pregnancy, preconception, fertility, and pregnancy planning counselling in the context of HIV infection. VALIDATION These guidelines have been reviewed and approved by the Infectious Disease Committee and the Executive and Council of the SOGC. SPONSOR Canadian Institutes of Health Research Grant Planning and Dissemination grant (Funding Reference # 137186), which funded a Development Team meeting in 2016. RECOMMENDATIONS
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Duff P, Kestler M, Chamboko P, Braschel M, Ogilvie G, Krüsi A, Montaner J, Money D, Shannon K. Realizing Women Living with HIV's Reproductive Rights in the Era of ART: The Negative Impact of Non-consensual HIV Disclosure on Pregnancy Decisions Amongst Women Living with HIV in a Canadian Setting. AIDS Behav 2018; 22:2906-2915. [PMID: 29627875 DOI: 10.1007/s10461-018-2111-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To better understand the structural drivers of women living with HIV's (WLWH's) reproductive rights and choices, this study examined the structural correlates, including non-consensual HIV disclosure, on WLWH's pregnancy decisions and describes access to preconception care. Analyses drew on data (2014-present) from SHAWNA, a longitudinal community-based cohort with WLWH across Metro-Vancouver, Canada. Multivariable logistic regression was used to model the effect of non-consensual HIV disclosure on WLWH's pregnancy decisions. Of the 218 WLWH included in our analysis, 24.8% had ever felt discouraged from becoming pregnant and 11.5% reported accessing preconception counseling. In multivariable analyses, non-consensual HIV disclosure was positively associated with feeling discouraged from wanting to become pregnant (AOR 3.76; 95% CI 1.82-7.80). Non-consensual HIV disclosure adversely affects WLWH's pregnancy decisions. Supporting the reproductive rights of WLWH will require further training among general practitioners on the reproductive health of WLWH and improved access to women-centred, trauma-informed care, including non-judgmental preconception counseling.
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Affiliation(s)
- Putu Duff
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- BC Women's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Mary Kestler
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- BC Women's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
| | - Patience Chamboko
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Melissa Braschel
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Gina Ogilvie
- BC Women's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
- Department of Obstetrics & Gynecology, University of British Columbia, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Andrea Krüsi
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Julio Montaner
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Deborah Money
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- BC Women's Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada
- Department of Obstetrics & Gynecology, University of British Columbia, 1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
| | - Kate Shannon
- Gender and Sexual Health Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Medicine, St. Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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O’Brien N, Hong QN, Law S, Massoud S, Carter A, Kaida A, Loutfy M, Cox J, Andersson N, de Pokomandy A. Health System Features That Enhance Access to Comprehensive Primary Care for Women Living with HIV in High-Income Settings: A Systematic Mixed Studies Review. AIDS Patient Care STDS 2018; 32:129-148. [PMID: 29630850 DOI: 10.1089/apc.2017.0305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Women living with HIV in high-income settings continue to experience modifiable barriers to care. We sought to determine the features of care that facilitate access to comprehensive primary care, inclusive of HIV, comorbidity, and sexual and reproductive healthcare. Using a systematic mixed studies review design, we reviewed qualitative, mixed methods, and quantitative studies identified in Ovid MEDLINE, EMBASE, and CINAHL databases (January 2000 to August 2017). Eligibility criteria included women living with HIV; high-income countries; primary care; and healthcare accessibility. We performed a thematic synthesis using NVivo. After screening 3466 records, we retained 44 articles and identified 13 themes. Drawing on a social-ecological framework on engagement in HIV care, we situated the themes across three levels of the healthcare system: care providers, clinical care environments, and social and institutional factors. At the care provider level, features enhancing access to comprehensive primary care included positive patient-provider relationships and availability of peer support, case managers, and/or nurse navigators. Within clinical care environments, facilitators to care were appointment reminder systems, nonidentifying clinic signs, women and family spaces, transportation services, and coordination of care to meet women's HIV, comorbidity, and sexual and reproductive healthcare needs. Finally, social and institutional factors included healthcare insurance, patient and physician education, and dispelling HIV-related stigma. This review highlights several features of care that are particularly relevant to the care-seeking experience of women living with HIV. Improving their health through comprehensive care requires a variety of strategies at the provider, clinic, and greater social and institutional levels.
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Affiliation(s)
- Nadia O’Brien
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Quan Nha Hong
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Susan Law
- Institute for Better Health—Trillium Health Partners, Mississauga, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sarah Massoud
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Joseph Cox
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Canada
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
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N o 354 – Lignes directrices canadiennes en matière de planification de la grossesse en présence du VIH. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:115-137. [DOI: 10.1016/j.jogc.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Jiwatram-Negrón T, El-Bassel N, Primbetova S, Terlikbayeva A. Gender-Based Violence Among HIV-Positive Women in Kazakhstan: Prevalence, Types, and Associated Risk and Protective Factors. Violence Against Women 2017; 24:1570-1590. [PMID: 29332520 DOI: 10.1177/1077801217741218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article examines the prevalence and associated multilevel risk and protective factors of intimate and nonintimate partner violence among a sample of 249 HIV-positive women in Kazakhstan. We found high prevalence of both lifetime intimate partner violence (52%) and nonintimate partner violence (30%). Together, nearly 60% experienced at least one incident of violence by either an intimate or nonintimate partner (gender-based violence [GBV]). In the multivariate analyses, we found associations between several individual, interpersonal, and socio-structural risk factors and GBV. Findings provide direction for practice, policy, and future research to address the intersection of GBV and HIV in Kazakhstan.
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Affiliation(s)
| | - Nabila El-Bassel
- 2 Columbia University, New York City, USA.,3 Global Health Research Center of Central Asia, Almaty, Kazakhstan
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O'Brien N, Greene S, Carter A, Lewis J, Nicholson V, Kwaramba G, Ménard B, Kaufman E, Ennabil N, Andersson N, Loutfy M, de Pokomandy A, Kaida A. Envisioning Women-Centered HIV Care: Perspectives from Women Living with HIV in Canada. Womens Health Issues 2017; 27:721-730. [PMID: 28887140 DOI: 10.1016/j.whi.2017.08.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women comprise nearly one-quarter of people living with human immunodeficiency virus (HIV) in Canada. Compared with men, women living with HIV experience inequities in HIV care and health outcomes, prompting a need for gendered and tailored approaches to HIV care. METHOD Peer and academic researchers from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study conducted focus groups to understand women's experience of seeking care, with the purpose of identifying key characteristics that define a women-centered approach to HIV care. Eleven focus groups were conducted with 77 women living with HIV across Quebec, Ontario, and British Columbia, Canada. RESULTS Women envisioned three central characteristics of women-centered HIV care, including i) coordinated and integrated services that address both HIV and women's health care priorities, and protect against exclusion from care due to HIV-related stigma, ii) care that recognizes and responds to structural barriers that limit women's access to care, such as violence, poverty, motherhood, HIV-related stigma, and challenges to safe disclosure, and iii) care that fosters peer support and peer leadership in its design and delivery to honor the diversity of women's experiences, overcome women's isolation, and prioritize women's ownership over the decisions that affect their lives. CONCLUSION Despite advances in HIV treatment and care, the current care landscape is inadequate to meet women's comprehensive care needs. A women-centered approach to HIV care, as envisioned by women living with HIV, is central to guiding policy and practice to improve care and outcomes for women living with HIV in Canada.
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Affiliation(s)
- Nadia O'Brien
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Johanna Lewis
- Women's College Hospital, Women's College Research Institute, Toronto, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Gladys Kwaramba
- Women's College Hospital, Women's College Research Institute, Toronto, Canada
| | - Brigitte Ménard
- Chronic Viral Illness Service Montreal, McGill University Health Centre, Montreal, Canada
| | - Elaina Kaufman
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Nourane Ennabil
- Chronic Viral Illness Service Montreal, McGill University Health Centre, Montreal, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Mona Loutfy
- Women's College Hospital, Women's College Research Institute, Toronto, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service Montreal, McGill University Health Centre, Montreal, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
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Flickinger TE, Saha S, Roter D, Korthuis PT, Sharp V, Cohn J, Moore RD, Ingersoll KS, Beach MC. Respecting patients is associated with more patient-centered communication behaviors in clinical encounters. PATIENT EDUCATION AND COUNSELING 2016; 99:250-5. [PMID: 26320821 PMCID: PMC5271348 DOI: 10.1016/j.pec.2015.08.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Attitudes towards patients may influence how clinicians interact. We investigated whether respect for patients was associated with communication behaviors during HIV care encounters. METHODS We analyzed audio-recordings of visits between 413 adult HIV-infected patients and 45 primary HIV care providers. The independent variable was clinician-reported respect for the patient and outcomes were clinician and patient communication behaviors assessed by the Roter Interaction Analysis System (RIAS). We performed negative binomial regressions for counts outcomes and linear regressions for global outcomes. RESULTS When clinicians had higher respect for a patient, they engaged in more rapport-building, social chitchat, and positive talk. Patients of clinicians with higher respect for them engaged in more rapport-building, social chitchat, positive talk, and gave more psychosocial information. Encounters between patients and clinicians with higher respect for them had more positive clinician emotional tone [regression coefficient 2.97 (1.92-4.59)], more positive patient emotional tone [2.71 (1.75-4.21)], less clinician verbal dominance [0.81 (0.68-0.96)] and more patient-centeredness [1.28 (1.09-1.51)]. CONCLUSIONS Respect is associated with positive and patient-centered communication behaviors during encounters. PRACTICE IMPLICATIONS Clinicians should be mindful of their respectful attitudes and work to foster positive regard for patients. Educators should consider methods to enhance trainees' respect in communication skills training.
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Affiliation(s)
- Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Somnath Saha
- Department of Medicine, Portland VA Medical Center, Portland, OR, USA; Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Debra Roter
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Victoria Sharp
- Department of Medicine, St. Luke's Roosevelt, New York, NY, USA
| | - Jonathan Cohn
- Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Karen S Ingersoll
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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15
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Greene S, Ion A, Kwaramba G, Smith S, Loutfy MR. "Why are you pregnant? What were you thinking?": How women navigate experiences of HIV-related stigma in medical settings during pregnancy and birth. SOCIAL WORK IN HEALTH CARE 2015; 55:161-179. [PMID: 26684355 DOI: 10.1080/00981389.2015.1081665] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Having children is a growing reality for women living with HIV in Canada. It is imperative to understand and respond to women's unique experiences and psychosocial challenges during pregnancy and as mothers including HIV-related stigma. This qualitative study used a narrative methodological approach to understand women's experiences of HIV-related stigma as they navigate health services in pregnancy (n = 66) and early postpartum (n = 64). Narratives of women living with HIV expose the spaces where stigmatizing practices emerge as women seek perinatal care and support, as well as highlight the relationship between HIV-related stigma and disclosure, and the impact this has on women's pregnancy and birthing experiences.
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Affiliation(s)
- Saara Greene
- a School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Allyson Ion
- a School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Gladys Kwaramba
- c School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Stephanie Smith
- c School of Social Work , McMaster University , Hamilton , Ontario , Canada
| | - Mona R Loutfy
- b Women's College Research Institute, Women's College Hospital , University of Toronto , Toronto, Ontario , Canada
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