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Reid R, Madhu A, Gonzalez S, Crosby H, Stjuste M, Dale SK. Burnout Among Service Providers for People Living with HIV: Factors Related to Coping and Resilience. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01784-2. [PMID: 37704906 DOI: 10.1007/s40615-023-01784-2] [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: 07/12/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023]
Abstract
Individuals who provide services for people living with HIV (PLWH) face numerous work-related challenges, including psychosocial and structural factors affecting the quality of care that they provide. Little is known about the factors that relate to burnout among service providers for PLWH. The current study seeks to examine the factors associated with burnout and the role of resilience and coping in the context of burnout. Via convenience sampling, data was collected from 28 professionals (e.g., peer counselors, HIV testers, case managers/case workers, group facilitators, or social workers) serving PLWH in the USA. Participants completed quantitative measures on sociodemographics, organizational factors, discrimination, trauma, depression, and burnout. A sub-sample of 19 participants provided in-depth qualitative data via semi-structured interviews on burnout, coping, and resilience as a buffer against the effects of burnout. Thematic content analysis revealed themes on the factors related to burnout (e.g., discrimination, limited financial and housing resources, and COVID-19), rejuvenating factors, coping with burnout, and intervention strategies. Additionally, Pearson's product moment correlations revealed significant associations between mental health variables such as depressive and posttraumatic stress disorder symptomology with (a) discrimination and microaggressions and (b) burnout. The current study highlights challenges to providing HIV care, including structural barriers and discrimination that are doubly impactful to the professionals in this sample who share identities with the PLWH whom they serve. These findings may inform the development of an intervention targeting burnout among individuals providing services to PLWH and motivate change to remove structural barriers and improve quality of care for PLWH.
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Affiliation(s)
- Rachelle Reid
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Aarti Madhu
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Stephanie Gonzalez
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Hannah Crosby
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Michelle Stjuste
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Miami, FL, 33146, USA.
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Cunningham J, Bailie J, Warner S, Condon A, Cheung D, Minc A, Herbert S, Edmiston N. Determinants of access to general practice in a shared care model for people living with HIV: a qualitive study of patients' perspectives in an Australian rural community. BMC PRIMARY CARE 2023; 24:179. [PMID: 37674116 PMCID: PMC10483738 DOI: 10.1186/s12875-023-02142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Improved management of human immunodeficiency virus (HIV) has resulted in improved life expectancy for people living with HIV and an ageing population with a significant comorbidity burden. Shared care models, involving the co-ordinated liaison between general practitioners and specialist physicians, have been advocated for in Australia to provide comprehensive care. People living with HIV in rural areas have reduced access to general practice and therefore shared care. This study explores the perspectives of people living with HIV on the barriers and enablers to accessing shared care in an Australian rural setting. METHODS In this qualitative study, semi-structured interviews were conducted with adults living with HIV who either resided in or accessed care in a rural area of Australia. Interviews were conducted via video conferencing, phone or face-to-face. Transcripts were imported into NVivo, coded and analysed in alignment with a conceptual framework of healthcare access defined by Levesque and colleagues. RESULTS Thirteen interviews were conducted in total. Participants' narratives demonstrated the substantial influence of accessibility to general practice on their ability to engage in effective shared care. Challenges included the perception that general practitioners would not provide additive value to participants' care, which restricted the ability to both seek and engage in the shared care model. Healthcare beliefs, expectations and experiences with stigma led participants to prioritise the perceived interpersonal qualities of specialist care above a shared care system. Access to shared care was facilitated by continuity of care in general practice but logistical factors such as affordability, transport and availability impacted the ability to access regular high-quality healthcare. CONCLUSIONS Navigating patient priorities and anticipated stigma in general practice within the resource limitations of rural healthcare were barriers to effective shared care. General practitioners' ability to build rapport and long-term relationships with participants was instrumental in the perception of valuable care. Strategies are required to secure continuity of care with interpersonally skilled general practitioners to ensure provision of quality primary care for people living with HIV, which can be supported by specialist physicians in a shared care model.
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Affiliation(s)
- Juliet Cunningham
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Sherridan Warner
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ashleigh Condon
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Daniel Cheung
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ariane Minc
- Northern New South Wales Sexual Health Service, North Coast Public Health, Mid North Coast Local Health District, Lismore, Australia
| | - Simone Herbert
- Northern New South Wales Sexual Health Service, North Coast Public Health, Mid North Coast Local Health District, Lismore, Australia
| | - Natalie Edmiston
- University Centre for Rural Health, The University of Sydney, Lismore, Australia.
- Northern New South Wales Sexual Health Service, North Coast Public Health, Mid North Coast Local Health District, Lismore, Australia.
- School of Medicine, Western Sydney University, Campbelltown, Australia.
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Wells N, Murphy D, Ellard J, Howard C, Keen P, Fairley C, Donovan B, Prestage G. Requesting HIV Results Be Conveyed in-Person: Perspectives of Clinicians and People Recently Diagnosed with HIV. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-8. [PMID: 37363348 PMCID: PMC10257370 DOI: 10.1007/s13178-023-00827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/28/2023]
Abstract
Introduction Guidelines recommend that, where possible, clinicians convey HIV-positive test results in person in Australia. However, HIV-negative and all other STI results are routinely delivered by phone or text message. Requesting individuals to obtain positive HIV test results in person could be a deviation from the standard delivery of healthcare and be interpreted as indicating a positive HIV diagnosis. Methods This paper is based on two related, ongoing qualitative studies conducted in Australia with HIV healthcare providers and people recently diagnosed with HIV. In study one, in-depth, semi-structured interviews were conducted with people who had recently received a positive HIV diagnosis. In study two, in-depth, semi-structured interviews were conducted with HIV healthcare and peer support providers. Interviews were analyzed thematically. Results While clinicians were willing to convey HIV-positive diagnoses by phone, most preferred in-person delivery. In-person delivery enabled clinicians to assess visual cues to better respond to the psychological and emotional needs of patients. For some participants living with HIV, however, the requirement to return to the clinic was interpreted as an unofficial HIV-positive diagnosis. This led to a period in which recently diagnosed participants believed they were HIV-positive without having received an explicit diagnosis. Conclusion Protocols for delivering HIV diagnoses by phone, followed by a face-to-face appointment, may reduce the period of anxiety for some patients and assist with an early connection to HIV care and support. Policy Implications In some instances, conveying HIV diagnoses by phone may be more appropriate than recalling individuals to the clinic to deliver a positive HIV diagnosis in person.
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Affiliation(s)
- Nathanael Wells
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Dean Murphy
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Jeanne Ellard
- Australian Research Centre for Sex, Health, and Society, Bundoora, Australia
| | - Chris Howard
- Queensland Positive People (QPP), Brisbane, Australia
- National Association for People With HIV Australia, Sydney, Australia
| | - Phillip Keen
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Christopher Fairley
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Basil Donovan
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - Garrett Prestage
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
| | - on behalf of the RISE Study Team
- Kirby Institute, University of NSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW 2052 Australia
- Australian Research Centre for Sex, Health, and Society, Bundoora, Australia
- Queensland Positive People (QPP), Brisbane, Australia
- National Association for People With HIV Australia, Sydney, Australia
- Alfred Health, Melbourne Sexual Health Centre, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Wells N, Philpot SP, Murphy D, Ellard J, Howard C, Rule J, Fairley C, Prestage G. Belonging, social connection and non-clinical care: Experiences of HIV peer support among recently diagnosed people living with HIV in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4793-e4801. [PMID: 35717630 PMCID: PMC10946990 DOI: 10.1111/hsc.13886] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/08/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Effective HIV treatments have transformed the medical needs of people living with HIV (PLHIV) to a chronic condition. However, stigma, poorer mental health outcomes and social isolation remain significant challenges for many PLHIV. HIV peer support programs have assisted PLHIV in navigating the clinical, emotional and social aspects of living with HIV. We draw on semi-structured interviews with 26 recently diagnosed PLHIV in Australia to explore experiences of HIV peer support services. Our thematic analysis identified three overarching themes. First, participants commonly reported that peer support programs offered a sense of belonging and connection to a broader HIV community. This established a network, sometimes separate to their existing social networks, of other PLHIV with whom to share experiences of HIV. Second, peer-based programs provided an opportunity for participants to hear firsthand, non-clinical perspectives on living with HIV. While participants valued the clinical care they received, the perspectives of peers gave participants insights into how others had managed aspects of living with HIV such as disclosure, sex and relationships. Finally, participants highlighted important considerations around ensuring referrals were made to socially and culturally appropriate support programs. Peer support programs fill an important gap in HIV care, working alongside and extending the work of the clinical management of HIV. Incorporating formal referrals to peer support services as part of the HIV diagnosis process could assist recently diagnosed PLHIV in adjusting to a positive diagnosis.
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Affiliation(s)
- Nathanael Wells
- Kirby InstituteUNSW SydneyKensingtonNew South WalesAustralia
| | | | - Dean Murphy
- Kirby InstituteUNSW SydneyKensingtonNew South WalesAustralia
| | - Jeanne Ellard
- Australian Research Centre in Sex, Health and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Chris Howard
- Queensland Positive People (QPP)East BrisbaneQueenslandAustralia
| | - John Rule
- National Association of People with HIV AustraliaNewtownNew South WalesAustralia
| | - Christopher Fairley
- Melbourne Sexual Health CentreMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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Khalpey Z, Fitzgerald L, Howard C, Istiko SN, Dean J, Mutch A. Peer navigators' role in supporting people living with human immunodeficiency virus in Australia: Qualitative exploration of general practitioners' perspectives. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1353-1362. [PMID: 34101291 DOI: 10.1111/hsc.13465] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/11/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
The redefining of human immunodeficiency virus (HIV) from an acute disease to a manageable chronic illness has reshaped the focus of care, emphasising clinical outcomes and sidelining the complex social barriers many people living with HIV (PLHIV) still face. This parallels changes in the location of HIV care in Australia, with many PLHIV seeking care from private general practitioners whose ability to address complex social issues is constrained by limitations of time and resources. In response, peer navigation has emerged as a model of care implemented by some HIV-based community health organisations seeking to support PLHIV's biomedical and psychosocial needs. However, there is limited understanding of how peer navigation operates in community settings or of the way these programmes integrate with primary care. This paper is the first to explore peer navigation from the perspective of general practitioners (GPs), with experience in treating PLHIV, to understand the role they see for peer navigators (PNs) in supporting PLHIV. Semi-structured in-depth interviews were conducted with six GPs (11.5% of specialty HIV GPs in Queensland, Australia) to examine their views and experiences of peer navigation in the context of HIV care. GPs highlighted the complexities of care for PLHIV and the need for additional resources and supports for psychosocial care. GPs valued peer navigation as part of a patient support network and bridge to health and social care systems. PNs normalised HIV, alleviating fear and stigma, educating and translating clinical information for patients. However, a key challenge was the absence of direct communication pathways with PNs. Peer navigation has clear potential in supporting the care of PLHIV, to alleviate constraints in GP settings and expand HIV care beyond the clinic.
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Affiliation(s)
- Zoyah Khalpey
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People (QPP), Brisbane, Queensland, Australia
| | - Satrio Nindyo Istiko
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith Dean
- 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
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Smith AKJ, Holt M, Hughes SD, Truong HHM, Newman CE. Troubling the non-specialist prescription of HIV pre-exposure prophylaxis (PrEP): the views of Australian HIV experts. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2020; 29:62-75. [PMID: 33411659 DOI: 10.1080/14461242.2019.1703781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/08/2019] [Indexed: 06/12/2023]
Abstract
The broadening of access to HIV pre-exposure prophylaxis (PrEP) in Australia has rekindled debates about which types of clinicians are best suited to deliver HIV prevention innovations: specialist HIV services or primary care physicians and general practitioners (GPs). We conducted 21 semi-structured qualitative interviews in 2017 with Australian HIV sector experts working across policy, advocacy, clinical service provision, research, and health promotion. These interviews took place before a national policy commitment to subsidising access to PrEP was achieved. We explored how participants conceptualised PrEP, patients and GPs at this key turning point in the history of HIV prevention. Participants expressed varied views regarding GPs' anticipated ability to successfully navigate the potential complexities associated with PrEP roll-out. While participants were supportive of greater patient access to PrEP, they expressed concerns about non-specialist GPs' cultural competence and expertise regarding sexuality and clinical practice, and the potential for patients to experience discrimination and homophobia from non-expert GPs. This study has broad implications for thinking about experts and expertise, the implementation of previously specialised medicine into mainstream settings, and the anticipated challenges of LGBTIQ+ inclusive healthcare.
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Affiliation(s)
- Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Shana D Hughes
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Hong-Ha M Truong
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Henrickson M, Fisher M. 'Treating Africans differently': using skin colour as proxy for HIV risk. J Clin Nurs 2016; 25:1941-9. [PMID: 27104481 DOI: 10.1111/jocn.13212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This paper examines the qualitative results of two studies of Black African new settler communities in New Zealand. The analysis investigates the issues of stigma and microaggressions and their effects on Black African communities. BACKGROUND Previous work that investigated experiences of stigma faced by relatively early Black African new settlers to New Zealand found that new settlers experienced stigma, and their resulting isolation had negative implications for access to health and social services, regardless of HIV status. DESIGN This paper is a meta-analysis of two published studies, using original qualitative data from each. METHODS Researchers for the first study, Standing in the Fire, interviewed 13 Black Africans living with HIV who were new settlers to New Zealand. The second study, AfricaNZ Care, was a national mixed method study which surveyed 703 Black African new settlers, and included 131 participants in 23 different focus groups. The present analysis includes only the qualitative data from the second study. Some, but not most, participants of the second study were living with HIV. RESULTS Black African identity is used as a proxy for HIV status among non-HIV specialist health care workers. Participants reported experiences of stigma and microaggressions based on their race, and a lack of knowledge about HIV in non-HIV specialist nurses and other health care workers. They also experienced poor health care and education practices, professional prejudice against colleagues living with HIV and institutional challenges including failure to protect patient confidentiality. CONCLUSIONS HIV-related stigma and microaggressions remain significant problems, not only for people living with HIV but also for those perceived to be at high risk for HIV. RELEVANCE TO CLINICAL PRACTICE Experiences of stigmatising behaviour by health care professionals have a broad and significant range of impacts on patients' health outcomes.
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Affiliation(s)
- Mark Henrickson
- School of Social Work, Massey University, Auckland, New Zealand
| | - Meaghan Fisher
- School of Social Work, Massey University, Auckland, New Zealand
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