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Foroozanfar Z, Hooshyar D, Joulaei H. Psychosocial predictors of quality of life among women living with HIV/AIDS: a cross-sectional study in a VCT centre in Shiraz, Iran. Qual Life Res 2024; 33:1063-1073. [PMID: 38231437 DOI: 10.1007/s11136-023-03586-9] [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] [Accepted: 12/09/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE We aimed to assess psychosocial predictors of quality of life (QOL) among women living with HIV/AIDS (WLHIV). QOL has been considered as an important indicator in evaluating the outcome of psychological and physical healthcare in people living with HIV (PLHIV). METHODS This cross-sectional study was carried out from October 2021 to April 2022 at the Voluntary, Counselling, and Testing (VCT) center in Shiraz, Iran. A total of 452 WLHIV were included in this study. Socio-demographic and clinical data, social support (MSPSS questionnaire), food insecurity (HFIAS questionnaire), resilience (CD-RISC questionnaire), mental health status (DASS questionnaire), and QOL (WHOQOL-BREF questionnaire) were collected through direct interviews and patients' files at Shiraz VCT. RESULTS Physical and social relationships domains of QOL had the highest (60.48 ± 18.00) and lowest (36.76 ± 23.88) scores, respectively. Higher clinical stage, psychotropic substances use, having a husband infected with HIV, history of hypertension, and higher socioeconomic status had a significant relationship with some domains of QOL. The score of social support, food insecurity, resilience, and mental health status had a significant relationship with all domains of QOL. CONCLUSION Social relationships domain of QOL had the lowest scores in WLHIV. Also, the mental health status of WLHIV was more related to their QOL than the physical status related to HIV/AIDS. Interventions such as improving the mental health care and resilience skills of WLHIV, including their social network in counseling services to promote their social support, could help them to improve their QOL.
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Affiliation(s)
- Zohre Foroozanfar
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Scienses, Shiraz, Iran
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dariush Hooshyar
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Scienses, Shiraz, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Scienses, Shiraz, Iran.
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Delle Donne V, Massaroni V, Lombardi F, Dusina A, Salvo PF, Borghetti A, Ciccullo A, Visconti E, Di Giambenedetto S. The association between stigma and wellbeing in an Italian cohort of PLWH: The role of social support and personal factors. Int J STD AIDS 2024; 35:176-187. [PMID: 37956698 DOI: 10.1177/09564624231213115] [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: 11/15/2023]
Abstract
Our aim was to assess the association between different types of stigma and physical, behavioural and emotional wellbeing, and to evaluate whether these associations were mediated by the level of social support, age, education, sex and time from HIV diagnosis in an Italian cohort of people living with HIV (PLWH). We enrolled 96 PLWH and had them complete a cross-sectional online survey that included the "HSS-12", the "SF-12" and the "DASS-21". We performed linear regression analyses to explore the associations between the HSS-12 scores and cART adherence, viral load, SF-12 and DASS-21 scores, and a mediation analysis to identify mediators in the significant associations. We showed that higher level of depression and worse perception of mental health were significantly associated with higher HSS-12 "personalised stigma" (p = .009, p = .020) "disclosure concerns" (p = .012, p = .039), "concerns about public attitudes" (p =.007, p = .005) and "negative self-image" scores; (p < .001, p = .001); worse perception of physical health status was associated with higher HSS-12 "personalised stigma" scores (p = .018); higher level of anxiety and stress were associated with higher "negative self-image" scores (0.001 and p < .001). The association between higher HSS-12 "negative self-image" and higher levels of depression, anxiety and stress were mediated by lower age (a*b = +0.10; a*b = +0.12; a*b = +0.11). This study may have important implications for clinical practice as it contributes to understanding the characteristics and consequences of HIV-related stigma in a population of PLWH with excellent viroimmunological status and therapeutic adherence.
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Affiliation(s)
- Valentina Delle Donne
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Valentina Massaroni
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Francesca Lombardi
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alex Dusina
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arturo Ciccullo
- UOC Infectious Diseases, Ospedale S. Salvatore, L'Aquila, Italy
| | - Elena Visconti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Di Giambenedetto
- Department of Safety and Bioethics, Infectious Diseases Institute, Catholic University of Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Brown MJ, Trask JS, Kaur A, Li X. Association between sociodemographic characteristics and HIV disclosure among people living with HIV in South Carolina: a structural equation modeling approach. AIDS Care 2023; 35:1904-1910. [PMID: 36630703 PMCID: PMC10333445 DOI: 10.1080/09540121.2022.2163612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
HIV disclosure continues to be a key consideration among people living with HIV (PLWH). However, there is a lack of studies assessing factors associated with HIV disclosure among PLWH in the Southern U.S. Therefore, the aim of this study was to assess the association between sociodemographic risk factors and HIV disclosure using a structural equation modeling approach among PLWH in South Carolina. Exploratory factor analysis was used to operationalize HIV disclosure. Structural equation models were used to determine the associations between sociodemographic factors and HIV disclosure among PLWH. Two latent variables were obtained for HIV disclosure: partners (stable partners, spouses, casual partners), and family/friends (parents, grandparents, siblings, children, adult children, friends, and coworkers). After adjusting for confounders, Black populations were less likely to disclose their HIV status to both partners (β = -0.250, p = 0.006) and family/friends (β = -0.246, p < 0.001) compared to non-Black populations. As yearly income increased, the likelihood of HIV disclosure to family/friends decreased (β = -0.300, p = <0.001). As time since diagnosis increased, the likelihood of HIV disclosure to family/friends increased (β = 0.266, p = 0.001). Future research can assess the feasibility of implementing disclosure interventions that are geared towards Black, high income and newly diagnosed PLWH and the associations of psychosocial factors and HIV disclosure.
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Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - J. Stewart Trask
- Department of Biological Sciences, College of Arts and Sciences, University of South Carolina
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
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Quality of Life of People Living with HIV in Australia: The Role of Stigma, Social Disconnection and Mental Health. AIDS Behav 2023; 27:545-557. [PMID: 35831492 PMCID: PMC9281266 DOI: 10.1007/s10461-022-03790-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/05/2022]
Abstract
HIV is a manageable chronic illness, due to advances in biomedical management. However, many people living with HIV (PLHIV) continue to experience psychosocial challenges, which have been associated with poorer quality of life (QoL). This study aimed to explore how psychosocial factors contributed to the QoL of PLHIV in Australia; specifically, the relationship between HIV-related stigma, social connectedness, mental health, and QoL. Participants were 122 PLHIV attending The Albion Centre (a tertiary HIV clinic in Sydney, Australia), who completed questionnaires which measured HIV-related stigma, social support, mental health symptomology and QoL. Results indicated that HIV-related stigma predicted poorer QoL, as did mental health symptomology. Conversely, social connectedness improved QoL. Additionally, social connectedness was found to mediate the relationship between HIV-related stigma and QoL, whereas the hypothesized moderating role of mental health symptomology on this model was not significant. These findings provide insight into the impact of psychosocial factors on QoL, offering practitioners various points of clinical intervention.
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Safreed-Harmon K, Fuster-RuizdeApodaca MJ, Pastor de la Cal M, Lazarus JV. Problems undermining the health-related quality of life of people living with HIV in Spain: a qualitative study to inform the development of a novel clinic screening tool. Health Qual Life Outcomes 2022; 20:84. [PMID: 35614470 PMCID: PMC9131550 DOI: 10.1186/s12955-022-01978-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background In settings with high antiretroviral therapy coverage, numerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). As part of a larger study to develop and validate a new patient-reported outcome measure for use in HIV clinical care in Spain, we sought to identify the most burdensome health-related issues experienced by PLHIV in order to determine which issues should be addressed in the new instrument. Methods We conducted a literature review and a qualitative study based on four focus group discussions (FGDs) with key informants in Spain. Participants were selected via purposive sampling. Two FGDs convened 16 expert HIV service providers, and two convened 15 PLHIV with diverse epidemiological profiles. FGDs followed semi-structured interview scripts and incorporated an exercise to prioritise the most critical health-related issues among those named in the discussions. Content analysis was conducted using MAXQDA 12. Results The analysis of FGD data identified several broad categories of issues that were perceived to negatively affect PLHIV. The most frequently named issues fell within the categories of social problems; physical symptoms; psychological problems; and sexuality-related problems. Regarding social problems, stigma/discrimination was by far the issue raised the most frequently. In the prioritisation exercise, stigma/discrimination was also ranked as the most burdensome issue by both service providers and PLHIV. Within the physical symptoms category, the issues named most frequently were sleep-related problems, fatigue, physical pain and body fat changes. Regarding psychological problems, FGD participants most commonly spoke of emotional distress in general terms, and also called attention to depression and anxiety. In the prioritisation exercise, both service providers and PLHIV ranked psychological well-being as the second-most important issue following stigma. Sexuality-related problems that were reported included sexually transmitted infections, hormonal problems, lack of libido, and general sexual dissatisfaction. Conclusions PLHIV are negatively affected by a wide range of health-related issues. HIV-related stigma and psychological well-being remain major challenges. Identifying and addressing these and other issues in routine clinical care supports healthy aging and may ultimately contribute to better health and HRQoL outcomes in this population.
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Affiliation(s)
- Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. .,Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Maria J Fuster-RuizdeApodaca
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain.,Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Marta Pastor de la Cal
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain.,Bizkaisida, Bilbao, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Rzeszutek M, Gruszczyńska E, Pięta M, Malinowska P. HIV/AIDS stigma and psychological well-being after 40 years of HIV/AIDS: a systematic review and meta-analysis. Eur J Psychotraumatol 2021; 12:1990527. [PMID: 34868481 PMCID: PMC8635597 DOI: 10.1080/20008198.2021.1990527] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 01/01/2023] Open
Abstract
Background In June 2021, 40 years have passed since the first cases of HIV infection were detected. Nonetheless, people living with HIV (PLWH) still suffer from intense HIV-related distress and trauma, which is nowadays mostly linked to the still-existing stigmatization of PLWH. Objectives The aim of this systematic review and meta-analysis was to examine the association between HIV/AIDS stigma and psychological well-being among PLWH. We also explored whether this association varies as a function of sociodemographic and clinical characteristics as well as study publication year and stigma measurement. Method A structured literature search was performed on Web of Science, Scopus, PsyARTICLES, MedLine, ProQuest, and Google Scholar databases. The inclusion criteria were quantitative, peer-reviewed articles published in English between 1996 and 2020. Results After selection, 64 articles were accepted for further analysis (N = 25,294 participants). The random-effects pooled estimate revealed an overall negative and medium-strength association between stigma and well-being (r = -.31, 95% CI [-.35; -.26]). The participants' age modified this effect with a stronger association for older PLWH. Other sociodemographic and clinical variables as well as publication year and stigma measurement did not explain the variation in association between stigma and well-being across studies. Conclusions The present meta-analysis and systematic review not only showed an expected negative relationship between stigma and well-being but also revealed a substantial heterogeneity between studies that suggests a strong role of context of a given study. This finding calls for more advanced theoretical and analytical models to identify protective and vulnerability factors to effectively address them in clinical practice and interventions.
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Affiliation(s)
| | - Ewa Gruszczyńska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | | - Paula Malinowska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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Fuster-RuizdeApodaca MJ, Safreed-Harmon K, Pastor de la Cal M, Laguia A, Naniche D, Lazarus JV. Development of a Clinic Screening Tool to Identify Burdensome Health-Related Issues Affecting People Living With HIV in Spain. Front Psychol 2021; 12:681058. [PMID: 34177734 PMCID: PMC8219862 DOI: 10.3389/fpsyg.2021.681058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Numerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). We developed a clinic screening tool (CST-HIV) for the purpose of identifying these issues in routine specialist clinical care in Spain. METHODS We used the following established instrument development procedures: (1) a literature review; (2) four focus group discussions (FGDs), two that convened 16 expert HIV care providers, and two that convened 15 PLHIV; (3) prioritisation, selection and definition of constructs (health-related issues) to include in the CST-HIV and drafting of initial item pool; and (4) a pilot study to analyse psychometric properties and validity of items and to determine which to retain in the final CST-HIV. The FGD interview scripts incorporated an exercise to prioritise the health-related issues perceived to have the greatest negative effect on HRQoL. The online questionnaire used for the pilot study included the pool of CST-HIV items and validated measures of each construct. RESULTS We identified 68 articles that reported on factors associated with the HRQoL of PLHIV. The most burdensome health-related issues identified in the FGDs related to stigma, socioeconomic vulnerability, sleep/fatigue, pain, body changes, emotional distress, and sexuality. Based on the literature review and FGD findings, we selected and defined the following constructs to include in the initial CST-HIV: anticipated stigma, emotional distress, sexuality, social support, material deprivation, sleep/fatigue, cognitive problems, and physical symptoms. Two researchers wrote six to eight items for each construct. Next, 18 experts rated 47 items based on their clarity, relevance, and representativeness. Pilot testing was carried out with 226 PLHIV in Spain. We retained 24 items based on empirical criteria that showed adequate psychometric properties. Confirmatory factor analysis confirmed the eight-factor structure with a good fit to the data (RMSEA = 0.035, AGFI = 0.97, CFI = 0.99). We found strong positive correlations between the instrument's eight dimensions and validated measures of the same constructs. Likewise, we found negative associations between the dimensions of the CST-HIV and HRQoL. CONCLUSION The CST-HIV is a promising tool for use in routine clinical care to efficiently identify and address health-related issues undermining the HRQoL of PLHIV.
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Affiliation(s)
- Maria José Fuster-RuizdeApodaca
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marta Pastor de la Cal
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain
- Bizkaisida, Bilbao, Spain
| | - Ana Laguia
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Denise Naniche
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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The Lived Experiences of Stigmatization in the Process of HIV Status Disclosure among People Living with HIV in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105089. [PMID: 34064970 PMCID: PMC8150537 DOI: 10.3390/ijerph18105089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
People living with HIV (PLWH) face social stigma which makes disclosure of HIV status difficult. The purpose of this descriptive qualitative study was to understand the lived experiences of stigmatization in the process of disease disclosure among PLWH in Taiwan. Analysis of the semi-structured interviews from 19 PLWH in Taiwan revealed two phases and six themes. Phase one “experiences before disclosure” involved three themes: “Struggles under the pressure of concealing the HIV Status”, “Torn between fear of unemployment/isolation and desire to protect closed ones”, and “Being forced to disclose the HIV status.” Phase two “experiences after disclosure” included three themes: “Receiving special considerations and requirements from school or work”, “Receiving differential treatments in life and when seeking medical care”, and “Stress relief and restart.” Healthcare professionals need to assess stigmatization in PLWH and develop individualized approaches to assist with the disease disclosure process.
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Scofield D, Moseholm E. HIV-related stigma and health-related quality of life in women living with HIV in developed countries: a systematic review. AIDS Care 2021; 34:7-15. [PMID: 33663284 DOI: 10.1080/09540121.2021.1891193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
HIV-related stigma has been shown to negatively affect the health-related quality of life (HRQoL) in people living with HIV. Women living with HIV (WLWH) suffer greater consequences from stigma on multiple health outcomes when compared to men. The objective of this review was to examine the association between HIV-related stigma and HRQoL in WLWH in developed countries. A systematic search was conducted in three medical databases. The PRISMA guideline was used as a methodical frame of reference, and the STROBE checklist as a quality assessment tool. Eight studies on a total of 2903 WLWH were included. All studies were cross-sectional of design and published between 2011-2019. All studies found a negative and statistically significant association between HIV-related stigma and HRQoL. The association was found to be weak to moderate in strength when examined using correlations statistics. Heterogeneity across the choice of measures and variables examined in the included studies made comparison difficult. Risk of bias was deemed present in majority of studies. Thus, this review reveals a negative association between HIV-related stigma and HRQoL in WLWH in developed countries. The association appears to be influenced by a range of complex factors, such as psychosocial variables and sociodemographic determinants.
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Affiliation(s)
- Ditte Scofield
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
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Abstract
BACKGROUND To evaluate differences between older women and men with HIV regarding HIV variables, comorbidity, physical function, and quality of life (QOL). SETTING The Modena HIV clinic. METHODS Prospective cohort study. Cross-sectional analysis. Patients >50 years were included, stratified by sex. We recorded sociodemographic data, comorbidities, variables related to HIV infection, frailty, data on body composition, physical function, physical activity, and QOL. RESULTS We evaluated 1126 older adults with HIV, of which 284 (25.2%) were women. Median age was 55 (IQR 6) years. There were significant differences between women and men in the median current CD4 T-cell and the mean CD4/CD8 ratio. There were differences regarding alcohol consumption, cardiovascular (CV) disease, hypertension, diabetes mellitus, and renal failure. Sarcopenia and slower gait speed were found more prevalent among men, but without significant differences. Significant differences were found regarding lower extremity strength measured by the chair stand test and in the short physical performance battery score. Short physical performance battery <9 was detected for 11.1% women vs. 5.6% men (P = 0.002). EQ5D5L score was 0.87 in women vs. 0.89 in men (P = 0.002). CONCLUSIONS In our cohort, older women represented one in 4 of the total patients. Despite the fact that women have better immunological recovery measured by CD4 T-cell count and CD4/CD8 ratio, and fewer CV disease and CV risk factors than men, their physical function and their QOL are worse. Therefore, older HIV-infected women have special characteristics, and the assessment of physical function in this group seems to be crucial.
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Hampton CJ, Gillum TL. 'Today I feel strong': African American women overcoming HIV-related stigma. Psychol Health 2020; 35:1440-1458. [PMID: 32372665 DOI: 10.1080/08870446.2020.1761978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: African American account for more than 60% of women living with HIV/AIDS in the United States. This population is disproportionately affected in areas of diagnosis, treatment, and morbidity. HIV-related stigma has been found to play a pivotal role in the experiences of African American women living with HIV/AIDS (WLWHA) impacting self-perception, treatment adherence, depression, interpersonal relationships, and overall quality of life. Limited studies have explored the ways in which HIV-related stigma impacts the self-perceptions of African American WLWHA. To explore these experiences, this study examined the ways in which HIV-related stigma impacts the intrapersonal experiences of African American WLWHA.Design: A phenomenological investigation was conducted to explore the experiences of African American WLWHA.Main Outcome Measure: In-depth, semi-structured qualitative interviews.Results: Interpretive phenomenological analysis revealed four emergent themes: (1) increased vulnerability; (2) processing the diagnosis of HIV/AIDS; (3) surviving HIV/AIDS; and (4) quality of life.Conclusion: Findings of this study contribute to existing literature by highlighting the intricacies of the lived experiences of African American WLWHA from initial diagnosis to present day. Exploring the trajectory of the illness among this population allows for a deeper understanding of the ways in which HIV/AIDS impacts the intrapersonal experiences and self-perceptions of WLWHA.
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Affiliation(s)
| | - Tameka L Gillum
- Department of Psychology, Russell Sage College, Troy, NY, USA
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Parcesepe AM, Nash D, Tymejczyk O, Reidy W, Kulkarni SG, Elul B. Gender, HIV-Related Stigma, and Health-Related Quality of Life Among Adults Enrolling in HIV Care in Tanzania. AIDS Behav 2020; 24:142-150. [PMID: 30927114 PMCID: PMC6768763 DOI: 10.1007/s10461-019-02480-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
HIV-related stigma has been associated with worse health-related quality of life (HRQoL) among people living with HIV (PLWH). Little is known about how different types of HIV-related stigma (i.e., anticipatory, internalized, or enacted HIV-related stigma) influence HRQoL and whether these relationships differ by gender. The sample included 912 PLWH aged 18 years or older enrolling in HIV care at four health facilities in Tanzania. HRQoL was assessed with the life satisfaction and overall function subscales of the HIV/AIDS-Targeted Quality of Life (HAT-QoL) instrument. Sex-stratified multivariable logistic regression modeled the association of anticipatory, internalized, and enacted HIV-related stigma on poor HRQoL. Across all participants, the mean life satisfaction score was 63.4 (IQR: 43.8, 81.3) and the mean overall function score was 72.0 (IQR: 58.3, 91.7). Mean HRQoL scores were significantly higher for women compared to men for overall function (5.1 points higher) and life satisfaction (4.3 points higher). Fourteen percent of respondents reported recent enacted HIV-related stigma and 13% reported recent medium or high levels of internalized stigma. In multivariable models, high internalized and high anticipatory stigma were significantly associated with higher odds of poor life satisfaction and poor overall function in both men and women. Psychosocial interventions to prevent or reduce the impact of internalized and anticipatory stigma may improve HRQoL among persons in HIV care. Future research should longitudinally examine mechanisms between HIV-related stigma, poor HRQoL, and HIV care outcomes.
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Awareness and Understanding of HIV Non-disclosure Case Law and the Role of Healthcare Providers in Discussions About the Criminalization of HIV Non-disclosure Among Women Living with HIV in Canada. AIDS Behav 2020; 24:95-113. [PMID: 30900043 DOI: 10.1007/s10461-019-02463-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In 2012, the Supreme Court of Canada ruled that people with HIV are legally obligated to disclose their serostatus before sex with a "realistic possibility" of HIV transmission, suggesting a legal obligation to disclose unless they use condoms and have a low HIV viral load (< 1500 copies/mL). We measured prevalence and correlates of ruling awareness among 1230 women with HIV enrolled in a community-based cohort study (2015-2017). While 899 (73%) participants had ruling awareness, only 37% were both aware of and understood ruling components. Among 899 aware participants, 34% had never discussed disclosure and the law with healthcare providers, despite only 5% being unwilling to do this. Detectable/unknown HIV viral load, lack of awareness of prevention benefits of antiretroviral therapy, education ≤ high-school and high HIV-related stigma were negatively associated with ruling awareness. Discussions around disclosure and the law in community and healthcare settings are warranted to support women with HIV.
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Laschober TC, Serovich JM, Brown MJ, Kimberly JA, Lescano CM. Mediator and moderator effects on the relationship between HIV-positive status disclosure concerns and health-related quality of life. AIDS Care 2019; 31:994-1000. [PMID: 30880426 DOI: 10.1080/09540121.2019.1595511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV-related stigma and the effect on quality of life is an on-going public health concern despite decades of education, prevention, and intervention efforts. The main purposes of this study were to examine the mediating role of four coping styles and the moderating role of gender on the relationship between HIV-positive status disclosure concerns and eight health-related quality of life outcomes. Data were collected from 346 women and men living with HIV. Results indicated that two coping styles - acquiring social support and positive reframing - mediated the negative relationship between disclosure concerns and health-related quality of life outcomes. There was no support for a moderated mediation. Interventions aimed at helping people living with HIV should focus on identifying and acquiring coping styles that transform perceptions of HIV-related stigma to support disclosure and improve health-related quality of life.
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Affiliation(s)
- T C Laschober
- a College of Behavioral and Community Sciences , University of South Florida , Tampa , FL , US
| | - J M Serovich
- a College of Behavioral and Community Sciences , University of South Florida , Tampa , FL , US
| | - M J Brown
- b Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , US
| | - J A Kimberly
- c Division of Biology and Medicine , Brown University , Providence , RI , USA
| | - C M Lescano
- d College of Behavioral and Community Sciences, Department of Mental Health Law and Policy , University of South Florida , Tampa , FL , US
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Logie CH, Wang Y, Kazemi M, Hawa R, Kaida A, Conway T, Webster K, de Pokomandy A, Loutfy M. Exploring social ecological pathways from resilience to quality of life among women living with HIV in Canada. AIDS Care 2018; 30:S67-S75. [PMID: 30626195 DOI: 10.1080/09540121.2018.1488031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/04/2018] [Indexed: 01/09/2023]
Abstract
Resilience, positive growth in contexts of stress and adversity, is shaped by social ecological factors. Among people living with HIV, resilience is associated with myriad positive health benefits and improved health-related quality of life (HR-QoL). Identifying contextual factors associated with resilience among women living with HIV (WLWH) is particularly important as this population experiences many stressors and inequalities. We examined social-ecological factors associated with resilience and its relationship with HR-QoL among WLWH. We utilized baseline survey data from a national cohort of WLWH (n = 1424) in Canada. We conducted structural equation modelling using maximum likelihood estimation methods to test the direct effects of social support and women-centred HIV care (WCHC) on resilience, and the direct effects of resilience on mental and physical HR-QoL. We also tested the indirect effects of resilience on HR-QoL via HIV disclosure concerns and economic insecurity. Participant median age was 43 years (IQR = 35-50); most participants were women of colour (29% Black; 22% Indigenous; 7% other ethnicities; 41% Caucasian). Social support and WCHC were associated with increased resilience. The direct path from resilience to mental HR-QoL was significant, accounting for the mediation effects of economic insecurity and social support. The direct path from resilience to physical HR-QoL was significant, accounting for the mediation effects of economic insecurity. Economic insecurity partially mediated the relationship between resilience and mental HR-QoL and physical HR-QoL. HIV disclosure concerns partially mediated the relationship between resilience and mental-HR-QoL. Model fit indices suggested that the model fit the data well (χ2[14] = 160.378, P < 0.001; CFI = 0.987; RMSE = 0.048 [90% CI:0.042-0.080]; SRMR = 0.036). Findings suggest social (social support) and structural (WCHC) factors increase resilience. While resilience is associated with improved HR-QoL, social (HIV disclosure concerns) and structural (economic insecurity) factors partially mediate these associations and threaten HR-QoL. Multi-level interventions can address social ecological contexts to advance resilience and HR-QoL among WLWH.
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Affiliation(s)
- Carmen H Logie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
- b Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Ying Wang
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Mina Kazemi
- b Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Roula Hawa
- b Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Angela Kaida
- c Faculty of Health Sciences , Simon Fraser University , Vancouver , BC , Canada
| | - Tracey Conway
- b Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Kath Webster
- c Faculty of Health Sciences , Simon Fraser University , Vancouver , BC , Canada
| | - Alexandra de Pokomandy
- d Department of Family Medicine , McGill University , Montreal , QC , Canada
- e Chronic Viral Illness Service , McGill University Health Centre , Montreal , QC , Canada
| | - Mona Loutfy
- b Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
- f Department of Medicine , University of Toronto , Toronto , ON , Canada
- g Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
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Community-Level HIV Stigma as a Driver for HIV Transmission Risk Behaviors and Sexually Transmitted Diseases in Sierra Leone: A Population-Based Study. J Acquir Immune Defic Syndr 2017; 75:399-407. [PMID: 28406807 DOI: 10.1097/qai.0000000000001418] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Although HIV stigma has been identified as an important risk factor for HIV transmission risk behaviors, little is known about the contribution of community-level HIV stigma to HIV transmission risk behaviors and self-reported sexually transmitted diseases (STDs) or how gender may modify associations. METHODS We pooled data from the 2008 and 2013 Sierra Leone Demographic and Health Surveys. For HIV stigma, we examined HIV stigmatizing attitudes and HIV disclosure concerns at both individual and community levels. Outcomes of HIV transmission risk behaviors were recent condom usage, consistent condom usage, and self-reported STDs. We assessed associations with multivariable logistic regressions. We also analyzed gender as an effect modifier of these associations. RESULTS Of 34,574 respondents, 24,030 (69.5%) who had heard of HIV were included in this analysis. Community-level HIV stigmatizing attitudes and disclosure concerns were associated with higher odds of self-reported STDs (adjusted odds ratio = 2.07; 95% confidence interval: 1.55 to 2.77; adjusted odds ratio = 2.95; 95% confidence interval: 1.51 to 5.58). Compared with men, community-level HIV stigmatizing attitudes among women were a stronger driver of self-reported STDs (interaction P = 0.07). Gender modified the association between community-level HIV disclosure concerns and both recent and consistent condom usage (interaction P = 0.03 and P = 0.002, respectively). Community-level HIV disclosure concerns among women were observed to be a driver of risky sex and self-reported STDs. CONCLUSIONS This study shows that community-level HIV stigma may be a driver for risky sex and self-reported STDs, particularly among women. Our findings suggest that community-held stigmatizing beliefs and HIV disclosure concerns among women might be important targets for HIV stigma reduction interventions.
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Schuft L, Duval E, Thomas J, Ferez S. To be or not to be sick and tired: Managing the visibility of HIV and HIV-related fatigue. Health (London) 2017; 22:317-336. [PMID: 28401815 DOI: 10.1177/1363459317693406] [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] [Indexed: 11/17/2022]
Abstract
This article takes a new direction in exploring HIV-related fatigue by adopting a qualitative interactionist approach. We analyse the social meanings attributed to fatigue among people living with HIV in France, the social gains and losses of its visibility and the social frames that condition its discursive and physical expression. The two-part methodology combines grounded theory analysis of 50 transcribed unstructured interviews conducted across France and participant observations within four HIV-related associations. Results reveal that the visibility of fatigue is in part dependent on the visibility of this stigmatized illness. The expression of fatigue is therefore closely linked with disclosure and concerns about HIV stigma. The degree to which HIV and HIV-related fatigue are rendered (in)visible also depends on structural factors including gender prescriptions, as well as context effects such as the type of social or 'care' relations involved in the social frame of interaction.
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Affiliation(s)
| | | | - Julie Thomas
- Univ. Lyon, UJM-Saint-Etienne, Centre Max Weber, France
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Garrido-Hernansaiz H, Heylen E, Bharat S, Ramakrishna J, Ekstrand ML. Stigmas, symptom severity and perceived social support predict quality of life for PLHIV in urban Indian context. Health Qual Life Outcomes 2016; 14:152. [PMID: 27809839 PMCID: PMC5094021 DOI: 10.1186/s12955-016-0556-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022] Open
Abstract
Background Multiple variables have been studied in relation to health-related quality of life (HRQoL), but research has not integrated the contributions of different variables in a single model that allows to compare them. This study, carried out with people living with HIV/AIDS in India, sought to develop a prediction model considering various predictors previously found to be related to HRQoL, namely sociodemographic factors, HIV symptoms, social support, stigmas and avoidant coping. Methods A sample of 961 HIV-positive persons from Bengaluru and Mumbai participated in this cross-sectional study, completing a sociodemographic questionnaire along with HRQoL, HIV symptoms, disclosure expectations, disclosure avoidance, social support and internalized, felt, vicarious and enacted stigma scales. Bivariate associations were obtained (correlations, ANOVAs and t tests) and a multiple regression analysis was performed. Results Results show that, when all variables are considered together, being married, widowed or deserted, symptom intensity, internalized stigma, disclosure avoidance and enacted stigma contribute negatively to predict HRQoL. On the other hand, being employed, good disclosure expectations and good social support contribute positively to predict HRQoL. Almost half of the variance in HRQoL was explained by this model. Conclusions Interventions seeking to increase HRQoL in people living with HIV/AIDS in India would benefit from addressing these aspects.
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Affiliation(s)
- Helena Garrido-Hernansaiz
- Department of Biological and Health Psychology, Psychology Faculty, Universidad Autónoma de Madrid, C/Ivan Pavlov, 6, 28049, Madrid, Spain
| | - Elsa Heylen
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th St, 3rd floor, San Francisco, CA, 94158, USA
| | - Shalini Bharat
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, V.N. Purav Marg, Chembur, Mumbai, Maharashtra, 400085, India
| | - Jayashree Ramakrishna
- Department of Mental Health Education, National Institute of Mental Health and Neurosciences, Post Bag 2900, Hosur Road, Bengaluru, 560 029, Karnataka, India
| | - Maria L Ekstrand
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th St, 3rd floor, San Francisco, CA, 94158, USA. .,St John's Research Institute, St John's National Academy of Health Sciences, 100 Feet Rd, Bengaluru, Karnataka, 560034, India.
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